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The Meaningful Care Organization – Patient-Centered Strategies
for the Intersection of MU and ACOs
RL Solutions Webinar Series
October 11, 2012 Page 1
Toronto Boston Adelaide London
www.rlsolutions.com
Timothy Kelly, Vice President
Dialog Medical, a Standard Register
Healthcare Company
The Meaningful Care Organization –
Patient-Centered Strategies for the
Intersection of MU and ACOs
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The Meaningful Care Organization – Patient-Centered Strategies
for the Intersection of MU and ACOs
RL Solutions Webinar Series
October 11, 2012 Page 2
The Meaningful Care Organization –
Patient-Centered Strategies for the
Intersection of MU and ACOs
Timothy Kelly, MS, MBA
Dialog Medical A Standard Register Healthcare Company
MU and ACOs (Meaningful Use and Accountable Care Organizations)
The Meaningful Care Organization – Patient-Centered Strategies
for the Intersection of MU and ACOs
RL Solutions Webinar Series
October 11, 2012 Page 3
Meaningful Use
American Recovery and Reinvestment Act of
2009
HITECH Act
Meaningful Use
Meaningful Use (MU)
5
Meaningful Use
$36 billion will be spent on the implementation of Electronic Health Records (EHRs)1
$6.9 billion paid through August2
• 3,884 hospitals have registered to receive incentive payments through the end of July
Medicare EHR incentive payments end in 2016 (Medicaid payments end in 2021)
Meaningful Use (MU)
6
1Rock and a hard place: An analysis of the $36 billion impact from health IT stimulus funding. Price Waterhouse Coopers. April 2009.
2Mosquera M, Healthcare IT News, September 7, 2012, http://www.healthcareitnews.com/news/government-ehr-incentives-near-7b (Accessed September 24, 2012)
The Meaningful Care Organization – Patient-Centered Strategies
for the Intersection of MU and ACOs
RL Solutions Webinar Series
October 11, 2012 Page 4
Accountable Care Organizations
Patient Protection and Affordable Care Act of
2010
Medicare Shared Savings Program
Accountable Care Organizations
Accountable Care Organizations (ACOs)
7
Accountable Care Organizations
Voluntary groups of physicians, hospitals and other
healthcare providers:
Responsible for care of a clearly defined Medicare
population
Designed to foster patient-centered, coordinated care
If it succeeds in providing high-quality care while
reducing cost, it shares in savings achieved for
Medicare
Accountable Care Organizations (ACOs)
8
Source: Berwick DM. N Engl J Med 2011;365:1753-1756.
The Meaningful Care Organization – Patient-Centered Strategies
for the Intersection of MU and ACOs
RL Solutions Webinar Series
October 11, 2012 Page 5
Accountable Care Organizations
32 Pioneer ACOs1
115 Medicare Shared Savings ACOs1
20 Advanced Payment Model ACOs1
221 total ACOs identified through the end of May2
118 are hospital-sponsored ACOs
Accountable Care Organizations (ACOs)
9
1CMS Center for Medicare & Medicaid Innovation. http://innovations.cms.gov/initiatives/ACO/index.html (Accessed September 24, 2012)
2Muhlestein D, et al. Growth and Dispersion of Accountable Care Organizations - June 2012 Update. Leavitt Partners, http://leavittpartners.com/wp-content/uploads/2012/06/Growth-and-Dispersion-of-ACOs-June-2012-Update2.pdf (Accessed September 24, 2012)
Accountable Care Organizations
Accountable Care Organizations (ACOs)
10
Source: January 2012 survey of hospitals, physician organizations and health
systems reported in: Tocknell MD. The Unsettled State of the ACO.
HealthLeaders Media Intelligence Report. April 2012.
Currently part of an
ACO?
11%
No - 89%
Plan to implement or join and
ACO?
Yes - 61%
No - 39%
Yes -
The Meaningful Care Organization – Patient-Centered Strategies
for the Intersection of MU and ACOs
RL Solutions Webinar Series
October 11, 2012 Page 6
Accountable Care Organizations
$510 million in estimated Medicare savings in the first three years (2012-2014)1
$560 million to $1.13 billion in bonuses paid to those ACOs over that period2
Top Driver for the organization creating an ACO – To engage physicians (56 percent of the respondents that are or plan to be part of an ACO)3
Accountable Care Organizations (ACOs)
11
1Section III.F. of the Preamble to the ACO Regulations. Federal Register Vol. 76(67):19640.
2Section III.C.3. of the Preamble to the ACO Regulations. Federal Register Vol. 76(67):19639.
3Tocknell MD. The Unsettled State of the ACO. HealthLeaders Media Intelligence Report. April 2012.
MU and ACOs
Intersection of MU and ACOs
12
MU Goals1
• Improve caregiver decisions
• Better outcomes
ACO Goals2
• Better care for individuals
• Better health for populations
• Slower growth in costs through improvements in care
1Blumenthal D and Tavenner M. N Engl J Med 2010;363(6):501-504. 2Berwick DM. N Engl J Med 2011;364(16):e32.
Patient-
Centered
Strategies
The Meaningful Care Organization – Patient-Centered Strategies
for the Intersection of MU and ACOs
RL Solutions Webinar Series
October 11, 2012 Page 7
Meaningful Use Objectives
Meaningful Use Objectives
Stage 1 Objectives for Hospitals
14 Core Objectives, 10 Menu Objectives (attain 5)
First eligible payment year: 2011
Stage 2 Objectives for Hospitals
16 Core Objectives, 6 Menu Objectives (attain 3)
First eligible payment year: 2014
Effectively incorporate all of the Stage 1 objectives,
along with additional objectives and higher
measurement thresholds
Meaningful Use Objectives
14
The Meaningful Care Organization – Patient-Centered Strategies
for the Intersection of MU and ACOs
RL Solutions Webinar Series
October 11, 2012 Page 8
Meaningful Use Objectives
Stage 2 Meaningful Use Objectives
15
Core Objectives Demographics Vital Signs Clinical Decision Support CPOE Transitions of Care View, Download and
Transmit to Third Party Privacy and Security Smoking Status Lab Results into EHR Patient-Specific Education Medication Reconciliation
Patient Input
Output
Input
Output Input
Core Objectives Generate Patient Lists Immunization Registries Lab Results to Public
Health Agencies Syndromic Surveillance
Menu Objectives Imaging Results Advance Directives ePrescribing Electronic Notes Electronic Lab Results Family Health History
Patient
Input
Input
Why Focus on Patient-Centered
Strategies that are “Output Oriented”?
The Meaningful Care Organization – Patient-Centered Strategies
for the Intersection of MU and ACOs
RL Solutions Webinar Series
October 11, 2012 Page 9
“Output Oriented” Strategies
Effective October, 1 percent of Medicare payments are
being withheld for payment to hospitals with above
average patient satisfaction scores.
$850 million in incentive payments
Patient Satisfaction
17
Rau J. Kaiser Health News; April 28, 2011,
http://www.kaiserhealthnews.org/Stories/2011/April/28/medicare-hospital-patient-satisfaction.aspx. (Accessed September 24, 2012)
“Output Oriented” Strategies
Survey metric: Nurses “always” communicated well
Top 3 states
• Louisiana – 81%
• South Dakota – 81%
• Maine – 80%
Bottom 3 states
• Washington DC – 68%
• Nevada – 69%
• California – 70%
Patient Satisfaction
18
Source: Hospital Compare hhs.gov
The Meaningful Care Organization – Patient-Centered Strategies
for the Intersection of MU and ACOs
RL Solutions Webinar Series
October 11, 2012 Page 10
“Output Oriented” Strategies
Survey metric: Doctors “always” communicated well
Top 3 states
• Alabama – 86%
• Louisiana – 86%
• Mississippi – 85%
Bottom 3 states
• Nevada – 73%
• Washington DC – 76%
• New York – 76%
Patient Satisfaction
19
Source: Hospital Compare hhs.gov
“Output Oriented” Strategies
Survey metric: Given information for recovery
Top 3 states
• New Hampshire – 87%
• Vermont – 87%
• Utah – 87%
Bottom 3 states
• Washington DC – 77%
• New Jersey – 78%
• Mississippi – 78%
Patient Satisfaction
20
Source: Hospital Compare hhs.gov
The Meaningful Care Organization – Patient-Centered Strategies
for the Intersection of MU and ACOs
RL Solutions Webinar Series
October 11, 2012 Page 11
“Output Oriented” Strategies
These metrics
are moving
beyond the
government
sites to
mainstream,
consumer sites
Patient
Satisfaction
21
Source: Kelly T. HIStalk, August
8, 2012
http://histalk2.com/2012/08/08/re
aders-write-8812/ (Accessed September 24, 2012)
“Output Oriented” Meaningful Use
Objectives
The Meaningful Care Organization – Patient-Centered Strategies
for the Intersection of MU and ACOs
RL Solutions Webinar Series
October 11, 2012 Page 12
“Output Oriented” MU Objectives
Patient-Specific Education
23
Patients who are provided patient-specific education resources
Number of unique patients admitted to the hospital’s inpatient or emergency
departments during the reporting period
> 10%
“Output Oriented” MU Objectives
2 Measures for this Meaningful Use objective
Both must be satisfied in order to meet the objective
View, Download and Transmit to Third Party
24
The Meaningful Care Organization – Patient-Centered Strategies
for the Intersection of MU and ACOs
RL Solutions Webinar Series
October 11, 2012 Page 13
“Output Oriented” MU Objectives
25
Patients whose information is available online within 36 hours of discharge
Number of unique patients discharged from the hospital’s inpatient or emergency
department during the reporting period
Patients who view, download or transmit to a third party the information provided online
Number of unique patients discharged from the hospital’s inpatient or emergency
department during the reporting period
> 50%
> 5%*
View, Download and Transmit to Third Party
*This measure was 10% in the Proposed Stage 2 Rule
Best Practices for Patient-Specific
Education Materials
The Meaningful Care Organization – Patient-Centered Strategies
for the Intersection of MU and ACOs
RL Solutions Webinar Series
October 11, 2012 Page 14
Best Practices
The informed consent discussion conducted by the surgeon should include:
1. The nature of the illness and the natural consequences of no treatment.
2. The nature of the proposed operation, including the estimated risks of mortality and morbidity.
3. The more common known complications, which should be described and discussed. The patient should understand the risks as well as the benefits of the proposed operation. The discussion should include a description of what to expect during the hospitalization and post hospital convalescence.
4. Alternative forms of treatment, including nonoperative techniques.
American College of Surgeons
27
American College of Surgeons Statements on Principles. Revised September 18, 2008. http://www.facs.org/fellows_info/statements/stonprin.html#anchor171960 (Accessed 9/24/12.)
Best Practices
Only 39% of 3,269 closed claims against anesthesiologists were judged to have adequate informed consent1
Inadequate informed consent was pursued as a secondary cause in more than 90% of ophthalmologic malpractice cases2
Lack of informed consent is one of the top 10 reasons for hospital malpractice claims3
Argument for Informed Consent
28
1Caplan RA, Posner KL. ASA Newsletter 1995;59(6):9-12. 2Kiss CG, Richter-Mueksch S, Stifter E, et at. Arch Ophthalmol 2004;122:94-98. 3Glabman M. Trustee 2004;57(2):12-16.
The Meaningful Care Organization – Patient-Centered Strategies
for the Intersection of MU and ACOs
RL Solutions Webinar Series
October 11, 2012 Page 15
Best Practices
Needs to be
electronic
Can’t be a
“Medical Miranda
Warning”
Argument for
Informed Consent
29
Best Practices
Need the consent for the Pre-Procedure Verification and/or the Time-Out
Verification of the consent is one of the most effective practices for avoiding wrong-patient/wrong-procedure/ wrong-site surgery1
Argument for
Informed Consent
30
1Clarke JR, Johnston J, Finley ED. Ann
Surg 2007;246:395-405.
The Meaningful Care Organization – Patient-Centered Strategies
for the Intersection of MU and ACOs
RL Solutions Webinar Series
October 11, 2012 Page 16
Best Practices
WHO Surgical Safety Checklist
31
Best Practices
Argument for
Informed Consent
32
The Meaningful Care Organization – Patient-Centered Strategies
for the Intersection of MU and ACOs
RL Solutions Webinar Series
October 11, 2012 Page 17
Best Practices
Reduce the risk of potentially life-threatening perioperative complications.
Pre-Procedure Instructions
33
Courtesy of the Baltimore VA Medical Center
Tea C. Perioperative concepts
and nursing management. In:
Smeltzer SC, et al, eds.
Brunner and Suddarth’s
Textbook of Medical-Surgical
Nursing. Philadelphia, PA:
Wolters Kluwer
Health/Lippincott Williams &
Wilkins; 2010:422-483.
Best Practices
Lower the incidence of
preventable surgery
cancellations.
Pre-Procedure Instructions
34
Henderson BA et al. Incidence and causes
of ocular surgery cancellations in an
ambulatory surgical center. J Catarct
Refract Surg. 2006;32(1):95-102
Pletta C et al. Efficiency improvement plan
through patient education on thyroid
imaging procedures. J Nucl Med.
2008;49(Supp 1):426P Courtesy of the Baltimore VAMC
The Meaningful Care Organization – Patient-Centered Strategies
for the Intersection of MU and ACOs
RL Solutions Webinar Series
October 11, 2012 Page 18
Best Practices for Viewing, Downloading
and Transmitting Patient Information
Best Practices
Providing
patients with
incomplete
information at
discharge can
result in patient
harm.
Discharge Instructions
36
Courtesy of the Portland VA Medical Center
Pennsylvania Patient
Safety Advisory. 2008.
Jun;5[2]:39-43.
The Meaningful Care Organization – Patient-Centered Strategies
for the Intersection of MU and ACOs
RL Solutions Webinar Series
October 11, 2012 Page 19
Best Practices
HRRP was created under the PPACA
Effective October 1, 2012
Establishes penalties for excessive readmissions with
maximum payment reductions of:
1 percent in 2013
2 percent in 2014
3 percent in 2015 and beyond
Hospital Readmissions Reduction Program
37
Source: Section 3025 of the Patient Protection and Affordable Care Act added
section 1886(q) to the Social Security Act. 42 CFR part 412 (§412.150 through
§412.154).
Best Practices
Anticipating $280 million in penalties in 2013
2,211 hospitals are projected to forfeit Medicare funds
278 hospitals are projected to lose the maximum of
1% of their base Medicare reimbursements
Hospital Readmissions Reduction Program
38
Source: Rau J, Kaiser Health News, August 13, 2012
http://www.kaiserhealthnews.org/Stories/2012/August/13/medicare-hospitals-readmissions-penalties.aspx (Accessed September 24, 2012)
The Meaningful Care Organization – Patient-Centered Strategies
for the Intersection of MU and ACOs
RL Solutions Webinar Series
October 11, 2012 Page 20
Best Practices
Reduced the 14-day
readmission rate three-
fold by employing
procedure-specific
discharge instructions
(4.1 per 1,000
outpatient procedures
to 1.5 per 1,000).
Discharge Instructions
39
Boast P, Potts C. PS&QH.
2010;7(1):14-16.
Courtesy of the Portland VA Medical Center
Best Practices
Most valuable if
they are sent well
prior to the 36-
hour threshold
Provided prior to
admission
Paper as well as
electronic
Discharge Instructions
40
The Meaningful Care Organization – Patient-Centered Strategies
for the Intersection of MU and ACOs
RL Solutions Webinar Series
October 11, 2012 Page 21
Developing Initiatives in Your Own
“Meaningful Care Organization”
The Meaningful Care Organization
Making Good on ACOs’ Promise — The Final Rule for the
Medicare Shared Savings Program. N Engl J Med
2011;365(19):1753-1756. November 10, 2011.
http://www.nejm.org/doi/pdf/10.1056/NEJMp1111671
Meaningful Use – The Whiteboard Story – Stage 1 Final Rule
Meaningful Use Objectives and Measures Compared to Stage
2 Final Objectives and Measures... Created as a reference tool
for public use and convenience by The Advisory Board Company.
http://www.advisory.com/~/media/Advisory-com/CampaignItems/MU-
Stage-2-White-Board-Story-Poster-2.pdf
Resources
42
The Meaningful Care Organization – Patient-Centered Strategies
for the Intersection of MU and ACOs
RL Solutions Webinar Series
October 11, 2012 Page 22
Stage 1 Stage 2
The Meaningful Care Organization
“Meaningful Care” Checklist
44
Is the initiative patient-centered?
Does it reduce risk?
Does it enhance safety?
Does it leverage the patient?
Can you utilize HIT (EHR or
other systems)?
Does it support Stage 1 or
Stage 2 Meaningful Objectives?
Yes No
The Meaningful Care Organization – Patient-Centered Strategies
for the Intersection of MU and ACOs
RL Solutions Webinar Series
October 11, 2012 Page 23
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