DRAFT MINUTES State Consumer Health Information and Policy Advisory Council Meeting Date: March 15, 2013 Time: 10:00am 2:00 pm Location: Agency for Health Care Administration Conference Room A Members Present: James Bracher, Chair; Nikole Helvey, Vice Chair; Elizabeth Dudek (Secretary); Michael Anway (via conference call); Laura Cantwell; Susan Douglas; Diane Godfrey; Jarrod Folwer (for Michael Wasylik, MD); Tom Herring (for Meade Grigg); Kim Streit; Jill Sumfest, MD; Karen van Caulil, Ph.D; and Tom Zutell (via conference call). Members Absent: Sally West. Staff Present: Cruz Conrad, Beth Eastman, Marisol Fitch, Heidi Fox, Adrienne Henderson, Patrick Kennedy, Cindy Kucheman, Laura McLafferty, James B. McLemore, Amanda Muller, Nancy Tamariz, Carolyn Turner, and Marsha Webb. Interested Parties Present: Thomas Hobbs, Liberty Partners of Tallahassee; Toni Large, Uhlfelder & Associates; and Steve Mindlin, Sundstrom, Friedman & Fumero, LLP. Call to Order, Welcome and Roll Call: Mr. Bracher, Chair, called the meeting to order, welcomed all attendees and called roll. The Chair welcomed two new members, Michael Anway from the Office of the Governor and Dr. Jill Sumfest from Humana. Review and Approval of Minutes: The Chair called for a review and approval of the November 29, 2012 draft minutes. A motion to approve the minutes was made by Karen van Caulil. The Council voted to accept the minutes as printed with no objections. Agency Updates: Liz Dudek, Secretary of the Agency for Health Care Administration, provided the Agency updates. She began by recognizing Beth Eastman for receiving the Florida Health Care Coalition s Innovations in Quality Award on behalf of the Agency for its work in developing the FloridaHealthFinder.gov website resource for consumers, researchers and healthcare professionals. Secretary Dudek commented that Ms. McKinstry and Mr. Gregg were not present at the Council as they were meeting with Senator Grimsley regarding Senate Bill 1258. Ms. Dudek went through the basics of the bill. There was some discussion from the Council questioning the Senate Bill 1258 s reasoning behind abolishing the State Consumer Health and Information and Policy Advisory Council. It was also noted by Secretary Dudek that the Agency was working on a number of bills including ones that dealt with assisted living facilities, transitional living facilities as well as a fraud and abuse language within a number of bills. Secretary Dudek briefly updated the Council on the Medicaid Managed Care, stating that the Agency is in the midst of rolling out Long Term Care Managed care as well as preparing to receive invitations to negotiate for Medicaid Managed Care Provider Contracts. She stated that the Agency is still waiting to hear what the Legislature will do with Medicaid regarding the Affordable Care Act. 1
She concluded by stating that the Governor s budget includes a pilot project for an All Payer Claims Database the foundation of which may begin with Medicaid and Medicare. Health Information Exchange Coordinating Committee (HIECC) Update: Nikole Helvey updated the Council on the meeting that was held March 1, 2013. She noted that the Committee welcomed new members, Stacey Lampkin (representing Florida Medicaid) and Dr. David Milov (representing Nemours). Ms. Helvey stated that the seven proposed changes to the Patient Look-Up (PLU) subscription agreements and four proposed changes to the Direct Secure Messaging (DSM) agreement were discussed. In addition, the results of the physician survey on HIE awareness were discussed along with the development of a consumer survey on HIE awareness. Ms. Helvey reported that Ms. Gigi Cowart, Harris Project Manager, present the quarterly HIE report through January 31, 2013 including increased transactions and registration during this period. She also noted that Ms. Pamela King presented on consumer outreach activities for the Florida HIE project team. It was noted that a Florida price list was posted on the Florida HIE website in January 2013 consistent with the sustainability plan. Action Item: Mr. Bracher, Chair, inquired further about pricing models and about the reasons the original price list had been revised. Ms. Turner responded that the pricing list had been simplified for easier use. In addition, three pricing tiers had been established based on the size of the health plans. She also noted that the team had pushed back implementation three months on this pricing model. The Chair requested some additional information. Ms. Heidi Fox stated that she would have her slides distributed to the members of the Council. Action Item: Several members of the Council voiced their concern on HIE pricing and would like to be provided with more specifics and clarity, including on software licenses and maintenance fees, for the next meeting. Action Item: Mr. Bracher, Chair, requested that the Council member receive a copy of the bidders for the All Payer Claims Database. Ms. Dudek stated that to the extent possible (pursuant to any blackout period) she would provide that information. This information was supplied to all members of the Council during the meeting. Presentation: Specialist Coverage of Emergency Departments and Related Reporting Requirements: Dr. Kelly Gray-Eurom, President of the Florida College of Emergency Physicians (FCEP) delivered an informative and detailed presentation on behalf of her group which exists to promote high quality emergency medical care. Specifically, her organization would like to work with the Agency for Health Care Administration to make the current system: More useful for patient care More transparent for providers Greater accessibility to the public Better service within the scope of legislative intent Dr. Gray-Eurom noted that these goals could be achieved with help from the Agency in disseminating and categorizing the information available in the current inventory of hospitals with emergency services. This information should: 2
State all services within the service capability of the hospital with new suggested clarifications to categories of service Each hospital having emergency services shall notify the agency of its service capability Assist in emergency medical service providers (and other) in locating appropriate emergency medical care Include an Agency assessment of the statewide inventory of emergency services Be available to the general public Dr. Gray-Eurom had six specific suggestions for additional clarifications or new categories of services to the existing Emergency Services Inventory, including: Adding Intervention Cardiology Changing Internal Medicine to Hospitalist or Primary Care Admissions Stroke (specifically Neurologists who administer thrombolytic agents) Separating Neurosurgery into two categories, cranial neurosurgery and spinal neurosurgery Separating out Hand Orthopedics to its own category Adding Pediatrics Dr. Gray-Eurom suggested that once the inventory was in place with the new clarifications that medical oversight be included to assist the hospital licensure unit with approval of emergency room exemptions as well as creating a non-punitive reporting structure to promote honesty and transparency among hospitals. She indicated that FloridaHealthFinder.gov might be the proper forum to house this information, but also stated that the inventory needed to be updated in real time. Action Item: Diane Godfrey suggested that some of these functions are already available on FloridaHealthFinder, but perhaps a link could be added to the exemption page on the hospital licensure site. Action Item: Kim Streit recommends that a group be created and meet on Emergency Services in various departments around the state and determine how information can be accurately and transparently presented to consumers and providers regarding these services. Presentation: Public Reporting of Cardiac Data: Dr. Jeffrey Bott, Chairman of the Department of Thoracic Surgery at Orlando Regional Medical Center, delivered a comprehensive and educational presentation on behalf of the Florida Society of Cardiovascular and Thoracic Surgeons. Dr. Bott s presentation was concerned with the data reporting done by the Society of Thoracic Surgeons (STS). The STS database has over 4.5 million patients and is quite thorough and detailed. It differs from many databases as it uses clinical instead of claims data and includes uniform definitions that ensure both accuracy and purity. In addition, the database is risk adjusted, peer reviewed with feedback provided quarterly. He noted that while 1,071 practices report their data to the database, only 250 practices publicly report. Dr. Bott identified several benefits as well as some issues with the type of reporting done by STS. He summarized these benefits and problems as follows: Data allows one to draw meaningful conclusion, but is quite complex Affirms patient right to know but not how the information will translate into an action Data is robust/reliable but there is no longitudinal studies for comparison 3
Data could result in the denial of care Currently, there is no mechanism to help those on the left side of the bell curve Dr. Bott presented some suggestions for the Agency to best utilize this kind of data for the public s use: Enforce reporting for all programs Consider requiring provider participation in other databases (i.e. ACC, SVS) Prepare for substantial costs to get actionable individual level data The need to educate the public on the data Must consider remedial actions for low performers Kim Streit asked whether the Agency required providers to report this information. Secretary Dudek stated that pursuant to the transition of cardiac cath rules from the purview of Certificate of Need to the hospital licensure unit, we do require facilities to report (although not necessarily publicly) this information and utilize for the facilities improvement. She clarified that the Agency is not looking at this data. Action Item: Kim Streit suggested that the data transparency group review the data that was presented by Dr. Bott and think about how it could be utilized. Diane Godfrey suggested that we should provide a link to this data on FloridaHealthFinder.gov. Update on Senate Bill 1258: Mr. Bracher, Chair, asked that Mr. Gregg, Director of the Florida Center for Health Information and Policy Analysis, provide and update to the Council on his early meeting regarding senate bill 1258. Mr. Gregg stated that the idea behind senate bill 1258 is to build a cloudbased information system beyond the current information/data the Agency currently collects. This system would include information from the various State Agencies and Departments in the State. The information system would connect all the data in a single source that would be available through the Agency, but not prepared or interpreted by the Agency. Mr. Gregg remarked that this bill should be viewed as a multi-year activity and that the language is quite broad and somewhat open to interpretation. When asked, Mr. Gregg did not have any further information or insight on the provision in senate bill 1258 which would dissolve the State Consumer Health Information and Policy Advisory Council. Update on FloridaHealthFinder.gov: Ms. Beth Eastman gave an update on the utilization of FloridaHealthFinder.gov. She stated that the website received a record number of hits in January of 2013, totaling over 201,000 visits. In addition, the site had a 17 percent increase in volume of visits for the month of February 2013 over February 2012. Ms. Eastman also provided the Council with a virtual tour of the website including the most popular feature, the Facility Locator page. She noted that webinars had been developed and were in the final stages of internal testing before a soft launch to partner organizations. Mr. Bracher, Chair, stated that he was happily surprised that the encyclopedia pages are still quite popular showing the viability of the website. He further applauded the website and considers the recent award a validation of the care put into the site. Mr. Bracher remarked that he was concerned with senate bill 1258 propositions, and in particular that some of the polish and accessibility of the site might be threatened by this bill. Ms. van Caulil shared these concerns. 4
Action Item: Mr. Bracher, Chair, stated the need to set up a data transparency committee meeting before the next quarterly meeting. Ms. Van Caulil suggested researching other society s that offer data collection/warehousing similar to Dr. Bott s presentation on STS. Action Item: Secretary Dudek stated that the hospital licensure unit will look into questions and suggestions that came up during Dr. Gray-Eurom s presentation. The Chair called for any new business, there being no further business, the Chair adjourned the meeting at 1:20 pm. 5