Transcript Document

The Never Events and Pay for
Performance.
Do These Initiatives Affect the Materials Manager?
Presented by: Amanda Llewellyn, FACHE, FAHRMM
July 17, 2015
1
Healthcare: Startling Statistics
• # of Healthcare Organizations Operating at a loss:
– 53% of Hospitals & Health Organizations Nationally
– Outpatient Volumes: +2.6%, Inpatient Volumes: +1.5%
– Overall Margin -7.6% 1
• Healthcare Supply Spend Accounts for:
– Over 30% of operating budget (supplies)
– Over 45% of operating budget (complete supply chain)
– Projections: 2011 / 2012 supply chain will eclipse labor
spend2
July 17, 2015
2
More Startling Statistics…..
• 40,000 instances of harm in US Healthcare
System annually
– 1 in 20 patients receive wrong medication
– 3.5 million documented infections due to poor
hand hygiene
– 195,000 patients die from medical mistakes
• 2005-2007 Medicare estimated $6.9B spent
on avoidable errors and events
July 17, 2015
3
The Johns Hopkins Story
• Josie King, 19992001
•
July 17, 2015
“Josie’s death,” Sorrell told the
crowd in Hurd Hall, “was the
result of a combination of many
errors, all of which were
avoidable. You are the only
ones who can solve this
problem. The medical
community must be open to the
possibility that shortcomings do
exist, and you must be prepared
to make the necessary
changes.”
http://www.hopkinsmedicine.org/hmn/S04/feature1.cfm
4
July 17, 2015
B
Fa
lls
un
ic
at
io
n
O
th
er
In
ju
ry
ec
or
ds
Incident Type
5
S
us
io
n
D
ru
g
ec
ur
it y
ra
ns
f
lo
od
-T
ur
gi
ca
l
en
t
ep
ar
tu
re
S
qu
ip
m
D
E
(N
ot
As
si
gn
ed
)
U
ne
xp
ec
te
d
N
/A
C
om
m
ns
to
ry
at
io
of
C
ar
e
al
R
si
on
ed
ic
ro
vi
M
P
ed
ic
La
bo
ra
M
Percent of Total Incidents Reported
Maryland State Safety Events
25%
Top 15 Incidents Reported by Volume, Jan 1, 2006 to Mar 16, 2009
20%
15%
10%
5%
0%
Top 15 Incidents Reported by Volume, Cumulative
Total Number of Incidents Reported Jan 1, 2006 to Mar 16, 2009 = 22,351
Incident Type
Count
% of Total Incidents Reported
Harm
No Harm
Don't Know
Ratio Harm/No Harm
Medications
4278
19.14%
258
2843
1177
0.09
1:11
Laboratory
3231
14.46%
206
1945
1080
0.11
1:9
Falls
2733
12.23%
682
1632
419
0.42
1:2
Provision of Care
2471
11.06%
580
1095
796
0.53
1:2
Medical Records
1464
6.55%
45
1125
294
0.04
1:25
Injury
1225
5.48%
954
117
154
8.15
8:1
Other
1056
4.72%
137
309
610
0.44
1:2
Communication
947
4.24%
124
540
283
0.23
1:4
N/A (Not Assigned)
786
3.52%
15
115
656
0.13
1:8
Equipment
728
3.26%
123
445
160
0.28
1:4
Surgical
723
3.23%
163
316
244
0.52
1:2
Unexpected Departure
713
3.19%
29
230
454
0.13
1:8
Blood-Transfusion
619
2.77%
56
406
157
0.14
1:7
Security
596
2.67%
77
397
122
0.19
1:5
Drug
528
2.36%
265
211
52
1.26
1:1
Never Events- Defined
• Never Events
– 27 Events established by the National
Quality Forum (NQF)
•
•
•
•
•
•
July 17, 2015
Surgical Events,
Product / Device Events
Patient Protection
Care Management
Environmental Events
Criminal Events
7
HAC – Hospital Acquired
Conditions
• Section 5001(c) of the Deficit Reduction Act (DRA) of 2005
required the Secretary of the Department of Health and
Human Services to select at least 2 conditions by October 1,
2007 that are:
–High cost, high volume or both;
–Assigned to higher paying DRG when present as a
secondary diagnosis; and
–Could reasonably have been prevented through the
application of evidence-based guidelines
• Further required hospitals to begin reporting on claims for
discharges, beginning October 1, 2007, whether the selected
conditions were present on admission (POA).
July 17, 2015
8
Deficit Reduction Act of 2005, Pub. L. No. 109-171, 120 Stat. 4 (Feb. 8, 2006)
Quality and Payment:
Strategic Cost Savings
• CMS position regarding payment:
That any treatment/care and costs
associated with these “Never Events”
are not deemed to be “Medically
Necessary” and as such, will not be
reimbursed
July 17, 2015
9
Initial CMS HACs
• Initial HACs selected in FY 2008
 Foreign Object Retained After Surgery (NQF Never Event)
 Air Embolism (NQF Never Event)
 Blood Incompatibility (NQF Never Event)
 Stage III & IV Pressure Ulcers (NQF Never Event)
 Falls and Trauma: Fractures; Dislocations; Intracranial Injuries;
Crushing Injuries; Burns; Electric Shock (NQF Never Events
address falls, electric shock, and burns)
 Catheter-Associated Urinary Tract Infection (UTI)
 Vascular Catheter-Associated Infection
 Surgical Site Infection-Mediastinitis after Coronary Artery
Bypass Graft (CABG)
10
Current CMS HACs
• Current HACs for FY 2009
 Surgical site infections following elective procedures
 Legionnaires’ disease
 Glycemic control
 Iatrogenic pneumothorax
 Delirium
 Ventilator associated pneumonia (VAP)
 Deep vein thrombosis (DVT)/Pulmonary Emoblism (PE)
 Staphylococcus aureus septicemia
 Clostridium difficile associated disease (CDAD)
 Methicillin resistant staphylococcus aureus (MRSA)
11
http://www.cms.hhs.gov/HospitalAcqCond/06_HospitalAcquired_Conditions.asp#TopOfPage
Rationale?
• To shift the burden of paying for medical
errors from taxpayers and patients to the care
provider arena in which the error occurred
• To motivate hospitals/healthcare
organizations to accelerate their efforts
toward improving patient safety and
preventing patient harm.
July 17, 2015
12
P4P = Safe + Effective + Quality
Care Delivery (and documentation)
• Current System: Volume Based
– Do more, get more.
– Vulnerable to external forces and
negative reinforcement of poor
delivery.
• Changing System: Quality Based
– Do better, get more.
– Do worse, get less.
– Challenged for resources and
profitability
July 17, 2015
13
So What?
• What is the risk?
– Already losing revenue.
– Is the organization at risk for additional RAC
audits, HAC denials?
– # and % of cases / patients
• What can supply chain do?
– Partner with providers.
– Focus on total patient cost and revenue cycle
rather than acquisition costs.
July 17, 2015
14
“The Genius Checklist”
• 2003 Michigan Study
– 3 mo HAI dropped 2.7 / 1000
to 0
– 1,500 lives saved in first 18
months
– Estimated Savings $183M
– Check list incorporated:
• Full Drape
• Chloraprep
• Long Gown for Providers
http://www.time.com/time/specials/2007/article/0,28804,1733748_1733754_1735344,00.ht
July 17, 2015
15
ml
Supply Chain: Where do we fit?
• “Process is as
important a resource
as labor, supplies
and money”
– Technology &
Equipment
– Supplies & Devices
– Strategic Partnership
July 17, 2015
16
Technology and Equipment
Myth: Quality is expensive and high tech.
• Cutting Edge Technology
Advances:
– Outcome Based
Assessments
– Process Realignment
– Evaluation of Efficiencies &
Quality ROI
– Smart Technologies
– Interfaces (the panacea)
July 17, 2015
17
Supplies & Devices
Research, Research, Research
• Engage Clinicians
– Evidence Based Outcomes
– Peer Review Processes
– Data analysis
• Evaluate the Revenue Cycle
– % reimbursement & DRG
– Documentation requirements
• Best Value not Lowest Cost
– Review entire system
– Not all commodities are equal
• Follow Up
– Track Outcomes and actualized efficiencies
July 17, 2015
18
Strategic Partnership:
Provider, Vendor and Me.
• Provider: Deliver consistent high quality care.
• Vendor: Provide innovative and reliable resources
and solutions to health organizations.
• Me: Provide safe, effective and
quality resources,
support and solutions to clinicians and patients.
Result: Safe, high quality care delivered
at the lowest total cost.
July 17, 2015
19
Amanda Llewellyn, FACHE,
FAHRMM
Asst Administrator
Ambulatory Services and
Clinical Operations
The Johns Hopkins Health
System
[email protected]
July 17, 2015
20