PHC4 - “Pay for Performance” Toolkit Mike Berney Community and Purchaser Relations Manager...

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


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


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


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


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””


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.


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


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)


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


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


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



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



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


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


Our Free ToolsOur Free Toolsavailable to the publicavailable to the public

Publish hospital outcomesPublish hospital outcomes Publish hospital financialsPublish hospital financials


PHC4’s PHC4’s Financial Financial

AnalysisAnalysis

GAC Volume OneGAC Volume One

Non-GAC Volume TwoNon-GAC Volume Two


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 )


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


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 %


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


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.


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


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


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


ANOTHER RESEARCH BRIEFANOTHER RESEARCH BRIEF

HOSPITAL ACQUIRED INFECTIONSHOSPITAL ACQUIRED INFECTIONS

PHC4 - “Pay for Performance” Toolkit Mike Berney Community and Purchaser Relations Manager...

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