we’re not in kansas anymore…part 2

Public Transparency and Accountability: A Threat, or an Opportunity?Marc P. VolavkaExecutive Director

Pennsylvania Health Care Cost Containment Council

Pennsylvania Health Care Cost Containment Council (PHC4)

What Ill try and do:

Three points:1) a bit about the history of the Council;2) a bit about public reporting and transparency;3) a bit about hospital acquired infections.


About PHC4Independent state agency established in 1986Improve the quality and restrain the cost of health care by PUBLICLY releasing data and reportsPromote competition in the health care marketplace


Sounds a bit like a 1980s version of transparency, doesnt it?


Council MembersPurchasers6 Business6 Labor1 Consumer

Insurers1 Commercial1 Non-Profit (Blues)1 HMOProviders2 Hospital2 Physician1 Nurse1 Health Care Quality Improvement ExpertState GovernmentSecretary of Health Secretary of WelfareInsurance Commissioner


PHC4 Data Sources:178 Acute Care Hospitals representing about 1.9 million inpatient admissionsOver 200 Surgery Centers representing about 2.5 million visitsThird party insurers, including Medicare and Medicaid


What data do we collect?4 million inpatient hospital discharge& ambulatory procedure records/year

More than 80 data fields available

Hospital Financial and Utilization Data

Actual payment from 3rd party payors

Updated 10/20/03


Public ReportsHospital Performance ReportHeart Bypass Report (physician specific)Hospital Financial ReportCommercial Managed Care ReportMedicare Managed Care ReportDiabetes Hospitalization ReportHip & Knee replacement (physician specific)Hospital Acquired Infections


Transparency and Consumerism?

When the Federal Government speaks, it must be so!


News ReleaseFOR IMMEDIATE RELEASE Thursday, June 1, 2006 Medicare Posts Hospital Payment InformationImportant Step Toward Transparency in Health Care Costs and QualityTo help consumers, providers, and payers make more informed health care decisions, the Department of Health and Human Services through its Centers for Medicare & Medicaid Services (CMS) today posted information on what Medicare pays for 30 common elective procedures and other hospital admissions. President Bush directed the data be made publicly available to all Americans as part of the Administrations commitment to make health care more affordable and accessible.

Once people gain better information, they become better consumers of health care and that helps get health care costs down and quality of care up, HHS SecretaryOnce people gain better information, they become better consumers of health care and that helps get health care costs down and quality of care up, HHS Secretary Mike Leavitt said. The federal government is the biggest single purchaser of health care in America, and by taking steps to post prices and quality data, we hope to encourage more insurance companies, hospitals, clinics and doctors to do the same.


Question:

What does consumerism and transparency mean in the world of 2006??


Answer: (2 more questions)

How much is it gonna cost me?Am I gonna be ok?

(and, probably in that order)


And, although I know this will come as a SHOCK to you, the Federal Government wasnt the first to discover transparency, even in pricing!


So, heres a riddle for your amusement:

When does HIPPA prevent a major 3rd party insurer from providing payment data to PHC4??


Answer:

Prior to August 17th, 2005

When their legal counsel says so!


Now:

When does HIPPA ALLOW a major 3rd party insurer from providing payment data to PHC4??


Answer:

After August 18th, 2005When their legal counsel says so!


Insurer Reveals What Doctors Really ChargeTo Help People Compare Fees, Aetna Posts Some Online; A Potential Bargaining ToolBy VANESSA FUHRMANS Staff Reporter of THE WALL STREET JOURNAL August 18, 2005 The growing effort to enlist consumers in reducing health-care costs has been stymied by the fact that most people just don't know what medical care costs.

Private and government health coverage has helped shield them from bills. And even with newer consumer-driven plans that employ Health Savings Accounts, which give people more of a financial stake in the issue, pricing information can be hard to come by.

Now, a major national health insurer is making an effort to change that. Starting tomorrow, Aetna Inc. plans to make available online the exact pricesStarting tomorrow, Aetna Inc. plans to make available online the exact prices it has negotiated with Cincinnati-area doctors for hundreds of medical procedures and tests. The initiative, which Aetna hopes to take eventually to other parts of the country, aims to give patients the tools to comparison shop and make savvier decisions with their health-care dollars.


Notice the date?


In Pennsylvania, with PHC4, weve been answering one of the questions (quality) for awhile, and were now starting to answer the other one (pricing)


This is what transparencylooked like, with our first report on hospital performance, in 1989:



Weve come a long way since then:




Since 1989, weve been demonstrating that you CAN bring some public disclosure to hospital and physician quality.


A study to be released today by the Pennsylvania Health Care Cost Containment Council echoes her questions. It found that readmissions at hospitals across the commonwealth rose last year even as death rates declined.


But, does it really matter?


At the same time, the council reported significant improvement in a key quality measure deaths.Overall, the death rates in Pennsylvanias hospitals in the categories examined have declined faster than the national average since 1991, the report said.


Heres what we believe 20 years of transparency have contributed to in Pennsylvania:



Now we face the harder job of making changes in the processes of care at our hospitals to reduce infection rates, complications of care, medical errors and patient readmissions, said David B. Nash, chairman of the department of health policy at Jefferson Medical College.Despite some limitations to this report, experts said public disclosure of quality paid off.There is growing evidence that in states with public reporting on health-care quality, mortality is lower and got there faster, Nash said.


Now, Ill fully admit that risk adjusted CABG mortality, or risk adjusted LOS arent exactly flowing off the tongues of PA consumers!


But, Hospital acquired infections

Now THAT got peoples attention!



Data Show Scourge of Hospital InfectionsAlarms raised on hospital infections


That wasnt so much of a surprise


But, I also got some interesting Fed Ex packages with solutions


These were a surprise!!


Let me show you what caught the nations attention, when we reported HAIs on a Statewide basis, in July of 2005:


11,668 patients were confirmed by PA hospitals as having 4 types of HAI (using CDC guidelines)

1793 died 1510 deaths were above what would have been expected 205,000 extra days in the hospital $2 BILLION in extra hospital billing that was sent to someone to pay


And, the national media got the two key points:


Hospital-acquired infections are deadly.


For 2004, in PA:

1,000 Patients(Who get an HAI) 130 Die

1,000 Patients (No HAI) 24 DieAdditional Deaths104 Additional Deaths Per 1,000 Patients


In other words, if you got an infection in a PA hospital in 2004, the odds of dieing during that hospitalization were 5.41 greater than if you didnt.

I Dont Like Those Odds!!!!


Second


The costs of hospital-acquired infections are staggering.


In 2004, PA received ACTUAL payment data from our 3rd party commercial insurersnot chargesPAYMENTS!


We linked hospital confirmed HAI patients with the ACTUAL payments made for each of those patients


So, were going to have a little test here:

Lets see who knows what it actually costs the person PAYING the bill:


In PA, the average PAYMENT for an acute care hospital stay is: $8,078


Ok, so what does the average hospitalization WITH a hospital acquired infection cost?

A) $22,247B) $33,698 C) $48,445D) $54,807 E) none of the above

$60,678Average PAYMENT!!


and, thats JUST the hospital portionthat doesnt include a penny for the physician payments to treat that patient


nor, the ACTUAL costs for the hospital



Stay tuned:

Coming to your local theaters on November 14, 2006

1st Hospital Acquired Infection Public Report, specific to 170 PA Hospitals


No folksWere not in Kansas anymore

In order to invest important health care stakeholders firmly in the process, a 25-member council was created to provide direction for the agency.

Majority of Council from business and labor

Council provides a safe haven, a common ground, for business and labor to interact as allies.

2 million inpatient and 2 million outpatient recordsReport can be used by consumers and purchasers in making more informed health care decisions. Can be used by providers to pinpoint opportunities for quality improvement and cost containment.

Three-version report - Western Pennsylvania- Central and Northeastern Pennsylvania- Southeastern Pennsylvania

(The system groups similar medical conditions and surgical procedures into hundreds of illness categories. DRGs are based on the patients illness and procedures.)

Report can be used by consumers and purchasers in making more informed health care decisions. Can be used by providers to pinpoint opportunities for quality improvement and cost containment.

Three-version report - Western Pennsylvania- Central and Northeastern Pennsylvania- Southeastern Pennsylvania

(The system groups similar medical conditions and surgical procedures into hundreds of illness categories. DRGs are based on the patients illness and procedures.)

we’re not in kansas anymore…part 2

Documents

cost of health care

health care costs

informed health care

department of health

acute care hospitals

quality data

releasing data

better information