Hospital Association of Rhode Island

Since 2005, hospitals report data on qualityNo submission = reduced update factor

ACA-mandated implementation of VBPLink payment to quality

CMS releases VBP final ruleBegins FFY 2013Utilizes quality data from the Inpatient Quality Reporting

ProgramFunding

Across the board reduction1% in FFY 2013, increasing by 0.25% each year until 2%

in FFY 2017 and subsequent years

 

Estimated Medicare IPPS Dollars

Contributed to VBP (1% Carve-Out)

VBP Score Weighted Average

VBP Payment

Percentage

Estimated Payment from VBP

Net VBP Gain/Loss

United States $855,139,105 48.93% 100% $855,139,105 $0

Connecticut $13,068,003 39.99% 81.36% $10,632,347 ($2,435,656)

Maine $4,083,935 51.73% 109.80% $4,484,329 $400,394

Massachusetts $26,560,760 51.67% 106.26% $28,222,143 $1,661,383

New Hampshire $4,008,757 51.86% 104.35% $4,183,111 $174,354

Rhode Island $2,933,615 44.87% 95.72% $2,808,139 ($125,476)

Vermont $1,313,035 43.68% 89.71% $1,177,878 ($135,157)

1% penalty for bottom quartile hospitals

Medicare Hospital-Acquired Condition (HAC) Rate Analysis

State HAC Rates and Ranks by Measure(Rates Per 1,000 Discharges)

 

Foreign Object Retained 

After Surgery

Air Embolism

Blood Incompatibility

Pressure Ulcers Stages III and IV

Falls and Trauma

Vascular Catheter-Associated Infection

Catheter-Associated Urinary Tract Infection

Manifestations of Poor Glycemic Control

Overall

  Rate Rank Rate Rank Rate Rank Rate Rank Rate Rank Rate Rank Rate Rank Rate Rank Rate Rank

Connecticut 0.116  35 0.000  1 0.000  1 0.091  19 0.496  8 0.437  41 0.417  37 0.067  42 1.623  31

Maine 0.176  46 0.000  1 0.010  47 0.167  44 0.679  38 0.272  16 0.491  43 0.031  13 1.826  45

Massachusetts 0.122  38 0.004  36 0.002  41 0.065  9 0.488  7 0.273  17 0.233  7 0.063  36 1.250  4

New Hampshire 0.000  1 0.014  49 0.000  1 0.082  13 0.775  47 0.530  46 0.625  48 0.095  48 2.120  50

Rhode Island 0.000  1 0.000  1 0.016  49 0.113  26 0.549  17 0.533  47 0.307  20 0.129  49 1.648  33

Vermont 0.225  48 0.000  1 0.000  1 0.071  12 0.740  44 0.141  1 0.423  38 0.141  50 1.740  40

Policy As mandated by the ACA, acute care hospitals with higher than

expected 30-day risk-adjusted readmission rates will receive reduced Medicare payments for every discharge.

Payments are to be reduced by the lower of a hospital-specific readmissions adjustment factor or a pre-determined maximum

1% of total DRG payments in FFY 2013, 2% in FFY 2014 and 3% in FFY 2015 and thereafter

3 conditions (heart attack, heart failure and pneumonia) in FY 13 and 14

Expanded in FY 15 to COPD, CABG, PTCA, and vascular

Impact Area 2013Ten-Year Impact

CMS Payment Reductions $11.5M $427.5M

DSH Payment Reductions $0 $79.6M

Quality-Based Payment Reductions $1.8M $67.2M

2% Sequestrian Reduction $11.4M $106.0M

Total $24.5M $680.2M

Proposed health reform legislation includes payment cuts to Medicare Advantage plans. Data is derived from HANYS KeySTATS.

• Accountable Care Organizations

• Group of providers to share in cost savings

• Must meet quality standards

• Medical Home

• Primary care

• CMMI/Partnership for Patients

• Test innovative payment and service delivery models to improve coordination, quality and efficiency

• Bundling

• Cover inpatient and outpatient hospital services, physician services (both in the inpatient and outpatient settings), post-acute care services (IRFs, LTCHs, SNFs and HHAs), and other services that the Secretary determines appropriate. The episode of care will start three days prior to a qualifying hospital admission and end 30 days after the patient’s discharge. Secretary will select ten conditions.

• Many of the initiatives such as HAC, VBP, etc. will be expanded to psych, rehab, physicians, Medicaid

• Focus on quality, patient safety, and efficiency

• Importance of collaboration and data analysis