COMMUNITY ONCOLOGY ALLIANCE YOU WON T BELIEVE WHAT CMS WILL BE REPORTING ON YOUR ONCOLOGISTS

Transcription

1 COMMUNITY ONCOLOGY ALLIANCE YOU WON T BELIEVE WHAT CMS WILL BE REPORTING ON YOUR ONCOLOGISTS

2 Community Oncology Alliance 2

3 Physician Ratings Consumers want information about quality Have become used to getting this information Payers want informed consumers Medicare and other payers want to transition for paying for service volume to paying for care quality Pay for the right care not the most care Hoped that by improving quality of care, medical costs can be lowered Community Oncology Alliance 3

4 Physician Ratings Limitations Data has to reliable Must capture the true complexity of patient s conditions Be communicated to patients in a way that they can understand Address problems of risk adjustment and random variation Data constrained by small numbers when reporting at the physician level Proper patient attribution is critical Community Oncology Alliance 4

5 What can we learn? Hospital Compare What can we learn? Physician Compare What is coming? Quality and Resource Use Reports (QRURs) Physician Value Based Payment Modifier Community Oncology Alliance 5

6 Hospital Compare Website Community Oncology Alliance 6

7 Hospital Compare Website Initiated in 2005 Data on 4000 Medicare certified hospitals Community Oncology Alliance 7

8 What is Reported? Timely and effective care Time to treatment of MI, pneumonia, etc Readmissions, complications, and deaths Rate of readmission and 30 day mortality Rate of complications Rates of preventable illness Use of medical imaging Community Oncology Alliance 8

9 What is Reported? Survey of patients experiences CAHPS Hospital Survey sent to recently discharged patients Number of Medicare patients Medicare payments Number based on how much Medicare spends on a hospital episode of care compared to the national average Community Oncology Alliance 9

10 Real World Validity? How does the rating system perform for the hospitals that you know? Can it affect hospital responsiveness to physicians? Community Oncology Alliance 10

11 2007 study How do the ratings compare? Compared Hospital Compare Health Grades Leapfrog Group US News and World Report Massachusetts Quality and Cost Community Oncology Alliance 11 Rothberg et al. Health Affairs. 2008;27(6):

12 How do the ratings compare? Ratings of Boston area hospitals For any given diagnosis, the ratings demonstrated little overall agreement Hospitals ranked first or second by one grading system often ranked seventh or eighth by another for certain measures such as mortality rates Community Oncology Alliance 12 Rothberg et al. Health Affairs. 2008;27(6):

13 Is it working? Performance has demonstrated improvement for process-of-care measurements Has this impacted risk adjusted mortality? Examined data from Medicare patients admitted with three publicly reported conditions Heart attack Heart failure Pneumonia Community Oncology Alliance 13 Ryan et al. Health Affairs. 2012; 31(3):

14 Is it working? Risk adjusted mortality improved during the study period ( , HC implemented 2005) Most of the reduction in mortality after introduction of Hospital Compare represented a continuation of preexisting trends with possible exception of heart failure which was modest First study to examine Hospital Compare public reporting on mortality Community Oncology Alliance 14 Ryan et al. Health Affairs. 2012; 31(3):

15 Hospital Inpatient Value Based Purchasing Program ACA mandated pay-for-performance program for hospitals Began October 2012 Bonus size known to be an important factor in the success of pay-for-performance programs New program will have a pool of $850 million for payment incentives in the initial year; double in 2017 Community Oncology Alliance 15

16 Hospital Inpatient Value Based Purchasing Program What will be the likely effect on payments changes to the programs 3000 hospitals? Potential to redistribute reimbursement from poor performers to higher performers Community Oncology Alliance 16 Werner at al. Health Affairs. 2012;31(9):

17 Hospital Inpatient Value Based Purchasing Program Data on hospital performance taken from Hospital Compare database Calculated hospital performance score in 2009 and applied the CMS final rule formula to determine change in Medicare payment Process based quality 70% Patient reported experience 30% Community Oncology Alliance 17 Werner at al. Health Affairs. 2012;31(9):

18 Hospital Inpatient Value Based Observations Purchasing Program Hawaii had the lowest average score New Hampshire had the highest New England hospitals had highest total scores Mountain and Pacific regions had the lowest total scores Community Oncology Alliance 18 Werner at al. Health Affairs. 2012;31(9):

19 Hospital Inpatient Value Based Purchasing Program Medicare payments would decline by greater than 0.5% for 3% of hospitals Mean actual payment change - $125,000 Medicare payments would increase by greater than 0.5% for 2.4% of hospitals Mean actual payment change + $55,000 65% of hospitals would see a payment change between -0.25% and +0.25% Compare this with the 2% sequester cut In the end, Capitol Hill dysfunction trumps performance incentives Community Oncology Alliance 19 Werner at al. Health Affairs. 2012;31(9):

20 Hospital Inpatient Value Based Purchasing Program Who would get a 0.25% or more payment increase? 30% of high margin hospitals 14% of low margin hospitals 21% of hospitals providing low proportion of care to low income patients 12% of hospitals providing high proportion of care to low income patients The rich get richer? Community Oncology Alliance 20 Werner at al. Health Affairs. 2012;31(9):

21 Physician Compare Website Community Oncology Alliance 21

22 Purpose of Database CMS required to create the Physician Compare website Section of the Patient Protection and Affordable Care Act Purpose Allow consumers to make more informed healthcare decisions by providing useful information Incentivize physician to optimize performance Community Oncology Alliance 22

23 The Data Redesigned the Medicare.gov Heathcare Provider Directory into the Physician Compare website The Medicare Provider Enrollment, Chain, and Ownership System (PECOS) is used as the underlying data source Also using Medicare claims data to ensure only active healthcare professionals included on the site and improve the accuracy of group practice affiliations Community Oncology Alliance 23

24 The Data Approximately 932,000 physicians are in the directory Community Oncology Alliance 24

25 Search Functionality Specialty name Physician name Keyword such as condition, body part, or organ system Community Oncology Alliance 25

26 What is on the site now? Physician name, gender, addresses, and phone numbers Accepting new Medicare patients Medical school and clinical training information Languages spoken Hospital Affiliation Affiliation with group practices and other healthcare professionals Accept Medicare Assignment Community Oncology Alliance 26

27 Timeline January 2011 developed the Physician Compare Website (launched December 30, 2010) January 2013 Implement a plan for making physician performance available on the website January 2015 Report to Congress on the website and develop plans to use the data for consumer choice and value based purchasing January 2019 demonstration project for creating financial incentives for Medicare beneficiaries to use high quality physicians Community Oncology Alliance 27

28 Timeline 2013 PQRS (2011, 2012) GPRO (group practice reporting option) erx EHR Incentive Program Participation Board certification status Accepting new Medicare patients Community Oncology Alliance 28

29 Timeline 2014 PQRS Maintenance of Certification Incentive Program 2012 and 2013 PQRS, GPRO, and ACO measures GPRO composite measures Clinician & Group Consumer Assessment of Healthcare Providers and Systems (CG-CAHPS) data for GPRO s and ACO s patient experience data 2013 and 2014 surveys for group practices of 100 or more Community Oncology Alliance 29

30 Timeline 2015 Individual Quality Measures Specialty Society Measures Community Oncology Alliance 30

31 Data CMS is to ensure the data are: Statistically valid and include risk adjustment methodology Accurate portrayal of a physician s performance Community Oncology Alliance 31

32 Personal Experience When I searched for oncology professional within 1 mile of my practice zip code, my partners and I were not on the list of seven providers When I searched within 5 miles, we all were Listed only one of my two hospital affiliations Listed only one of my two office locations Listed as Hematologic Oncologist If errors found, providers encouraged to log into their PECOS account Community Oncology Alliance 32

33 Community Oncology Alliance 33

34 Community Oncology Alliance 34

35 Quality and Resource Use Report (QRUR) ACA, the Secretary of Health and Human Services required to phase in provision of confidential feedback reports to physicians Reports based on clinical data (PQRS) to CMS and Medicare claims data by all providers caring for feefor-service patients Community Oncology Alliance 35

36 Quality and Resource Use Report Phased approach to creating and distributing feedback reports Initial round includes physicians in Iowa, Kansas, Missouri, and Nebraska Community Oncology Alliance 36

37 Quality and Resource Use Report Purpose Enable physicians to compare the quality and cost of your care both within your specialty and all physicians within a region Identify possible components of a payment modifier to provide differential payment amounts based on quality and cost Payment modifier to be phased in beginning in 2015 Community Oncology Alliance 37

38 Quality and Resource Use Report All cost data risk adjusted based on age, gender, Medicaid eligibility, and history of medical conditions PQRS data reported Cost data based on: Medicare Part A institutional claims hospital/skilled nursing care Medicare Part B professional services claims Community Oncology Alliance 38

39 Quality and Resource Use Report Three groups of patients for cost attribution Patients whose care you directed Physician billed 35% or more of all of a patient s outpatient E&M visits Patients whose care you influenced Physician billed fewer than 35% of a patient s outpatient E&M visits but 20% or more of their professional costs (example surgeon or other proceduralist ) Patients to whose you contributed Physician billed fewer than 35% of a patient s outpatient E&M visits and less than 20% of their total medical professional costs Community Oncology Alliance 39

40 Quality and Resource Use Report Based on data from ALL treating physicians Community Oncology Alliance 40

41 Quality and Resource Use Report Based on individual physician reporting of PQRS Community Oncology Alliance 41

42 Quality and Resource Use Report Community Oncology Alliance 42

43 Quality and Resource Use Report Community Oncology Alliance 43

44 Value Based Payment Modifier Fee for service Physician Quality Reporting System Physician Feedback Program Value Based Payment Modifier Community Oncology Alliance 44

45 Value Based Payment Modifier 2008 Medicare Improvements for Patients and Providers Act The secretary shall establish a payment modifier that provides for differential payment to a physician or group of physicians based upon the quality of care furnished compared to cost during a performance period 2010 ACA Expands the requirement for a value modifier Community Oncology Alliance 45

46 Value Based Payment Modifier Apply to specific physicians in 2015 Groups of 100+ eligible professionals Performance period for 2015 VM is 2013 Apply to all physicians in 2017 Modifier based on both quality and cost of care provided Community Oncology Alliance 46

47 Value Based Payment Modifier Measures used for quality teiring PQRS measures selected by the group Three outcome measures All cause readmission Composite of Acute Prevention Quality Indicators Bacterial pneumonia UTI dehydration Composite of Chronic Prevention Quality Indicators COPD CHF Diabetes Community Oncology Alliance 47

48 Value Based Payment Modifier Measures used for quality teiring Total per capita cost both Part A and B Total per capita cost four chronic conditions ü COPD ü CHF ü CAD ü DM Cost measure payment standardized and risk adjusted Community Oncology Alliance 48

49 Value Based Payment Modifier Community Oncology Alliance 49

50 Value Based Payment Modifier Community Oncology Alliance 50

51 Community Oncology Alliance 51