hscrc call for papers patrick redmon, ph.d. director berkeley research group, llc january 31, 2014
TRANSCRIPT
HSCRC Call for Papers
Patrick Redmon, Ph.D.
Director
Berkeley Research Group, LLC
January 31, 2014
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Demonstration Model
3.58% per capita growth in
hospital revenue
$330 million Medicare
savings over 5 years
Reduce readmissions to national average
Reduce MHACs by 30%
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Public Engagement
Advisory Council
• Guiding principles for implementation
• Final report in preparation
Work Groups
• Convene on February 6, 2014
• Provide recommendations on technical implementation issues
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Purpose of Call for Papers
“The purpose of the papers is to encourage individuals and organizations to actively participate in policy discussions in a well developed and fact-based manner. The goal is to have an informed dialogue in which the technical approaches and findings from different papers are discussed, refined and ultimately contribute to technical analyses that will support HSCRC policy decisions.”
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Topics for Discussion• First Group (due January 10, 2014)
– Potentially Avoidable Volume– Methods for Monitoring Total Costs of Care– Service Area / Market Share– Gain Sharing and Other Physician Alignment Programs
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Topics for Discussion• Second group (due date to be determined)
– Attribution– Variable Cost Factor– Efficiency and Value Measurement– Payment Incentives for Quality-Based Reimbursement– Predictive Models for Uncompensated Care– Payment Models for Population Based Approaches– Financing Major Capital Projects
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Themes
Incentives for Volume Quality of Care
Measurement Uncompensated care
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Incentives for Volume• Per capita versus per case incentives• Variable Cost Factor• Global Budgets• Per capita measurement and population attribution• Potentially avoidable utilization
– Readmissions– Prevention quality indicators– MHACs– Avoidable ER visits
• Future capacity and innovation -- capital
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Quality of Care• Be at the national average for readmissions by the
end of the demonstration period• Reduce MHACs by 30%• Improve QBR performance
– Includes patient satisfaction and mortality measures
• Strengthen incentives begun in existing programs
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Measurement
Demonstration Compliance
System Revenue
Management
Data
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Measurement• Demonstration Compliance
– Total cost of care– Medicare per beneficiary performance for
hospital services– Per capita hospital spending for Maryland
residents
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Measurement• Managing System Revenue
– Market share definitions– Patient attribution for direct measurement of
hospital per capita revenue growth by hospital– Efficiency
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Measurement• Data
– Medicare– Enhanced HSCRC Collection of Hospital Data– All Payer Data Base– CRISP
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Uncompensated Care• Policy Response to Insurance Expansion
– Exchanges• Expanded coverage• Higher deductibles and copays
– Medicaid Expansion
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Conclusion• Rapid development necessary to achieve
demonstration goals over the five year time frame
• Process will require resources to develop• Policies are likely to require revision over
time
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Questions?
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Patrick Redmon, Ph.D.
Director
Berkeley Research Group, LLC
(484) 554-9654