1. Hospital Association of Rhode Island

2. Heart Attack or Chest Pain Heart FailurePneumonia Surgical Care Improvement ScoreRankScoreRankScoreRankScoreRank United States98.2%95.9%95.7%97.4% Connecticut98.2%3094.9%3195.0%3496.9%42 Maine98.7%797.4%297.1%297.9%4 Massachusetts98.8%397.0%796.0%1697.8%10 New Hampshire99.0%197.1%596.8%497.8%11 Rhode Island98.7%993.8%4093.5%4696.9%41 Vermont98.9%295.4%2596.7%898.0%2

3. StateComposite ScoreState Rank United States70.6% Connecticut68.4%43 Maine74.5%3 Massachusetts70.5%29 New Hampshire73.0%12 Rhode Island69.7%33 Vermont71.8%22

4. Since 2005, hospitals report data on quality No submission = reduced update factor ACA-mandated implementation of VBP Link payment to quality CMS releases VBP final rule Begins FFY 2013 Utilizes quality data from the Inpatient Quality Reporting Program Funding Across the board reduction 1% in FFY 2013, increasing by 0.25% each year until 2% in FFY 2017 and subsequent years

5. 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$855,139,10548.93%100%$855,139,105$0 Connecticut$13,068,00339.99%81.36%$10,632,347($2,435,656) Maine$4,083,93551.73%109.80%$4,484,329$400,394 Massachusetts$26,560,76051.67%106.26%$28,222,143$1,661,383 New Hampshire$4,008,75751.86%104.35%$4,183,111$174,354 Rhode Island$2,933,61544.87%95.72%$2,808,139($125,476) Vermont$1,313,03543.68%89.71%$1,177,878($135,157)

6.  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 RateRankRateRankRateRankRateRankRateRankRateRankRateRankRateRankRateRank Connecticut0.116350.0001 10.091190.49680.437410.417370.067421.62331 Maine0.176460.00010.010470.167440.679380.272160.491430.031131.82645 Massachusetts0.122380.004360.002410.06590.48870.273170.23370.063361.2504 New Hampshire0.00010.014490.00010.082130.775470.530460.625480.095482.12050 Rhode Island0.0001 10.016490.113260.549170.533470.307200.129491.64833 Vermont0.225480.0001 10.071120.740440.14110.423380.141501.74040

7.  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

8. Impact Area2013 Ten-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

10. 19972010 Rhode Island14.8%-8.3% Massachusetts16.1%-4.2% Maine-3.1%-9.2% New Hampshire4.0%-12.6% Vermont4.0%-9.1% Connecticut9.7%-1.8% United States10.9%-4.0%

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

13. 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.

14. 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