NAPA Brief

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Brief 1 2 3 4 5 6 Our Unmatched Experience. Your OR’s Advantage. NAPA Value-Based Purchasing Program The next step aligns the goals of the The incentive pool increases by 0.25% The 2012 federal elections decisively determined that health care hospital and its perioperative services each year until it reaches 2% in Financial reform is here to stay and will continue to be implemented in the department around quality metrics Year 2017, or over $2 billion. The coming months. This in turn calls for hospitals to form an impacting hospital payment as authorized measures are a subset of those collected Accountable Care Perioperative Practice and take five clear under Title III of the Patient Protection under Medicare’s Inpatient Quality steps to ensure maximum performance and superior clinical and Affordable Care Act (PPACA) signed Reporting Program (IQRP) and include into law in 2010. 12 clinical “Process of Care” measures outcomes. The core of that model requires the hospital’s anesthesia Title III. Improving the , which account for 70% of the hospital’s department to work in alignment with hospital administration and Quality and Efficiency of Health Care included a section “Linking Payment to score and eight “Experience of Care” perioperative staff, surgeons, nursing, and ACOs. Quality Outcomes in Medicare,” which led measures that account for the remaining to the creation of Medicare’s Value-Based 30%. For Financial Year 2014, additional Purchasing and Hospital Readmissions measures will be added. With an Accountable Care Perioperative Practice Model in place, Reduction Program. a framework for the Five Steps to Drive Operating Room To develop the scoring methodology, the Alignment, and Steps 1, 2, and 3 defined, hospitals should take The inpatient VBP program, which Centers for Medicare & Medicaid launched on October 1, 2012, provided Services (CMS) used IQRP results from the fourth step to ensure their anesthesia practice is aligned for a reduction of Medicare inpatient 7/1/11-3/31/12 for the baseline period. around their priorities. payment by 1% to fund a national VBP Hospitals are scored on two domains: pool (estimated at $956 million for “Improvement” from their individual STEP 4: PAYER COST/ Financial Year 2013). baseline and “Achievement” based on QUALITY REIMBURSEMENT actual results. The domains are each weighted at 50%. To receive points on Achievement, a hospital must score Perioperative Payer Cost/ ACO/Shared above the VBP threshold which CMS OR Efficiency/ Public Quality Quality Savings Effectiveness Reporting sets at the baseline national median. The Improvement Reimbursement Programs higher the score over the threshold, the more points the hospital receives. A hospital’s Total Performance Score (TPS) Benchmarking Medicare VBP targets, Hospital Readmissions Reduction Program, is calculated by taking the greater of their Inpatient Prospective Payment Systems (IPPS) policies Improvement or Achievement score for each measure. The threshold can Goals Improve process and outcome measures for fee-for-service (FFS) increase each year. CMS also set a payment incentives “benchmark” which is the median of the top decile of hospitals nationally. Reduce readmissions, complications, and length of stay (LOS)

qtl ö= VALUE-BASED PURCHASING qeobb=== | VALUE-BASED PURCHASING MEASURES QUALITY REPORTING, PUBLIC REPORTING, The chart below lists the Surgical Care Improvement Project (SCIP) measures AND VALUE-BASED PURCHASING which account for seven of the 12 process measures and which anesthesia influences or controls. When weighted, these seven account for 41% of a INPATIENT QUALITY REPORTING PROGRAM (IQRP) hospital’s Financial Year 2013 VBP score. IQRP s tarted FY 04 Patient/Surgeon/ Currently 72 inpatient indicators Measures FY 13 Hospital Impact MEDICARE HOSPITAL COMPARE • SCIP Inf-1: Antibiotic received one hour • Inpatient VBP Incentive Web-based repository of IQRP indicators prior to incision • Joint Commission’s Top Performers Compares up to three hospitals at a time • SCIP Inf-2: Antibiotic selection • Medicare’s Inpatient Compare • SCIP Inf-3: Antibiotics discontinued • Thomson Reuters’ 100 Top Hospitals INPATIENT VALUE-BASED PURCHASING within 24 hours • Other Public Reporting or Rankings For FY 13, 12 “process” indicators and 8 “experience” indicators • SCIP Inf-4: Cardiac surgery patients Mortality “outcome” indicators added in FY 14 for three medical diagnoses with controlled 6 a.m. postoperative By FY 17, the inpatient VBP pool will top $2 billion blood glucose • SCIP Card-2: Surgery patients on beta-blocker therapy prior to arrival who received beta-blocker perioperatively Hospital Readmissions Reduction Program • SCIP VTE-1: Surgery patients with A 2003-04 study found one-fifth of Medicare patients were readmitted recommended venous thromboembolism within 30 days at a cost of $17 billion annually. A 2007 study of the (VTE) prophylaxis ordered Medicare Provider Analysis and Review (MEDPAR) data found 17% of • SCIP VTE-2: Surgery patients received readmissions were potentially preventable, at a cost of $7,200 per appropriate VTE prophylaxis within admission. The PPACA authorized the Hospital Readmission Program 24 hours prior to surgery to 24 hours under Section 1886(q). Hospital payments will be reduced up to 1% in after surgery Financial Year (FY) 2013, 2% in FY 14, and 3% in FY 15 for patients readmitted within 30 days of discharge for three diagnoses: , Proposed New Measure Patient/Surgeon/ myocardial infarction, and . CMS is proposing to add additional for FY 15 Hospital Impact measures (COPD, CABG, PTCA, and other vascular events) for FY 15.

• Patient Safety Indicators (PSI) 90: • Inpatient VBP Incentive Composite of 11 PSIs; majority surgical • Medicare’s Inpatient Compare

clro ö= VALUE-BASED PURCHASING cfsb=== | NAPA tracks the SCIP scores of its client hospitals for comparison to the VBP thresholds and statewide peers using The Joint Commission database. NAPA’s results for 2011 show its client hospitals exceed the Medicare VBP threshold on all seven measures and exceed their statewide peers on six of seven measures.

NAPA’S VALUE-BASED PURCHASING RESULTS

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Source: The Joint Commission, All-payer, CY 2011, New York, Pennsylvania, Maryland and New Jersey Hospitals

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About North American Partners in Anesthesia Founded in 1986, North American Partners in Anesthesia (NAPA) is the leading single specialty anesthesia and perioperative management company in the United States. NAPA is comprised of the most respected clinical staff, providing thousands of patients with superior and attentive care. The company is known for partnering with hospitals and other health care facilities across the nation to provide anesthesia services and perioperative leadership that maximize operating room performance, enhance revenue, and demonstrate consistent patient and surgeon satisfaction ratings.

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