Transcript Task Force on Health Care Access and Reimbursement

Governor’s Task Force on Health Care
Access and Reimbursement
&
MHCC’s efforts to Expand Health Information
Technology Adoption
Rural Health Roundtable
October 2, 2008
Ben Steffen
Center Director
Maryland Health Care Commission
Organization of Presentation
• Task Force on Health Care Access and Reimbursement
– Possible Recommendations
– Impact on Rural Communities and Rural Providers
• State Health Information Technology Initiatives
– Opportunities for Rural Providers
HCAR Mission Develop Recommendations on …
1.
Options to increase physician reimbursements given limitations in
Federal law.
2.
Options available to increase the ability of physicians to negotiate
reimbursement rates with health insurance carriers
3.
The sufficiency of present statutory formulas for the reimbursement of
noncontracting providers.
4.
Do state agencies have sufficient authority to regulate rate-setting and
market–related practices of insurance carriers ( that unreasonably
reducing reimbursements)?
HCAR Mission Develop Recommendations on…
6.
Need to establish a rate–setting system for physicians and other health care
providers.
7.
Advisability of the use of payment method linked to quality of care or
outcomes,
8.
Need to prohibit a health insurance carrier from requiring health care
providers to participate in another carrier’s network.
9.
Should carriers provide incentives for physicians to provide care on evenings
and on weekends.
10. The ability of primary care physicians to be reimbursed for mental health
services performed within their scope of practice.
What are the some of the problems?
1.
Geographic and income-driven access problems, concerns that problems are
worsening.
2.
Federal law limits state policymakers ability to act.
3.
Highly concentrated health insurance market – little prospect for new
entrants.
4.
High costs per user has fueled purchaser and consumer resistance to fee
increases.
5.
Reimbursement systems poorly linked to desired outputs.
6.
Uneven quality and cost efficiency – systems to measure quality and
effectiveness are in their infancy.
Process
October 2007 – August 2008 – gathered information on…
• Insurance market concentration
• Physician workforce and future needs
• Challenges of rural areas and existing programs to address shortages
• Variations in reimbursement rates across specialties
• Alternatives for spawning growth in primary care
• Factors affecting practice formation
October – December 2008
• Task Force develops recommendations
• Public Comment
• Submission of the recommendations to Governor and General Assembly
Options that affect rural communities
• Establish a practice development loan program
– Many communities struggle to attract providers
– Practices are economic resource
• Modify incentives for reimbursing non-participating providers (§19-710.1)
– Raise reimbursement levels for non-participating providers that treat HMO patients
– Set payment floors for PPO payment to non-participating providers in hospital-setting
(where patient can’t choose provider).
• Require the carrier or provider to absorb cost of non-participation
– Limit carriers ability to designate a hospital as a participating provider ,if physicians are
non-participating.
• Allow further experimentation with reimbursement alternatives
–
Develop a demonstration to test the feasibility of a hospital-based physician payment
system.
– Require pay-for-performance systems to be linked to factors in addition to cost efficiency
– Promote greater transparency in design
Options that affect rural communities
(continued)
• Further primary care practice development.
– Leverage Maryland’s leadership in patient-centered medical home development by
participating in demonstrations .
– Encourage rural hospital residency program development .
• Establish a loan program to finance residency program development.
– Require commercial carriers and Medicaid to pay 10 percent bonus in rural geographic
HPSAs as required under Medicare.
• Expand incentives to provide cost effective care.
– Require commercial payers to incentivize providers for after hours care, phone and
eVisit communications delivered at any time of the day or night.
– Establish parity in payments for primary care physicians that provide mental health
services within scope of practice.
• Improve ability to plan for future needs by improving data collection on
physician practices through the Maryland Board of Physicians and MHCC.
The promises of Health IT
•
Fewer adverse drug events, medical errors, and redundant tests and procedures
because EHRs can ensure physicians have access to an accurate and complete
health history.
•
Faster diagnoses and treatment of serious illnesses with comprehensive
information available at the touch of a screen.
•
Timely provision of preventative care and services, such as health screenings,
which can help reduce health care costs.
•
Better communication between patients and physicians, giving patients enhanced
access to timely information.
•
Shorter wait times for patients and lower operating costs for physicians through
improved office efficiency.
Why the Slow Pace?
• Health IT adoption in integrated systems VA, DOD, Kaiser Permanente,
Geisinger, Mayo Clinic.
– Significant internal savings and quality improvements accrue to
organization bearing the expense.
• Non-integrated providers have a more difficult time capturing the benefits
of IT.
– External savings accrue to the system , not the investor .
– Current financial incentives may penalize providers for use.
– Providers and payers feel competitive pressures -- sharing information may allow
competitors to pursue patients.
• Inability to internalize investment is a major factor in slow adoption.
Maryland’s Health Information Technology
Strategy
• Determine roadblocks and identify possible solutions.
• Plan a Consumer-Centered Information Exchange.
• Collaborate with other states and federal gov’t in joint initiatives and
demonstrations.
• Use the planning process and shared knowledge gained through
collaboration to launch health information exchange.
• Need for experimentation is great and other parallel innovations in care
delivery and reimbursement must also occur.
Consumer-Centered Health Information
Exchange – Planning Phase
(Building the Backbone)
• Two multi-stakeholder groups were chosen: the Chesapeake Regional
Information System for our Patients and the Montgomery County Health
Information Exchange Collaborative.
– Both groups received approximately $250,000 to take part in the planning phase funded
through the all-payer rate system
– A final report is due in early 2009 that will address governance, privacy and security,
access policies, strategies to ensure appropriate patient engagement, general
architecture, proposed technology, estimated costs, and a possible sustainable business
model.
– Development phase to follow for an exchange based on principles proven in the
planning period. Development phase will be funded at significantly higher level through
all-payer system.
Collaborate with other states and the federal
gov’t
Centers for Medicare & Medicaid Services – Electronic Health Record
Demonstration Project
• A five-year project designed to show that widespread adoption and use of
EHRs will reduce medical errors and improve quality of care.
– 200 Family Practices, General Practices, Geriatrics and Internal Medicine practices with
20 or less physicians are eligible to participate.
• 100 practices will be assigned to the demonstration and 100 to the control group.
– Practices can receive an incentive payment ranging from $58,000 (per physician) to
$290,000 (per physician practice) over five-year period.
– To participate, practices must have a minimum of 50 “fee for service” Medicare
beneficiaries for which they provide the greatest number of primary care visits. (Primary
source of Care).
– MHCC estimates that approximately 1,200 practices eligible to participate.
Time Frame
• September 2, 2008 Recruitment begins
• November 26, 2008 Last day for applications
• March 2009 Notification to practices of their participation
• May 2009 Local kick off meetings
• June 1, 2009 Demonstration begins
• May 31, 2014 Demonstration ends
Where we need to go
• Better information
– Access to information when it is needed
- Comparative effectiveness research
- Greater transparency
• Improved financial incentives
– Better care, not more care
– Coverage patients vs. differentiated payments for each treatment
• Focus on Health behavior
– Evidence-based behavior and social norms among medical
professionals
– Manage chronic disease
– Emphasize prevention
– Make it easy for people to lead healthy lives
For More Information
• Task Force on Health Care Access and Reimbursement
– http://www.dhmh.state.md.us/hcar/index.html
– Ben Steffen [email protected]
• Electronic Health Record Demonstration Project
– http://mhcc.maryland.gov/electronichealth/cmsdemo/index.html
– [email protected] or by phone to Kathy Francis at
(410)764-5590.