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PHC4 - “Pay for Performance” Toolkit

PHC4 - “Pay for Performance” Toolkit. Mike Berney Community and Purchaser Relations Manager Pennsylvania Health Care Cost Containment Council ALPHA BENEFITS – Apr. 11, 2007. Who is Mike Berney?. chocolate lover health care guy family and community guy …

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PHC4 - “Pay for Performance” Toolkit

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  1. PHC4 - “Pay for Performance” Toolkit Mike Berney Community and Purchaser Relations Manager Pennsylvania Health Care Cost Containment Council ALPHA BENEFITS – Apr. 11, 2007

  2. Who is Mike Berney? • chocolate lover • health care guy • family and community guy … • “I’m from the state government, and I’m here to help you …”

  3. Today some health care execs and politicians talk about consumer empowerment, responsibility, and transparency

  4. REALLY? Where’s the information on cost and quality coming from??

  5. HOW ABOUTFREEPUBLIC REPORTS

  6. Welcome to PHC4 • Independent state agency established 1986 • 25-Member Board • About 50 employees • $4 million annual budget

  7. PHC4Mission • Improve the quality and restrain the cost of health care • Promote competition in the health care marketplace

  8. Purchasers 6 Business 6 Labor 1 Consumer Insurers 1 Commercial 1 Non-Profit (Blues) 1 HMO Providers 2 Hospitals 2 Physicians 1 Nurse 1 Health Care Quality Improvement Expert State Government Secretary of Health Secretary of Welfare Insurance Commissioner PHC4 – Governing Board

  9. PHC4 data • 4 millioninpatient and outpatient-ambulatory records annually. • All176General Acute Care hospitals

  10. Useful tool: Data is “Severity Adjusted”

  11. What’s severity-adjusted mean? • Accounts for differences in patient risk factors and illness levels. • Hospitals treating a higher percentage of very sick patients or complex cases are not penalized for doing so. • Applies to outcomes data.

  12. PHC4 Toolkit (public reports) • Hospital Performance • Financial Analysis • Heart Bypass (CABG) ** • Hip & Knee ** • Diabetes Hospitalization ** includes surgeon-specific info All are free to the public

  13. Useful Web tools www.phc4.org

  14. PHC4 Web-based tools PHC4 Research Briefs ( examining topics ) PHC4 FYI – purchaser-focused (short topic papers)

  15. PHC4 Free Toolsavailable to the public • Hospital Performance Report Online and hard copies If your employees or colleagues need a hospital procedure … our tools can help

  16. Hospital Performance Report Three regional versions of this tool promote competition in the marketplace

  17. PHC4 Hospital Performance Report • Outcome data for 30 treatment categories • Quarterly online updates for 49 treatment categories

  18. Hospital Performance Report Resource to purchasers, providers, insurers, researchers and the public Compares hospitals to HOW WELL THEY SHOULD PERFORM on cost and QUALITY by treatment and procedure

  19. Hospital Performance Report An employer recently used PHC4 data to review charges at a regional medical center for specific procedures

  20. Data Use The employer studied the PHC4 data and determined that the average charge for a procedure at the medical center soared from $5,403 in 2000 to $18,988 in 2004. HC Purchasers – large and small orgs - used the data in negotiations

  21. Our Free Toolsavailable to the public • Publish hospital outcomes • Publish hospital financials

  22. PHC4’s Financial Analysis GAC Volume One Non-GAC Volume Two

  23. PHC4 Hospital Financial Analysis ‘05 For 176 PA GAC Hospitals for FY 05 Total Charges = $92.5 Billion Total Payments (net patient REVENUES) = $25.9 Billion Hospitals receive about 29 cents on the dollar ( 29 % of billed amount )

  24. It shouldn’t surprise us to see this data: Increase in PA-Licensed Surgery Centers May 1995 May 2005 46177

  25. Heart surgeries • PHC4 data collected since 1996 shows: • # of coronary artery surgeries declined by – 17 % • # of open-heart surgery units increased by + 41 %

  26. Total GAC Hospital Charges

  27. First Of Its Kind Tool Physician-Specific Hip & Knee Report Readmissions due to complications resulted in $35 million in hospital charges & 7,700 additional hospital days.

  28. PHC4 Research Briefs – Examine health care topics relevant to public policy and public interest

  29. PHC4 Research Brief – MRSA in Pennsylvania Hospitals In 2004; there were 13,722 hospitalizations in PA in which the patient had a MRSA infection. That is 7.4 per every 1,000 patients MRSA = Staph Infection

  30. DOES PUBLIC REPORTING WORK? Some say no Some say yes

  31. February 1, 2005 Patrick J. Brennan, head of a panel named by the secretary of Health and Human Services years ago to advise the CDC on infection issues – while not taking a position on mandatory public reporting of infection rates –said:“There is no evidence to support public disclosure as a means to reduce the incidence of these infections.” Letter to the Editor - Marc P. Volavka, Executive Director, PHC4 “Unfortunately, Dr. Brennan was only half right. There is no evidence to support public disclosure because public disclosure of hospital-acquired infection has never occurred.”

  32. ANOTHER RESEARCH BRIEF • HOSPITAL ACQUIRED INFECTIONS

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