TRIPLE AIM. Update on Governmental and Other Regulations Affecting Anesthesiology

Transcription

1 Randall M. Clark, M.D. Department of Anesthesiology University of Colorado School of Medicine Board of Directors, American Society of Anesthesiologists Chair ASA Section on Professional Standards No financial conflicts of interest to disclose The opinions expressed are my own and not necessarily those of the University of Colorado or the American Society of Anesthesiologists Provide updates on governmental action at the federal level affecting health care delivery and payment for anesthesia services Understand how the American Society of Anesthesiologists is responding to the challenges created by health care reform Learn what you can do at the group, department, and individual level to prepare for MACRA and MIPS The Triple Aim High Quality TRIPLE AIM Low Cost Affordability Patient Experience -vs- Access vs- Healthier Living 1

2 SGR Repealed 2015 Updates July December - 0.5% Further Updates 2016 through 2019: 0.5% 2020 through 2025: 0.0% forward: 0.5% APM 2026 forward: 1% PQRS, VBM, EHR MU Consolidated 2% sequestration in effect through 2024 CMS Losers Negative Adjustments 2019: Up to 4.0% 2020: Up to 5.0% 2021: Up to 7.0% 2022: Up to 9.0% Winners Positive Adjustments * Worst case under current PQRS, VBM, MU scenarios is approximately - 11% Based on funds available from losers i.e. lots of losers means larger adjustments for winners, fewer losers means smaller adjustments for winners. Year 1 Year 2 Set Threshold Compete Against Threshold Set Threshold Received designation as a Qualified Clinical Data Registry in 2014 Allows AQI to specify the outcomes to be measured without complicated NQF process Easily incorporated into other AQI reporting Year 3 Compete Against Threshold Set Threshold 2

3 $10 million since start in 2008 $1.6 million in 2015 redesign (in order to move from startup to mature organization) Currently receiving $1.4 million per year in fees Contract signed in October 2015 with ArborMetrix Data delivery is now standardized Data integrity is much improved Now with ability to scale to much larger programs Perioperative Surgical Home* Health Policy Analysis and Research Practice Management Anesthesia Quality Institute & NACOR: QCDR* Measure Development Exploring and Promoting Alternative Payment Models* Population Health* What is the Perioperative Surgical Home? A Coordinated System of Perioperative Care - The PSH model is a physician-led, patient-centric, team-based system of coordinated care that guides patients through the entire surgical experience, from the decision to undergo surgery to discharge and beyond, with the goal of providing cost-effective, high quality perioperative care and exceptional patient experiences. - Achieved through shared decision-making and seamless continuity of care for surgical patients 2016 AMERICAN SOCIETY OF ANESTHESIOLOGISTS. 3

4 PSH Collaborative 2.0 PSH Learning Collaborative 2.0 Timeline Two-year timeline provides time to collaborate, transform, and measure performance to demonstrate success April 1, 2016 Launch date Spring 2016 First in-person all-member meeting Summer 2016 First Advanced Cohort PI sprint Fall 2016 Second in-person all-member meeting Key benefits of participation include: Peer-to-peer networking and shared learning opportunities Access to subject matter experts on a variety of topics Tools and resources to support successful implementation and performance optimization Winter 2017 Second Advanced Cohort PI sprint Spring 2017 Third in-person all-member meeting Summer 2017 Third Advanced Cohort PI sprint Fall 2017 Fourth in-person all-member meeting Winter 2018 Fourth Advanced Cohort PI Sprint March 31, 2018 PSH 2.0 end date Ongoing Outreach Efforts ASA White Paper on Perioperative Surgical Home Practice Management Conferences 3 rd ASA PSH Meeting 2 nd ASA Quality Meeting ASA Website: Special thanks to Zeev Kain, MD (UC Irvine), Stan Stead, MD (ASA VP Professional Affairs), and Mike Schweitzer, MD (now managing Population Health for Premiere, Inc.) 4

5 8.9 million seniors in Medicare shared savings, Pioneer or Next Generation ACOs representing $85 billion in spending 415 hospitals, 305 physician groups, and 723 skilled nursing facilities in BPCI accounting for $10 billion in spending CJR program to add another $3 billion 30% target met in March BPCI Participation Baptist Health System 2016 BPCI Report 5

6 MACRA/MIPS Update Understanding Alternative Payment Models: d_page/content/44/alt%20payment%20models%20and%20 PSH_Stead.pdf The population health approach is positioned as a unifying force for the entire spectrum of health system interventions from prevention and promotion to health protection, diagnosis, treatment and care and integrates and balances action between them. This will be the framework for all future action in government funded health care, and soon thereafter, all American health care. Oversaw initial roll out of Perioperative Surgical Home Now studying the role of the anesthesiologist in population health management Recognizes the unique role of anesthesiology the unifying factor in the care of all surgical patients Publishing a white paper and action plan for ASA leadership, Board of Directors, and House of Delegates alth_management_and_its.10.aspx Intersection of Population Health and Anesthesiology me at randall.clark@childrenscolorado.org Currently preparing upcoming publication in A&A ome More_Than_Smoke.2.aspx 6

7 Educate yourself on PSH and Population Health Understand what your institutions (surgical specialties, hospital, health system, academic medical center) are planning in the realm of population health Appoint a lead coordinator to facilitate communication with the external entities Participate in any discussion on how the financial pillar will be handled and how if will affect anesthesiology Primary Clinical Work Settings Consolidation in the Anesthesiology Industry 45% 40% 35% 30% 25% 20% 15% 10% 5% 0% Community Hospital Multi location Health System Medical School Non government Hospital Free standing Surgery Government Hospital Office based Practice Other 2012 ASA Member Needs Assessment, McKinley Advisors; 2015 ASA Member Needs Assessment, Avenue M Group Chart Title /15-9/ AMERICAN SOCIETY OF ANESTHESIOLOGISTS AMERICAN SOCIETY OF ANESTHESIOLOGISTS. 7

8 A Consolidating Industry - All sectors Insurance Hospitals Physicians and professional services Pharmaceuticals and Devices - Why? Cost and complexity of business Leverage in negotiations Improved margin with size 2016 AMERICAN SOCIETY OF ANESTHESIOLOGISTS AMERICAN SOCIETY OF ANESTHESIOLOGISTS. Local Driving Factors Economic pressures National Demand & Value Changing Scope of Practice Workforce Supply Technology Payer Provider Market Power Relationships Hospital administration Surgeons, other providers Gradual? Disruptive? Change How gradual? Accelerating? Is there a disruptive force in anesthesiology? What are your planning assumptions? 2016 AMERICAN SOCIETY OF ANESTHESIOLOGISTS. Increase in hospital employment Increase in practice consolidation Mega groups Technology Disruptive public policy (e.g. ACA, baby boomers, ) Alternative models of payment ASA will represent the interests of our patients and members no matter the practice setting, employment status, or payment model 8

9 Review current state of the ACS program Review potential negative impacts on patients and anesthesia care delivery Prepare a list of options for ASA and members 9

10 Anesthesiology is a value added service Current government payments systems are hopelessly unrealistic on paying for our services Future payment models hold the chance to correct historical errors But we must recognize Delivery System Reform as a team sport 10