ge healthcare top 10 for 2010
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Webinar presented by GE HealthcareTRANSCRIPT
1 /GE Top 10 in 2010 /
12/10/2009
GE Healthcare
Top 10 for 2010How can your practice prepare for the changes ahead?
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©2009 General Electric Company – All rights reserved.
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Today’s speakersDon McDanielPresident and CEO, Sage Growth PartnersFaculty, Healthcare Economics and Competitive Strategy,The Johns Hopkins University
Mark J. Segal, PhD Director, Government and Industry Affairs, GE Healthcare
Chris Freer, MBA, CPHIMSGeneral Manager, GE Healthcare
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Top 10 for 2010
1. The push for HCIT – Stimulus 101
2. EMR arrives in earnest
3. Key bodies shaping future directions
4. Health reform
5. Cost containment and reimbursement pressures mount
6. Will pay for performance take shape?
7. Consolidation all around
8. Physician enterprise challenges continue
9. Workforce and skills
10. The age tsunami
The Push for HCIT: Stimulus 1011
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The push for HCIT – Stimulus 101• $36.6B Investment (CMS: $45B for incentives)• Objective: Increase EHR Adoption
– Goal: All in U.S. by 2014– Projection: 90% Physicians and 70% Hospitals by 2019
• Incentives and Penalties– Medicare major factor for most physicians (Medicaid for some)– Physicians (non-hospital-based): $44K maximum for 2011-12 start– There is no fixed pot for incentives: based in a statutory formula– Physician penalties start 2015: 1-3% of allowed charges at risk
• Terms: Qualified EHR, Certified EHR , Meaningful Use• State HIE Infrastructure• New Privacy and Security Rules
EMR Arrives in Earnest2
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EMR arrives in earnest• Key Regulations: December 2009/Spring 2010
• Certification: What is in the EMR– Shift from current approach: driven by meaningful use, interop, security– “ARRA” Certification, modular/site, multiple certifiers– Criteria (“final”) and process (proposed) in ONC December rules
• Meaningful Use: What you do with the EMR/HIT– Step up in rigor every two years from “light(er)” 2011-12– Structured data, quality reporting, HIE, CPOE, CDSS, patient-centric– CMS December NPRM rule: Refinement of Policy Committee proposal– RECs
• Payment Policies: Medicare and Medicaid– How payments flow and how do I prove certification and meaningful use– “When do I have to be a meaningful user?”– In CMS December NPRM rule
Change (management) the only constant
Key Bodies Shaping Future Directions3
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HIT Policy Committee
HIT Standards Committee
ONC & CMSHHS Secretary
Certification
Federal Gov.
Vendors
Providers
SDOs
?
GE is focused onmonitoring andinfluencing keydecision points
Key bodies shaping future directions
Health Reform4
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Health reform
• Insurance Market Reform
• Covering the Uninsured
• Delivery Reform and “Bending the Curve”– Bundling– Pay for Performance– Care Coordination– Accountable Care Organizations– Medical Homes
• Quality Measurement and Reporting
• HIT as an Enabler
• Funding Reform: Taxes and Medicare Cuts
Cost Containment & Reimbursement Pressure5
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Cost containment andreimbursement pressures mount• Reform may further constrain public sector reimbursement
• Fee for Service under assault– Poorly aligned incentives– Recovery Audit Contractors– Bundled and Global payment “Demonstrations”– P4P– Denials for mistakes?
• Higher deductibles with patient due balances
• New codes and documentation procedures for PQRI, ARRA,and eRX incentives
Will Pay for Performance Take Shape?6
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Will pay for performance take shape?• Consensus Shifting from Pay for Volume
• Healthcare Reform Will be a Major Driver
• But Private Payer use Continues to Rise
• Focus on “Efficiency” and Episodes of Care
• Increased Funding for Quality Measures
• Quality Reporting from EMRs: ARRA/PQRI are Drivers
• PQRI: Shift to Penalties from Incentives
• Medicare P4P– Hospitals by 2013 (Senate HCR)– Physicians by 2015 (Senate HCR)
Consolidation All Around7
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Consolidation all around• Physicians
– Lifestyle– Employment– Cottage – industry
• Hospitals – expect more IDN formation given environment– Regulatory– Reimbursement– Public payor reimbursement
• Health IT Vendors– Certification regimen– Balance sheet– R&D
– Health IT deployment needs– Skills
– Commitment to industry– Above and beyond: “the health
care cloud”
– Access to capital challenged– Investment portfolio returns down
Physician Enterprise Challenges Abound8
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Physician enterprise challengesabound• Scale dis-economies still the order of the day
– 50% of US physicians operate in groups of less than 5 physicians*
• Reimbursement environment tough—inflation +/- forforeseeable future
• Health reform on back of medicine cuts
• Tremendous pressure on operating expenses in many placesdespite economic downturn
– Labor and related (health insurance)– Rent– Medical malpractice
• Inability to fund “productivity enhancing” technologies*Source:http://www.hschange.org/CONTENT/1078/?words=Practice+Size#fig1
Workforce and Skills9
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Workforce and skills
• Physician shortages here and anticipated, especiallyin the primary care arena
• Aging of nursing workforce continues, “calamity”stalled by economy, structural issues remain
• Big push to deploy technology – both to enhanceproductivity and improve quality of care and patientsafety
• Informatics capacity will be challenged to reach90% EHR physician organization user adoption by2019
The Age Tsunami10
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The age tsunami
• Population over 65 will grow from 13% to 20% by2050
• Includes substantial growth in racial and ethnicminorities
• Complexity intensifies!– One-quarter of all Medicare recipients
– Have five or more chronic conditions*– See, on average, 13 physicians per year– Secure 50 prescriptions per year
– Over 13,000 different drugs being sold in the U.S. in2007 – 16x what was available 50 years ago
*Source: New England Journal of Medicine: 353;3, July 21,2005: “Medicare and Chronic Conditions”, Gerard F Anderson,PHD
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For more information• General questions
• Stimulus Simplicity and the ARRA HITECH Act– www.gehealthcare.com/HITECHtoday– [email protected]– 1-800-535-7921
• EMR Value Calculator– www.gehealthcare.com/EMRValueCalculator
Thank you!