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PHC4 - “Pay for Performance” ToolkitPHC4 - “Pay for Performance” Toolkit
Mike BerneyMike BerneyCommunity and Purchaser Relations Manager Community and Purchaser Relations Manager
Pennsylvania Health Care Cost Containment CouncilPennsylvania Health Care Cost Containment Council
ALPHA BENEFITS – Apr. 11, 2007ALPHA BENEFITS – Apr. 11, 2007
Pennsylvania Health Care Cost Containment Council (PHC4)Pennsylvania Health Care Cost Containment Council (PHC4)
Who is Mike Berney?Who is Mike Berney?
chocolate lover chocolate lover health care guyhealth care guy family and community guy …family and community guy … ““I’m from the state government, and I’m I’m from the state government, and I’m
here to help you …”here to help you …”
Today some health care execs Today some health care execs and politiciansand politicians
talk about talk about consumer empowerment, consumer empowerment,
responsibility, and responsibility, and ttransparencyransparency
REALLY?REALLY?
Where’s the information Where’s the information on cost and quality on cost and quality
coming from?? coming from??
HOW ABOUTHOW ABOUT FREEFREE
PUBLIC REPORTSPUBLIC REPORTS
Pennsylvania Health Care Cost Containment Council (PHC4)Pennsylvania Health Care Cost Containment Council (PHC4)
Welcome to PHC4Welcome to PHC4
Independent state agency Independent state agency established 1986established 1986
25-Member Board25-Member Board
About 50 employeesAbout 50 employees
$4 million annual budget$4 million annual budget
Pennsylvania Health Care Cost Containment Council (PHC4)Pennsylvania Health Care Cost Containment Council (PHC4)
PHC4PHC4 MissionMission
Improve the quality and Improve the quality and restrain the cost of health carerestrain the cost of health care
Promote competition in the Promote competition in the health care marketplacehealth care marketplace
Pennsylvania Health Care Cost Containment Council (PHC4)Pennsylvania Health Care Cost Containment Council (PHC4)
PHC4PHC4 – Governing Board – Governing Board
PurchasersPurchasers 6 Business6 Business 6 Labor6 Labor 1 Consumer1 Consumer
InsurersInsurers 1 Commercial1 Commercial 1 Non-Profit (Blues)1 Non-Profit (Blues) 1 HMO1 HMO
ProvidersProviders 2 Hospitals2 Hospitals 2 Physicians2 Physicians 1 Nurse1 Nurse 1 Health Care Quality 1 Health Care Quality
Improvement ExpertImprovement Expert
State GovernmentState Government Secretary of Health Secretary of Health Secretary of WelfareSecretary of Welfare Insurance Insurance
CommissionerCommissioner
Pennsylvania Health Care Cost Containment Council (PHC4)Pennsylvania Health Care Cost Containment Council (PHC4)
PHC4PHC4 data data
4 million4 million inpatient and outpatient-inpatient and outpatient-ambulatory ambulatory records annuallyrecords annually..
AllAll 176176 General Acute Care General Acute Care hospitalshospitals
Useful tool:Useful tool:
Data is Data is
““Severity AdjustedSeverity Adjusted””
Pennsylvania Health Care Cost Containment Council (PHC4)Pennsylvania Health Care Cost Containment Council (PHC4)
What’s severity-adjusted mean?What’s severity-adjusted mean?
Accounts for differences in patient risk Accounts for differences in patient risk factors and illness levels.factors and illness levels.
Hospitals treating a higher percentage of Hospitals treating a higher percentage of very sick patients or complex cases are very sick patients or complex cases are not penalized for doing so. not penalized for doing so.
Applies to outcomes data. Applies to outcomes data.
Pennsylvania Health Care Cost Containment Council (PHC4)Pennsylvania Health Care Cost Containment Council (PHC4)
PHC4PHC4 Toolkit Toolkit (public reports) (public reports)
Hospital PerformanceHospital Performance Financial AnalysisFinancial Analysis Heart Bypass (CABG) Heart Bypass (CABG) **** Hip & Knee Hip & Knee **** Diabetes HospitalizationDiabetes Hospitalization
** ** includes surgeon-specific infoincludes surgeon-specific info
All are All are freefree to the public to the public
Useful Web toolsUseful Web tools
www.phc4.orgwww.phc4.org
Pennsylvania Health Care Cost Containment Council (PHC4)Pennsylvania Health Care Cost Containment Council (PHC4)
PHC4 Web-based tools PHC4 Web-based tools
PHC4 PHC4 Research BriefsResearch Briefs
( examining topics )( examining topics )
PHC4 PHC4 FYIFYI – purchaser-focused – purchaser-focused
(short topic papers)(short topic papers)
Pennsylvania Health Care Cost Containment Council (PHC4)Pennsylvania Health Care Cost Containment Council (PHC4)
PHC4 Free ToolsPHC4 Free Toolsavailable to the publicavailable to the public
Hospital Performance Report Hospital Performance Report
Online and hard copiesOnline and hard copies
If your employees or colleagues need a If your employees or colleagues need a hospital procedure … our tools can helphospital procedure … our tools can help
Pennsylvania Health Care Cost Containment Council (PHC4)Pennsylvania Health Care Cost Containment Council (PHC4)
Hospital Performance ReportHospital Performance Report
Three regional Three regional versions of this versions of this tool promote tool promote competition in the competition in the marketplacemarketplace
Pennsylvania Health Care Cost Containment Council (PHC4)Pennsylvania Health Care Cost Containment Council (PHC4)
PHC4 Hospital PHC4 Hospital Performance ReportPerformance Report
Outcome data for 30 treatment categoriesOutcome data for 30 treatment categories Quarterly online updates for 49 treatment Quarterly online updates for 49 treatment
categoriescategories
Pennsylvania Health Care Cost Containment Council (PHC4)Pennsylvania Health Care Cost Containment Council (PHC4)
Hospital Performance ReportHospital Performance Report
Resource to purchasers, providers, Resource to purchasers, providers, insurers, researchers and the publicinsurers, researchers and the public
Compares hospitals to Compares hospitals to HOW WELL HOW WELL THEY SHOULD PERFORMTHEY SHOULD PERFORM on cost and on cost and QUALITYQUALITY by treatment and procedure by treatment and procedure
Pennsylvania Health Care Cost Containment Council (PHC4)Pennsylvania Health Care Cost Containment Council (PHC4)
Hospital Performance ReportHospital Performance Report
An employer recently used PHC4 data An employer recently used PHC4 data to review charges at a regional medical to review charges at a regional medical center for specific procedurescenter for specific procedures
Pennsylvania Health Care Cost Containment Council (PHC4)Pennsylvania Health Care Cost Containment Council (PHC4)
Data UseData Use
The employer studied the PHC4 data The employer studied the PHC4 data and determined that the average charge and determined that the average charge for a procedure at the medical center for a procedure at the medical center soared from $5,403 in 2000 to $18,988 in soared from $5,403 in 2000 to $18,988 in 2004.2004.
HC Purchasers – large and small orgs HC Purchasers – large and small orgs - used the data in negotiations- used the data in negotiations
Pennsylvania Health Care Cost Containment Council (PHC4)Pennsylvania Health Care Cost Containment Council (PHC4)
Our Free ToolsOur Free Toolsavailable to the publicavailable to the public
Publish hospital outcomesPublish hospital outcomes Publish hospital financialsPublish hospital financials
Pennsylvania Health Care Cost Containment Council (PHC4)Pennsylvania Health Care Cost Containment Council (PHC4)
PHC4’s PHC4’s Financial Financial
AnalysisAnalysis
GAC Volume OneGAC Volume One
Non-GAC Volume TwoNon-GAC Volume Two
Pennsylvania Health Care Cost Containment Council (PHC4)Pennsylvania Health Care Cost Containment Council (PHC4)
PHC4 Hospital Financial Analysis ‘05PHC4 Hospital Financial Analysis ‘05
For For 176176 PA GAC Hospitals for FY 05 PA GAC Hospitals for FY 05
Total Charges = Total Charges = $92.5 Billion$92.5 BillionTotal Payments (net patient REVENUES) Total Payments (net patient REVENUES)
= = $25.9 Billion$25.9 Billion
Hospitals receive about 29 cents on the Hospitals receive about 29 cents on the dollardollar ( 29 % of billed amount ) ( 29 % of billed amount )
Pennsylvania Health Care Cost Containment Council (PHC4)Pennsylvania Health Care Cost Containment Council (PHC4)
It shouldn’t surprise us to see this data:It shouldn’t surprise us to see this data:
Increase in PA-Licensed Surgery CentersIncrease in PA-Licensed Surgery Centers
May 1995May 1995 May 2005 May 20054646 177177
Pennsylvania Health Care Cost Containment Council (PHC4)Pennsylvania Health Care Cost Containment Council (PHC4)
Heart surgeries Heart surgeries
PHC4 data collected since 1996 shows:PHC4 data collected since 1996 shows:
# of coronary artery # of coronary artery surgeries surgeries
declined by – 17 %declined by – 17 %
# of open-heart surgery # of open-heart surgery units units
increased by + 41 % increased by + 41 %
Pennsylvania Health Care Cost Containment Council (PHC4)Pennsylvania Health Care Cost Containment Council (PHC4)
Total GAC Hospital ChargesTotal GAC Hospital Charges
$0
$10
$20
$30
$40
$50
$60
$70
$80
$90
Ch
arg
es
, in
Bill
ion
s
1999 2000 2001 2002 2003 2004
Pennsylvania Health Care Cost Containment Council (PHC4)Pennsylvania Health Care Cost Containment Council (PHC4)
First Of Its Kind ToolFirst Of Its Kind Tool
Physician-SpecificPhysician-Specific
Hip & Knee ReportHip & Knee Report
Readmissions Readmissions due todue to
complications resultedcomplications resulted
in $35 million in in $35 million in
hospital charges &hospital charges &
7,700 additional 7,700 additional
hospital days.hospital days.
Pennsylvania Health Care Cost Containment Council (PHC4)Pennsylvania Health Care Cost Containment Council (PHC4)
PHC4 Research PHC4 Research BriefsBriefs – – Examine Examine health care health care topics relevant to topics relevant to public policy and public policy and public interestpublic interest
Pennsylvania Health Care Cost Containment Council (PHC4)Pennsylvania Health Care Cost Containment Council (PHC4)
PHC4 Research BriefPHC4 Research Brief – –
MRSA in Pennsylvania HospitalsMRSA in Pennsylvania Hospitals
In 2004; there were 13,722 hospitalizations in PA in which the patient had a MRSA infection. That is 7.4 per every 1,000 patients
MRSA = Staph Infection
DOES PUBLIC DOES PUBLIC REPORTING REPORTING
WORK? WORK?
Some say noSome say no
Some say yesSome say yes
Pennsylvania Health Care Cost Containment Council (PHC4)Pennsylvania Health Care Cost Containment Council (PHC4)
Patrick J. Brennan, head of a panel named by the secretary of Health Patrick J. Brennan, head of a panel named by the secretary of Health and Human Services years ago to advise the CDC on infection issues and Human Services years ago to advise the CDC on infection issues – while not taking a position on mandatory public reporting of – while not taking a position on mandatory public reporting of
infection rates –said:infection rates –said: ““There is no evidence to support public There is no evidence to support public disclosure as a means to reduce the incidence of these disclosure as a means to reduce the incidence of these infectionsinfections.”.”
Letter to the Editor - Marc P. Volavka, Executive Director, PHC4Letter to the Editor - Marc P. Volavka, Executive Director, PHC4
““Unfortunately, Dr. Brennan was only half right. There is Unfortunately, Dr. Brennan was only half right. There is no evidence to support public disclosure no evidence to support public disclosure because public because public disclosure of hospital-acquired infection has never disclosure of hospital-acquired infection has never occurred.”occurred.”
February 1, 2005
Pennsylvania Health Care Cost Containment Council (PHC4)Pennsylvania Health Care Cost Containment Council (PHC4)
ANOTHER RESEARCH BRIEFANOTHER RESEARCH BRIEF
HOSPITAL ACQUIRED INFECTIONSHOSPITAL ACQUIRED INFECTIONS