News Team Presentation

News Team Presentation

MHA 6000

names here

Amy Teal, Ricardo Noriega, Dakota Martinez

Start

Meet the Cats!

01:00

Warmup

01:00

Warmup 2

01:00

Warmup 3

Patient Safety: Lucian Leape

David W. Bates

Situation: A Healthcare System Vulnerable to Harm

• Preventable harm remains a leading cause of death within hospitals (estimated 160,000 lives lost annually).
• Many institutions continue to lack non-punitivie reporting systems. In addition, also fail to learn from preventable errors.

Background

• Harvard Pediatric Surgeon turned safety pioneer.

• Error in Medicine (1994) reframed harm as a system issue, rather than focusing on individual blame.

• Contributed to Err is Human (1999) reforming safety nationally.

"It's not bad people, it's bad systems."

- Lucian L. Leape, Making Healthcare Safe: The Story of the Patient Safety Movement (2021)

• Founder of the Lucian Leape Institute, for transparency, system designi, and culture.

• Published a 2001 blueprint for quality improvement in patient safety.

Timeline

2025

1994

1973

Death

JAMA (Error in Medicine)

Chair Pediatric Surgery Tufts Med

1999

1986

Institute of Medicine

Epidimiology

Assessment

Why haven't we reached zero harm?

Care Fragmentation - safety is not embedded in leadership nor strategy. Culture - many organizations punish whistleblowing or reporting.

Burnout - Safety relies heavily on humans and stress. Accountability - little regulation forces any systemic change

2x

1 in 20

higher patient mortality in hospitals with weak safety culture.

Patients experience preventable harm (AHRQ 2024).

Recommendation

Leadership Action - Administrators and CEOs should priortize with safety metrics. Patient Involvement - Treating patients as safety partners, rather than recipients. Training - Emphasize safety during undergraudate programs.

01:00

Bonus Question 1

00:15

00:35

00:30

State Efforts To Monitor Outpatient Facility Fees

Julia Burleson, Karen Davenport, Rachel Swindle, Christine H. Monahan

00:45

Situation

• Outpatient facility fees are charges billed by hospital outpatient departments (HOPDs) in addition to professional fees

• These are contributing to rising healthcare costs in the commercial insurance market.

• These fees are often poorly understood by patients and difficult to track in claims data, prompting several states to investigate and regulate their use.

Background

• Facility fees are often charged when care is delivered in hospital-owned outpatient clinics, even for routine services.
• Commercial insurers typically pay significantly more for identical services in hospital-affiliated settings due to these fees and hospital market power.
• These fees can significantly increase patient out-of-pocket costs and are often not clearly disclosed.
• Claims data often lack clarity on where services are delivered and whether facility fees were applied, limiting transparency and accountability.
• The rise in telehealth and hospital acquisitions of physician practices has expanded the use of facility fees.
• States like Connecticut and Maine have enacted laws requiring transparency and data collection on these fees.

00:30

Assessment/Analysis

Connecticut• Since 2015, requires hospitals and health systems to report detailed outpatient facility fee data annually. • These filings are publicly available in the Notifications and Filings database and include trends in facility fee revenue and patient visits. • The state also banned facility fees for telehealth services. • Facility Fee Revenue Increased Significantly for Off- and On-Campus HOPDs • Higher Facility Fees per Visit for Commercial Insurers

Maine• In 2005, Maine enacted a facility fee prohibition for office visits regardless of whether that office is physically located in a hospital facility • Enacted a facility fee transparency law in 2023. • Requires the state’s All-Payer Claims Database (APCD) to publish annual reports on commercial outpatient facility fee payments.

Assessment/Analysis

Colorado• In 2023, Colorado established the hospital facility fee steering committee No restrictions on facility fees for routine services. • Facility fee payments grew 6.5% annually (2017–2022). • The committee was not able to estimate the total cost of care for services delivered due to data restraints

Washington• Beginning in 2012, the state requires annual reporting to the Department of Health • Wide variation in facility fee charges, with some exceeding $6,900 per visit, while others reported maximum charges of less than $200 • Hospitals must report the number of patient visits, outpatient facility fee revenue, and outpatient facility fees. •The Department of Health lacks authority to enforce compliance

00:45

00:45

Recommendations

• Encourage broader adoption of state-level policies requiring upfront disclosure of facility fees to patients.

• Strengthen Enforcement: Ensure compliance with existing prohibitions and transparency laws through audits and penalties.

• Support Cross-State Learning

• Support legislation that mandates data collection and public reporting of facility fee usage.

• Promote federal standards to ensure consistency across states.

• Educate patients and providers about the implications of facility fees to foster informed decision-making.

00:30

00:15

Reforming Medicare Quality Measurement

Joel White Joseph Puthumana Peter Cram Ge Bai

Situation

The shift from fee-for-service to value-based care aimed to collect data, track how doctors perform, and reward high-quality care. However, these well-meaning efforts to improve care have not succeeded.

• Complicated quality industry.
• Bureaucratic amalgamation of health care providers, regulators, and private companies
• This has raised costs, punished disadvantaged groups and their doctors, and increased doctor burnout, all without meaningfully improving patient outcomes.

Background

• Value-based care - 2006 by Michael Porter and Elizabeth Olmsted Teisberg in their book "Redefining Health Care."

• The 2006 Tax Relief and Health Care Act created the Physician Quality Reporting System, which rewarded physicians for reporting on both quality and patient outcomes

• The 2010 Affordable Care Act added “value” to the equation—incorporating concepts of both cost and quality.

Assessment/Analysis

Questionable Incentives And Gamesmanship

• According to a 2024 CMS report, the agency runs 26 quality programs with 492 unique measures.

40%

60%

Outcomes

Surrogate The program’s clinic-BP control rate jumped from 58% → 78%. True Outcome But over 12 months, stroke/MI didn’t change

Heart attack, stroke, or death.

Blood preasure Percent of patients with clinic systolic BP <140 mmHg at their quarterly visit.

Assessment/Analysis

Questionable Incentives And Gamesmanship

• The Hospital Readmissions Reduction Program (HRRP), introduced in Medicare as part of the Affordable Care Act.

• Punish a hospital’s payments if too many patients come back within 30 days.

• Hospitals avoid readmitting patients, even when a readmission is actually the right medical call.

• The program failed to adequately risk-adjust for patient severity
• Programs tend to penalize providers that care for more high-risk patients and reward those serving healthier.

Assessment/Analysis

Compliance Burden

• Medicare merit-based incentive payment system (MIPS)
• Documentation can require as much as 4.5 hours per day

• MIPS measures often lack clinical relevance
• Small, solo, and rural physician practices are penalized at significantly higher rates compared to larger and urban practices.

“just fee-for-service with this extra layer of reporting and accountability that the system is not structured to support,”

Johns Hopkins Hospital spent more than 100,000 person-hours and $5.5 million a year on quality reporting.

Recomendations

• Replace MIPS with meaningful incentives to improve patient outcomes and lower costs. Ideally, this would tie financial incentives to patient outcomes, not reporting.

• Consolidate different elements (HRRP, HACRP, VBPP) into a single pay-for-outcome and lower the cost. This should compare avoidable outcomes to national targets.

• Use measures made by clinicians, for clinicians. Prioritize metrics designed by practicing doctors that actually help clinical care.
• Build on existing physician registries. Tap into clinical quality registries (like those started by ophthalmology and thoracic surgery) that already create practical, up-to-date measures.
• Engage patients: Make doctors tell patients and share the savings by lowering patients’ copays/coinsurance when the program succeeds.

References

• https://www.healthaffairs.org/content/forefront/state-efforts-monitor-outpatient-facility-fees
• https://www.hospitalsafetygrade.org/LivesLost
• https://pubmed.ncbi.nlm.nih.gov/29763131/
• https://www.healthaffairs.org/content/forefront/remembering-lucian-leape
• https://www.healthaffairs.org/content/forefront/reforming-medicare-quality-measurement