Presentation is loading. Please wait.

Presentation is loading. Please wait.

Health Care Reform: Potential Implications for Transplantation Edward Y. Zavala, M.B.A. Administrator, Vanderbilt Transplant Center Vanderbilt University.

Similar presentations


Presentation on theme: "Health Care Reform: Potential Implications for Transplantation Edward Y. Zavala, M.B.A. Administrator, Vanderbilt Transplant Center Vanderbilt University."— Presentation transcript:

1 Health Care Reform: Potential Implications for Transplantation Edward Y. Zavala, M.B.A. Administrator, Vanderbilt Transplant Center Vanderbilt University Medical Center Adjunct Professor of Management Vanderbilt Owen Graduate School of Management Research Assistant Professor Department of Surgery Vanderbilt University Nashville, Tennessee

2 What Does the Health Care Reform Bill Attempt to Accomplish? Cost Health care is currently around 17.5% of our GDP and forecast to grow to 25% by 2025 Rate of growth in health care costs has outstripped other goods and services most every year for the past 25 years Access About 45 – 47 million uninsured –11 million have income below the Federal Poverty Line (FPL) –12 million have incomes in excess of 300% of the FPL ($66,000) –5 million have incomes in excess of 500% of the FPL ( $110,000) –10 million are not US citizens –25% are eligible for Medicaid but have not signed up Quality Variability in utilization without demonstration of improved outcomes

3 Coverage Provisions Health Care Reform Implementation 201020112012 2013201420152016201720182019 COVERAGE PROVISIONS Insurance Reforms (Pre-existing conditions for children, no annual or lifetime limits, children on parents insurance until 26) Medicaid Expansion Insurance Reforms (Pre-existing conditions for adults, premium limits) Individual Mandate

4 Private Insurance Reform Improved access to transplant evaluation and listing Reduced risk of non- adherence from loss of drug coverage Negatives for Transplant Stronger “in-network” provisions may limit access to some transplant centers Elimination of high cost, high choice plans Longer waits without increase in organ supply Positives for Transplant

5 Medicaid Program Positives for Transplant Improved “access” to transplant Coverage for uninsured patients in the post transplant period Reduced organ loss to medication non-adherence Negatives for Transplant Expansion in patients with inadequate coverage Medicaid payments often do not cover organ acquisition costs

6 Payment Constraint and Quality Provisions Health Care Reform Implementation 20102011201220132014201520162017 20182019 COVERAGE PROVISIONS Insurance Reforms (Pre-existing conditions for children, no annual or lifetime limits, children on parents insurance until 26) Medicaid Expansion Insurance Reforms (Pre-existing conditions for adults, premium limits) Individual Mandate PAYMENT CONSTRAINT PROVISIONS CMS Hospital Behavioral Offset Relating to IPPS Hospital Market Basket Reduction Hospital Productivity Adjustments Independent Payment advisory Board Medical Device Tax Medicare DSH Payment Reduction Medicaid DSH Payment Reduction QUALITY PROVISIONS RULE MAKING  Hospital Value-Based Purchasing RULE MAKING  Hospital Readmission Payment Reductions RULE MAKING  Hospital-Acquired Conditions Penalties

7 Medicare Positives for Transplant Better drug coverage through reduction in the donut hole Shift to episode of care reimbursement which is already familiar in transplantation Development of comparative effectiveness research Negatives for Transplant Reimbursement reductions for professional services by independent medical board Reduction in disproportionate share payments Penalties for re-admissions and hospital acquired infections

8 Modeled Medicare Payment Components of Reimbursement for Typical Teaching Hospital 2.9736DRG weight =5.06154.27524.756910.13589.454311.754024.8548

9 Delivery System Provisions Health Care Reform Implementation 2010201120122013201420152016201720182019 COVERAGE PROVISIONS Insurance Reforms (Pre-existing conditions for children, no annual or lifetime limits, children on parents insurance until 26) Medicaid Expansion Insurance Reforms (Pre-existing conditions for adults, premium limits) Individual Mandate PAYMENT CONSTRAINT PROVISIONS CMS Hospital Behavioral Offset Relating to IPPS Hospital Market Basket Reduction Hospital Productivity Adjustments Independent Payment advisory Board Medical Device Tax Medicare DSH Payment Reduction Medicaid DSH Payment Reduction QUALITY PROVISIONS RULE MAKING  Hospital Value-Based Purchasing RULE MAKING  Hospital Readmission Payment Reductions RULE MAKING  Hospital-Acquired Conditions Penalties DELIVERY SYSTEM PROVISIONS  Accountable Care Organizations RULE MAKINGBundled Payments Pilot

10 Transplant Impact Health Care Reform Implementation 2010201120122013201420152016201720182019 COVERAGE PROVISIONS Favorable PAYMENT CONSTRAINT PROVISIONS Unfavorable QUALITY PROVISIONS Within Our Control DELIVERY SYSTEM PROVISIONS To Be Determined – Value-Based Pricing and ACOs

11 Strategic Readiness Economic Repositioning Retreat Identify Opportunities for Cost Reduction Identify Opportunities for Revenue Optimization Establish Subcommittees Monitor Results

12 Strategic Readiness - continued Economic Repositioning Costs/Inpatient Admission Inpatient Pharmacy Costs

13 Transplant Cost Review Phase 3 Transplant Procedure Cost

14 Strategic Readiness - continued Economic Repositioning Medicare Cost Report Optimization Managed Care Contracts

15 Strategic Readiness - continued Economic Repositioning Optimize Living Donor Processes to Increase Transplantation Safely –Web-Based Living Donor Application Process

16 Web-Based Living Donor Application Access Through VTC Website Goal: Screen Candidates More Efficiently

17 Results First 5 calendar year quarters post implementation:  1200 donor self referrals  801 (67%) web-based referrals  399 (33%) phone referrals

18 Results

19 Web-Based Application A conservative estimate of living donor administrative staff time saved with the implementation of the web application is 160 hours for the 801 candidates screened by the web-based application.

20 Documenting Value and Quality Quality of Life Patient Satisfaction

21 Health-Related Quality of Life and Patient Satisfaction Program Vanderbilt Transplant Center Launched January, 2002 > 9,500 transplant candidates and recipients > 4,000 longitudinal, multi-survey data points Patient-reported outcomes HRQOL and satisfaction as a quality measure Research Contact: Irene Feurer, Ph.D. irene.feurer@vanderbilt.edu

22 HRQOL Survey Battery and Assessment Schedule (effective January, 2002) Listed Transplant

23 Physical and Mental HRQOL at Post-Transplant Year 1 A Patient-Reported Quality Benchmark Dashed lines indicate targeted threshold

24 Mean = 34±5 Median = 36 25 th %ile = 31 Validated Transplant-Specific Patient Satisfaction Inventory Feurer et al. Progress in Transplantation. 2007;17:121-128. Determining the minimum target threshold for the 13-item summary score

25 Distribution of Satisfaction Scores by Year in relation to the minimum target threshold (31)

26 Examples of Item-Level Analysis of Satisfaction Survey Data

27 Spend Time on Staff Development, Retention and Internships Develop Opportunities for Education Develop Opportunities for Research Projects Support Staff Involvement in UNOS, NATCO, ITNS, AST, ASTS, ISHLT, ATA, TFCA Send Staff to Transplant Meetings Graduate Student Internships – MBA, MHA, MPH, etc.

28 Spend Time Planning and Thinking Strategic Planning Business Planning Communication Continuous Improvement and Re-enginneering of Systems and Processes

29 Questions


Download ppt "Health Care Reform: Potential Implications for Transplantation Edward Y. Zavala, M.B.A. Administrator, Vanderbilt Transplant Center Vanderbilt University."

Similar presentations


Ads by Google