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Hospital Association of Rhode Island
Since 2005, hospitals report data on qualityNo submission = reduced update factor
ACA-mandated implementation of VBPLink payment to quality
CMS releases VBP final ruleBegins FFY 2013Utilizes quality data from the Inpatient Quality Reporting
ProgramFunding
Across the board reduction1% in FFY 2013, increasing by 0.25% each year until 2%
in FFY 2017 and subsequent years
Estimated Medicare IPPS Dollars
Contributed to VBP (1% Carve-Out)
VBP Score Weighted Average
VBP Payment
Percentage
Estimated Payment from VBP
Net VBP Gain/Loss
United States $855,139,105 48.93% 100% $855,139,105 $0
Connecticut $13,068,003 39.99% 81.36% $10,632,347 ($2,435,656)
Maine $4,083,935 51.73% 109.80% $4,484,329 $400,394
Massachusetts $26,560,760 51.67% 106.26% $28,222,143 $1,661,383
New Hampshire $4,008,757 51.86% 104.35% $4,183,111 $174,354
Rhode Island $2,933,615 44.87% 95.72% $2,808,139 ($125,476)
Vermont $1,313,035 43.68% 89.71% $1,177,878 ($135,157)
1% penalty for bottom quartile hospitals
Medicare Hospital-Acquired Condition (HAC) Rate Analysis
State HAC Rates and Ranks by Measure(Rates Per 1,000 Discharges)
Foreign Object Retained
After Surgery
Air Embolism
Blood Incompatibility
Pressure Ulcers Stages III and IV
Falls and Trauma
Vascular Catheter-Associated Infection
Catheter-Associated Urinary Tract Infection
Manifestations of Poor Glycemic Control
Overall
Rate Rank Rate Rank Rate Rank Rate Rank Rate Rank Rate Rank Rate Rank Rate Rank Rate Rank
Connecticut 0.116 35 0.000 1 0.000 1 0.091 19 0.496 8 0.437 41 0.417 37 0.067 42 1.623 31
Maine 0.176 46 0.000 1 0.010 47 0.167 44 0.679 38 0.272 16 0.491 43 0.031 13 1.826 45
Massachusetts 0.122 38 0.004 36 0.002 41 0.065 9 0.488 7 0.273 17 0.233 7 0.063 36 1.250 4
New Hampshire 0.000 1 0.014 49 0.000 1 0.082 13 0.775 47 0.530 46 0.625 48 0.095 48 2.120 50
Rhode Island 0.000 1 0.000 1 0.016 49 0.113 26 0.549 17 0.533 47 0.307 20 0.129 49 1.648 33
Vermont 0.225 48 0.000 1 0.000 1 0.071 12 0.740 44 0.141 1 0.423 38 0.141 50 1.740 40
Policy As mandated by the ACA, acute care hospitals with higher than
expected 30-day risk-adjusted readmission rates will receive reduced Medicare payments for every discharge.
Payments are to be reduced by the lower of a hospital-specific readmissions adjustment factor or a pre-determined maximum
1% of total DRG payments in FFY 2013, 2% in FFY 2014 and 3% in FFY 2015 and thereafter
3 conditions (heart attack, heart failure and pneumonia) in FY 13 and 14
Expanded in FY 15 to COPD, CABG, PTCA, and vascular
Impact Area 2013Ten-Year Impact
CMS Payment Reductions $11.5M $427.5M
DSH Payment Reductions $0 $79.6M
Quality-Based Payment Reductions $1.8M $67.2M
2% Sequestrian Reduction $11.4M $106.0M
Total $24.5M $680.2M
Proposed health reform legislation includes payment cuts to Medicare Advantage plans. Data is derived from HANYS KeySTATS.
• Accountable Care Organizations
• Group of providers to share in cost savings
• Must meet quality standards
• Medical Home
• Primary care
• CMMI/Partnership for Patients
• Test innovative payment and service delivery models to improve coordination, quality and efficiency
• Bundling
• Cover inpatient and outpatient hospital services, physician services (both in the inpatient and outpatient settings), post-acute care services (IRFs, LTCHs, SNFs and HHAs), and other services that the Secretary determines appropriate. The episode of care will start three days prior to a qualifying hospital admission and end 30 days after the patient’s discharge. Secretary will select ten conditions.
• Many of the initiatives such as HAC, VBP, etc. will be expanded to psych, rehab, physicians, Medicaid
• Focus on quality, patient safety, and efficiency
• Importance of collaboration and data analysis