NONE NONE Peter Gloviczki, MD Peter Gloviczki, MD Robert Zwolak, - PowerPoint PPT Presentation

Conflict of Interest Conflict of Interest What is Vascular Surgery What is Vascular Surgery Worth to a Health Care Worth to a Health Care System? System? NONE NONE Peter Gloviczki, MD Peter Gloviczki, MD Robert Zwolak, MD Robert Zwolak, MD Sean Roddy, MD Sean Roddy, MD Mayo Clinic, Rochester, MN, Mayo Clinic, Rochester, MN, Dartmouth-Hitchcock Medical Center, Lebanon, NH, Dartmouth-Hitchcock Medical Center, Lebanon, NH, Albany Medical Center Hospital, Albany, NY Albany Medical Center Hospital, Albany, NY Average Health Care Spending per Average Health Care Spending per Patient Protection and Affordable Patient Protection and Affordable Capita 1980 - 2009 Capita 1980 - 2009 Care Act (PPACA) Care Act (PPACA) • US federal statute signed into law in 2010, • US federal statute signed into law in 2010, upheld June 28, 2012 by the Supreme Court upheld June 28, 2012 by the Supreme Court • Aims to improve healthcare outcomes and • Aims to improve healthcare outcomes and streamline the delivery of health care streamline the delivery of health care • Reduces health care costs • Reduces health care costs • Increases rate of health insurance coverage • Increases rate of health insurance coverage • Decrease insurance premiums • Decrease insurance premiums • Instead of fee for service (volume based) • Instead of fee for service (volume based) providers will receive global payments for providers will receive global payments for taking care of people over time taking care of people over time 1

Affordable Care Act Affordable Care Act Increased taxes Increased taxes The Effects on Vascular Surgeons The Effects on Vascular Surgeons • Increased taxes • Increased taxes • Medicare payroll tax increased 0.9% • Medicare payroll tax increased 0.9% • Physician Quality • Physician Quality Reporting System (PQRS) Reporting System (PQRS) for individuals with an annual income for individuals with an annual income • Misvalued Code Provision • Misvalued Code Provision > $200,000 and for families with an > $200,000 and for families with an • Multiple procedure • Multiple procedure annual income > $250,000. annual income > $250,000. payment reduction payment reduction • Equipment utilization rate • Equipment utilization rate • Investment income tax increased by • Investment income tax increased by • Independent payment • Independent payment 3.8%. 3.8%. advisory board advisory board • Other factors affecting • Other factors affecting physician pay physician pay Quality Measures Quality Measures PQRS Medicare Services PQRS Medicare Services Payment Schedule for physician Payment Schedule for physician for Vascular Surgeons for Vascular Surgeons reported quality measures reported quality measures • • Provider participation in approved clinical data registries Provider participation in approved clinical data registries • Prevention of catheter-related bloodstream infections • Prevention of catheter-related bloodstream infections • Electronic prescribing • Electronic prescribing • Use of electronic health records • Use of electronic health records 2011 Additional 1% 2012 Additional 0.5% • Documentation of current medications in the medical record • Documentation of current medications in the medical record 2013 Additional 0.5% • Pain assessment and follow-up • Pain assessment and follow-up 2014 Additional 0.5% • Exposure times reported for fluoroscopic procedures • Exposure times reported for fluoroscopic procedures 2015 Decrease of 1.5% • Documentation of specific methods for reporting carotid • Documentation of specific methods for reporting carotid 2016 Decrease of 2% stenosis stenosis 2

Quality Measures Quality Measures MISVALUED CODE PROVISION MISVALUED CODE PROVISION for Vascular Surgeons for Vascular Surgeons • Most endovascular and interventional • Most endovascular and interventional radiology/cardiology CPT codes have radiology/cardiology CPT codes have • Use of aspirin or other antithrombotic • Use of aspirin or other antithrombotic been identified as being potentially been identified as being potentially • Medications in patients with PAD • Medications in patients with PAD misvalued misvalued • Screening and cessation intervention for tobacco use • Screening and cessation intervention for tobacco use • Changing, bundling and revaluation of • Changing, bundling and revaluation of • Chronic wound care measures • Chronic wound care measures these codes is underway these codes is underway • Surveillance after EVAR • Surveillance after EVAR • Reduced valuations for endovascular • Reduced valuations for endovascular • Lipid control in patients with PAD • Lipid control in patients with PAD services services • Appropriate follow-up of biopsy results by the performing • Appropriate follow-up of biopsy results by the performing • Redistribution of $2.5 billion within the • Redistribution of $2.5 billion within the physician physician Medicare Physician Payment Schedule Medicare Physician Payment Schedule • Screening for hypertension with documented follow-up • Screening for hypertension with documented follow-up between 2009 and 2013 between 2009 and 2013 MULTIPLE PROCEDURE MULTIPLE PROCEDURE INDEPENDENT PAYMENT INDEPENDENT PAYMENT PAYMENT REDUCTION (MPPR) PAYMENT REDUCTION (MPPR) ADVISORY BOARD ADVISORY BOARD • Limits overpayment for duplication of portions of • Limits overpayment for duplication of portions of • Maintains Medicare spending below a cap by • Maintains Medicare spending below a cap by the services the services restricting payments to physicians and hospitals restricting payments to physicians and hospitals • Started with the technical component (TC) of • Started with the technical component (TC) of • Can decrease physician payments • Can decrease physician payments diagnostic cardiovascular imaging, now includes diagnostic cardiovascular imaging, now includes • 15-member panel of unelected federal employees • 15-member panel of unelected federal employees the professional fee for certain procedures the professional fee for certain procedures with a minority of health care providers with a minority of health care providers • a 25% MPPR will apply when one or more • a 25% MPPR will apply when one or more • Will act when spending outpaces GDP per capita • Will act when spending outpaces GDP per capita physicians with the same National Provider physicians with the same National Provider plus 1%, similar to the Medicare Sustainable plus 1%, similar to the Medicare Sustainable Identity (same practice) interpret multiple Identity (same practice) interpret multiple Growth Rate (SGR) (that has been shown to be Growth Rate (SGR) (that has been shown to be procedures for a patient on the same day procedures for a patient on the same day flawed) flawed) • By January 15 of each year a plan is proposed to • By January 15 of each year a plan is proposed to achieve Medicare savings targets in the following achieve Medicare savings targets in the following year year 3

Focus on Primary Care Focus on Primary Care Sequestration Sequestration Balanced Budget Act 2011 Balanced Budget Act 2011 • Health care costs reduced by • Health care costs reduced by enhancing preventive care enhancing preventive care Super Committee Super Committee • Funding shifted to primary care • Funding shifted to primary care medicine from specialty medicine, medicine from specialty medicine, Sequestration of 2.1 trillion (for 10 years) Sequestration of 2.1 trillion (for 10 years) including endovascular interventions including endovascular interventions 400 billion in health care costs 400 billion in health care costs • This shift affects specialist training • This shift affects specialist training (123 billion in Medicare costs) (123 billion in Medicare costs) and physician payments and physician payments 2% cut for Medicare physician payment (March 1, 2013) 2% cut for Medicare physician payment (March 1, 2013) “Doc fix” “Doc fix” International Coding of Disease (ICD) International Coding of Disease (ICD) Revision-10 Revision-10 • Planned 26.5% Medicare physician • Planned 26.5% Medicare physician • Implemented on October 1, 2014 • Implemented on October 1, 2014 payment cut (30 billion) delayed until payment cut (30 billion) delayed until • Codes for diagnosis and inpatient • Codes for diagnosis and inpatient January 1, 2014 January 1, 2014 procedures procedures • RVU Conversion factor unchanged • RVU Conversion factor unchanged ($34) ($34) • Research fund is less • Research fund is less • Additional provider cuts • Additional provider cuts 4