Leadership Pulse – January 10, 2014

2014 WSMA and WSHA Joint Legislative Advocacy Priorities

The Washington State Medical Association and the Washington State Hospital Association work together on statewide advocacy efforts that are of paramount importance to physicians and hospitals. As partners in these efforts, these two associations work together on policy and budgetary issues. The issues below are examples of joint priorities for both associations going into 2014.

  • Telehealth – Advocate for legislation to guarantee that if an insurer covers a clinical service on a face-to-face basis, they will also cover the same service if it is provided using video technology; payment levels subject to negotiation.
  • Suspect and Inmate Care – Protect caregivers and other patients by requiring adequate guarding by law enforcement of patients who are suspected or convicted of a violent or sexual crime, unless directed otherwise by the patient’s attending physician.
  • Crisis Standards of Care – Provide liability relief if providers follow state triage requirements in a government-declared major disaster or emergency when adequate health care personnel or supplies are not available, such as an earthquake or H1N1 outbreak.
  • Mental Health Funding – Correct an error in mental health funding tied to Medicaid expansion, secure additional funding for capital and operating costs for new evaluation and treatment centers, and create new pathways for the integration of behavioral and mental health care.
  • Health Care Reform – Defer decision on whether to create a new state operated program (Federal Basic Health) to eliminate almost all premiums for those less than 200 percent of poverty until more information on enrollment is known. The decreased premiums are proposed to come in part through providers accepting Medicaid-like rates.
  • Transparency and All-Payer Claims Database – Support the development of meaningful, accessible data that includes physician- and hospital-friendly policies when implementing a statewide All-Payer Claims Database.
  • Access to Primary Care – Retain funding for primary care support through continuing the Medicare rates increase for Medicaid providers.

If you would like to get involved in supporting these legislative priorities, please contact Katie Kolan, WSMA’s director of legislative and regulatory affairs at kak@wsma.org or Cassie Sauer, Cassie Sauer, WSHA’s senior vice president of advocacy and government affairs at cassies@wsha.org.


WSHA Hospital Engagement Network Selected to Catapult Patient Safety Forward

We are excited to share with you news that the Centers for Medicaid & Medicare Services (CMS) identified the Washington State Hospital Association Hospital Engagement Network (WSHA) as a participant in the Leading Edge Advanced Practice Topics or LEAPT program. WSHA is one of just six Hospital Engagement Networks in the nation selected by CMS for the program.

LEAPT was created by CMS to expand and spread knowledge in several important areas of patient harm. The LEAPT program began September 26, 2013 and will continue until December 8, 2014. This year-long project will provide intensive focus on areas important to our clinicians and patients.

What is Different?

LEAPT builds on the Partnership for Patients initiative. Through this program WSHA will work with groups of five to fifteen hospitals to discover the leading edge practices in 12 focus areas. The strategies will then be shared with hospitals locally and nationally.

  • Severe Sepsis and Septic Shock
  • Clostridium difficile, Including Antibiotic Stewardship
  • CAUTI (house-wide – moving beyond ICU)
  • CLABSI (house-wide – moving beyond ICU)
  • Failure to Rescue
  • Airway Safety
  • Iatrogenic Delirium
  • Undue Exposure to Radiation
  • Obstetrical Safe Delivery Roadmap
  • All Cause Harm Report
  • Readmissions Bundle (Acute Myocardial Infarction, Heart Failure, Pneumonia)
  • Hospital Culture of Safety with Worker Safety

Interest in participation has been very strong. We are pleased to announce that 45 hospitals from across our state, including several multi-state health care systems will participate with us.


Choosing Wisely® Update

The Choosing Wisely Task Force was recently formed as a joint effort between the Washington Health Alliance, WSMA, and WSHA. The 14 Task Force members represent 11 delivery systems and 3 health plans. The group will meet every other month with the purpose of strategizing and promoting the implementation of Choosing Wisely recommendations across Washington State in a collaborative way that minimizes duplicated efforts.

The Task Force held their first meeting on November 25, at which they carefully reviewed and recommended 10 Choosing Wisely recommendation measurement specifications. Special thanks to Premera for providing the starting point for the measurement specifications. The recommendations cover a broad range of topics, including PAP smears; NSAIDS; spirometry; antiobiotics; imaging for back pain, headaches, and adnexal cysts; syncope; appendicitis; and DEXA screening. Watch for the results of this data analysis, which will be published at the county-level statewide in the first quarter of 2014.

If you’d like to confirm who is representing your organization on the Choosing Wisely Task Force, please email Jessica Martinson, WSMA’s director of clinical education and professional development, at Jessica@wsma.org.


New Developments in Health Care Price Transparency 

There is much interest in Washington State in providing more information, especially to purchasers, on cost and quality.  About a dozen other states have done so through the establishment of an All Payer Claims Database (APCD), which captures paid claims data from insurers.  This data allows reports and information to be disseminated based on the contracted price.   We anticipate legislation this session.

The Washington OIC was awarded a $3.4m grant to establish the framework for implementing an APCD for Washington State that builds upon the capabilities of the Washington Health Alliance (previously the Puget Sound Health Alliance). The vision is to develop a community resource of comprehensive health care claims data from multiple sources that informs improvements in the quality and cost of health care in Washington State.

At the end of the Health Care Price Transparency Project, Washington State will have:

  • Introduced legislation, regulatory changes, and/or purchasing leverage required to ensure submittal of medical claims data, including reimbursement amounts, from all payers in Washington State.
  • Qualified the Washington Health Alliance to receive Medicare data.
  • Established the infrastructure needed to receive all medical claims data for the state.
  • Developed some publicly-facing tools that provide consumers and other stakeholders with information on the cost and quality of health care services.
  • Developed a plan for ensuring the sustainability of the All Payer Claims Database in the future.

APCDs are designed to accumulate data from health insurance payers in order to inform users regarding cost containment and quality improvement efforts. Payers can include both private and public payers (e.g. Medicaid, state employee health benefit programs, prescription drug plans, dental insurers, self-insured employer plans).

The databases can contain claims and eligibility data (e.g. medical, pharmaceutical, dental). The data can consist of “service-level” information based on valid claims processed by health payers. Service-level information includes charges and payments, the provider(s) receiving payment, clinical diagnosis and procedure codes, and patient demographics. To mask the identity of patients and ensure privacy, states usually encrypt, aggregate and suppress patient and provider identifiers.

Generally, the data can be used to report cost, use and quality information. APCDs can also be used for various research and policy purposes and consumer and purchaser information.


AMA, WSMA and WSHA General Principles, Operations and Governance of an APCD

AMA model legislation can be used to guide Washington in building and governing its APCD in order to best benefit physicians and patients.

  • State Oversight: If data collection or reporting resides with a private agency, the work should be overseen directly by the state.
  • Governance: Such an agency should have a governing body with adequate representation of all party’s interests and all areas of the state, including physicians.
  • Standardization of data: Approaches to data-standardization is non-uniform in each state. We recognize the benefit of each state harmonizing data collection standards.
  • Accurateness and completeness of data: Health plans must submit all relevant data, regardless of whether the data resides on multiple data platforms, and a process to certify the accurateness of data must be in place.
  • Release of Data/Reporting: Any report at the aggregate level describing health care service variation and utilization and cost patterns must be complete, accurate, statistically valid, methodologically sound, and must be the product of a risk adjustment methodology. Any report must clearly disclose the time frame of the data upon which the report is based. If the data is available at the individual physician level, it’s very important that physicians be able to review their data if it is going to be reported at the individual physician level. Reports should also recognize the variability in treatments and cost driven by acuity of the patient, as well as other factors that may influence a provider’s cost structure or quality measures – such as total treatment patterns that recognize some providers may substitute for expensive treatments or procedures, provider location, patient mix, and amount of charity and government sponsored care.
  • Appealing data: The appeals process and what a physician can do if their data is incorrect must be addressed.
  • Use of data: Non-patient identifiable data should be made easily available to consumers, purchaser, payers, and providers. Data should not be used for the purposes of specifically informing reimbursement and contracting negotiations.


Our Position

WSMA and WSHA support transparency of provider cost and quality as a way to promote efficiency and evidence-based care. The development of transparency tools is an opportunity for quality improvement, cost containment, and better decision making on the part of consumers, payers, purchasers and providers. The development of these tools will benefit from valid data, public oversight and a sustainable payment model. For more information from WSMA, visit the WSMA legislative agenda page. For more information from WSHA, visit www.wsha.org/policyadvocacy.cfm.


Alliance Releases Report on Health Care Cost Variation

The Washington Health Alliance recently released a report that shows variation in aggregate professional and facility costs for 24 select high-volume hospitalizations for reasons such as deliveries, joint replacements, and spine surgery. The report found at least a 240 percent difference in individual case prices across delivery systems and as much as a 780 percent difference.  The data for the report was provided by six health plans and eight self-insured purchasers. To meet concerns about anticompetitive behavior, the Alliance has only made the full report available to purchasers and plans, however, a summary is available online.


Upcoming Events

January 15 WSHA 2014 Legislative Session Preview Webcast
January 18 ER/LA Opioid REMS: Achieving Safe Use While Improving Patient Care
February 10 2014 WSMA Legislative Summit
February 28
Health Care Data: Business Intelligence and Predictive Analytics for Physician Practices
March 7 to May 10
WSMA & UW Physician Leadership Course
March 31
CMO Safe Table Learning Collaborative (More details soon!)
May 16-17
Annual WSMA Leadership Development Conference
May 30 to April 1
WSHA Patient Safety CEO & Trustee Summit