Health Care Reform: Potential Implications for Transplantation
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Health Care Reform: Potential Implications for Transplantation

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Health Care Reform: Potential Implications for Transplantation




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Presentation on theme: "Health Care Reform: Potential Implications for Transplantation"— Presentation transcript:

Slide1

Health Care Reform: Potential Implications for Transplantation

Edward Y. Zavala, M.B.A.

Administrator, Vanderbilt Transplant Center

Vanderbilt University Medical Center

Adjunct Professor of Management

Vanderbilt Owen Graduate School of Management

Research Assistant Professor

Department of Surgery

Vanderbilt University

Nashville, Tennessee

Slide2

What Does the Health Care ReformBill Attempt to Accomplish?

CostHealth care is currently around 17.5% of our GDP and forecast to grow to 25% by 2025Rate of growth in health care costs has outstripped other goods and services most every year for the past 25 yearsAccessAbout 45 – 47 million uninsured11 million have income below the Federal Poverty Line (FPL)12 million have incomes in excess of 300% of the FPL ($66,000)5 million have incomes in excess of 500% of the FPL ( $110,000)10 million are not US citizens25% are eligible for Medicaid but have not signed upQualityVariability in utilization without demonstration of improved outcomes

Slide3

Coverage Provisions

Health Care

Reform Implementation

20102011

2012

2013

2014

20152016201720182019COVERAGE PROVISIONSInsurance Reforms (Pre-existing conditions for children, no annual or lifetime limits, children on parents insurance until 26)Medicaid ExpansionInsurance Reforms (Pre-existing conditions for adults, premium limits)Individual Mandate

Slide4

Private Insurance Reform

Improved access to transplant evaluation and listing

Reduced risk of non-adherence from loss of drug coverage

Negatives for TransplantStronger “in-network” provisions may limit access to some transplant centersElimination of high cost, high choice plansLonger waits without increase in organ supply Positives for Transplant

Slide5

Medicaid Program

Positives for Transplant

Improved “access” to transplant Coverage for uninsured patients in the post transplant period

Reduced organ loss to medication non-adherenceNegatives for TransplantExpansion in patients with inadequate coverageMedicaid payments often do not cover organ acquisition costs

Slide6

Payment Constraint andQuality Provisions

Health Care

Reform Implementation

20102011

2012

2013

2014

20152016201720182019COVERAGE PROVISIONSInsurance Reforms (Pre-existing conditions for children, no annual or lifetime limits, children on parents insurance until 26)Medicaid ExpansionInsurance Reforms (Pre-existing conditions for adults, premium limits)Individual Mandate

PAYMENT CONSTRAINT PROVISIONS

CMS Hospital Behavioral Offset Relating to IPPS

Hospital Market Basket Reduction

Hospital Productivity Adjustments

Independent Payment advisory Board

Medical Device Tax

Medicare DSH Payment Reduction

Medicaid DSH Payment Reduction

QUALITY PROVISIONS

RULE MAKING



Hospital Value-Based Purchasing RULE MAKING  Hospital Readmission Payment Reductions RULE MAKING  Hospital-Acquired Conditions Penalties

Slide7

Medicare

Positives for Transplant

Better drug coverage through reduction in the donut hole

Shift to episode of care reimbursement which is already familiar in transplantationDevelopment of comparative effectiveness researchNegatives for TransplantReimbursement reductions for professional services by independent medical boardReduction in disproportionate share payments

Penalties for re-admissions and hospital acquired infections

Slide8

Modeled Medicare Payment Components of Reimbursement for Typical Teaching Hospital

2.9736

DRG weight =

5.06154.27524.756910.1358

9.4543

11.7540

24.8548

Slide9

Delivery System Provisions

Health Care

Reform Implementation

20102011

2012

2013

2014

20152016201720182019COVERAGE PROVISIONSInsurance Reforms (Pre-existing conditions for children, no annual or lifetime limits, children on parents insurance until 26)Medicaid ExpansionInsurance Reforms (Pre-existing conditions for adults, premium limits)Individual Mandate

PAYMENT CONSTRAINT PROVISIONS

CMS Hospital Behavioral Offset Relating to IPPS

Hospital Market Basket Reduction

Hospital Productivity Adjustments

Independent Payment advisory Board

Medical Device Tax

Medicare DSH Payment Reduction

Medicaid DSH Payment Reduction

QUALITY PROVISIONS

RULE MAKING



Hospital Value-Based Purchasing RULE MAKING  Hospital Readmission Payment Reductions RULE MAKING  

Hospital-Acquired Conditions Penalties

DELIVERY SYSTEM PROVISIONS



Accountable Care Organizations

RULE MAKING

Bundled Payments Pilot

Slide10

Transplant Impact

Health Care Reform Implementation

2010

2011

2012

2013

2014

20152016201720182019COVERAGE PROVISIONSFavorablePAYMENT CONSTRAINT PROVISIONSUnfavorableQUALITY PROVISIONSWithin Our ControlDELIVERY SYSTEM PROVISIONSTo Be Determined – Value-Based Pricing and ACOs

Slide11

Strategic Readiness

Economic Repositioning

RetreatIdentify Opportunities for Cost ReductionIdentify Opportunities for Revenue OptimizationEstablish SubcommitteesMonitor Results

Slide12

Strategic Readiness - continued

Economic Repositioning

Costs/Inpatient AdmissionInpatient Pharmacy Costs

Slide13

Transplant Cost Review

Phase 3 Transplant Procedure Cost

Cost Tracking

PATIENT ID

LOS

ICU

LOS

ICU COSTMED/SURG COSTLABS COSTRADIOLOGY COSTO.R. COSTPHARMACY COSTORGAN ACQUISITION COSTBLOOD TRANSFUSION COSTOTHER DEPT. COSTPHASE 3 TRANSPLANT COST100$0$0$0

$0

$0

$0

$0

$0

$0

$0

2

0

0

$0

$0

$0

$0$0$0$0$0$0$0300$0$0$0$0$0$0$0$0$0$0400$0$0$0$0$0$0$0$0$0$0500

$0

$0

$0

$0

$0

$0

$0

$0

$0

$0

6

0

0

$0

$0

$0

$0

$0

$0

$0

$0

$0

$0

AVERAGES

0.00

0.00

$0

$0

$0

$0

$0

$0

$0

$0

$0

$0

TRANSPLANT COST REVIEW

Slide14

Strategic Readiness - continued

Economic Repositioning

Medicare Cost Report OptimizationManaged Care Contracts

Slide15

Strategic Readiness - continued

Economic Repositioning

Optimize Living Donor Processes to Increase Transplantation SafelyWeb-Based Living Donor Application Process

Slide16

Web-Based Living Donor Application

Access Through VTC Website

Goal: Screen Candidates More Efficiently

Slide17

Results

First 5 calendar year quarters post implementation:

1200 donor self referrals

801 (67%) web-based referrals399 (33%) phone referrals

Slide18

Results

Slide19

Web-Based Application

A conservative estimate of living donor administrative staff time saved with the implementation of the web application is 160 hours for the 801 candidates screened by the web-based application.

Slide20

Documenting Value and Quality

Quality of Life

Patient Satisfaction

Slide21

Health-Related Quality of Life

and Patient Satisfaction Program

Vanderbilt Transplant Center

Launched January, 2002 > 9,500 transplant candidates and recipients > 4,000 longitudinal, multi-survey data points Patient-reported outcomes HRQOL and satisfaction as a quality measure Research

Contact: Irene Feurer

, Ph.D.

irene.feurer@vanderbilt.edu

Slide22

HRQOL Survey Battery and Assessment Schedule

(effective January, 2002)

Listed

Transplant

Slide23

Physical and Mental HRQOL at Post-Transplant Year 1

A Patient-Reported Quality Benchmark

Dashed lines indicate targeted threshold

Slide24

Mean = 34

±5

Median = 36

25th %ile = 31

Validated Transplant-Specific

Patient Satisfaction Inventory

Feurer et al.

Progress in Transplantation. 2007;17:121-128.Determining the minimum target thresholdfor the 13-item summary score

Slide25

Distribution of Satisfaction Scores by Yearin relation to the minimum target threshold (31)

Slide26

Examples of Item-Level Analysis of Satisfaction Survey Data

Slide27

Spend Time on Staff Development,Retention and Internships

Develop Opportunities for Education

Develop Opportunities for Research ProjectsSupport Staff Involvement in UNOS, NATCO, ITNS, AST, ASTS, ISHLT, ATA, TFCASend Staff to Transplant MeetingsGraduate Student Internships – MBA, MHA, MPH, etc.

Slide28

Spend Time Planning and Thinking

Strategic Planning

Business PlanningCommunicationContinuous Improvement and Re-enginneering of Systems and Processes

Slide29

Questions