Meeting of the Market Oversight and Transparency Committee February - PowerPoint PPT Presentation

Meeting of the Market Oversight and Transparency Committee February 14, 2018

AGENDA  Call to Order  Committee Chair Appointment  Approval of Minutes  Review of Past Transactions  2017 Health Care Cost Trends Report  2018 Data Submission for the Registration of Provider Organizations  Update on Reporting Out-of-State Transactions  Schedule of Next Meeting (June 13, 2018)

AGENDA  Call to Order  Committee Chair Appointment  Approval of Minutes  Review of Past Transactions  2017 Health Care Cost Trends Report  2018 Data Submission for the Registration of Provider Organizations  Update on Reporting Out-of-State Transactions  Schedule of Next Meeting (June 13, 2018)

AGENDA  Call to Order  Committee Chair Appointment  Approval of Minutes  Review of Past Transactions  2017 Health Care Cost Trends Report  2018 Data Submission for the Registration of Provider Organizations  Update on Reporting Out-of-State Transactions  Schedule of Next Meeting (June 13, 2018)

VOTE: Committee Chair Appointment MOTION: That, pursuant to Article 4.1 of the Commission’s By- Laws, the Market Oversight and Transparency Committee members appoint David Cutler as Chairperson of the Committee. 5

AGENDA  Call to Order  Committee Chair Appointment  Approval of Minutes  Review of Past Transactions  2017 Health Care Cost Trends Report  2018 Data Submission for the Registration of Provider Organizations  Update on Reporting Out-of-State Transactions  Schedule of Next Meeting (June 13, 2018)

VOTE: Approving Minutes MOTION: That the joint Committee hereby approves the minutes of the joint CTMP/CHICI Committee meeting held on December 6, 2017, as presented. 7

AGENDA  Call to Order  Committee Chair Appointment  Approval of Minutes  Review of Past Transactions – Past Beth Israel Deaconess and Lahey Health System Transactions  2017 Health Care Cost Trends Report  2018 Data Submission for the Registration of Provider Organizations  Update on Reporting Out-of-State Transactions  Schedule of Next Meeting (June 13, 2018)

AGENDA  Call to Order  Committee Chair Appointment  Approval of Minutes  Review of Past Transactions – Past Beth Israel Deaconess and Lahey Health System Transactions  2017 Health Care Cost Trends Report  2018 Data Submission for the Registration of Provider Organizations  Update on Reporting Out-of-State Transactions  Schedule of Next Meeting (June 13, 2018)

The HPC has been monitoring a range of performance metrics for providers that have formed new corporate or contracting affiliations. The HPC is monitoring a range of metrics for providers that have new affiliations such as: • Site of care for community-appropriate discharges; • Relative price and composite relative price percentile; • Inpatient net patient service revenue per case mix adjusted discharge; • Inpatient costs per case mix adjusted discharge; • Case mix index; • Occupancy rate; • Payer mix; • Nationally-recognized quality metrics; • Total Medical Expenses for patients residing in the providers’ primary service areas; and • Total Medical Expenses by provider organization. 10

Trends after Recent Beth Israel and Lahey Transactions Today, we are going to preview trends we’ve observed across some of these measures, specifically for hospitals that have joined the Beth Israel and Lahey systems, either as a corporate or contracting affiliate. • Site of care for community-appropriate discharges; • Relative price and composite relative price percentile; • Inpatient net patient service revenue per case mix adjusted discharge; • Inpatient costs per case mix adjusted discharge; • Case mix index; • Occupancy rate; • Payer mix; • Nationally-recognized quality metrics; • Total Medical Expenses for patients residing in the providers’ primary service areas; and • Total Medical Expenses by provider organization. 11

Trends after Recent Beth Israel and Lahey Transactions Beth Israel Lahey Post-Transaction Trends for: Owned Contracting Owned Hospitals Affiliate Hospitals Hospitals Share of local discharges retained Share of local discharges going to higher- priced AMCs Hospital price Patient severity/complexity Internal hospital costs Occupancy Analyses across other measures are also ongoing 12

Statewide, community-appropriate inpatient care is increasingly being provided by teaching hospitals and AMCs. Shares of Community Appropriate Discharges (CADs) at Community Hospitals vs. Teaching Hospitals and AMCs Statewide 66% 64% 62% 60% CADs at 58% Community 56% Hospitals 54% 52% 50% 48% 46% 44% CADs at 42% Teaching 40% Hospitals/AMCs 38% 36% 34% 2009 2010 2011 2012 2013 2014 2015 2016 Few hospitals that were acquired or formed contracting affiliations appear to have reversed this trend. Source: HPC analysis of FY2009-16 CHIA Hospital Discharge Database 13

Statewide, case mix has generally been increasing at both AMCs/teaching hospitals and community hospitals. Statewide Average Case Mix Index CMI at Teaching 1.25 Hospitals/AMCs 1.23 1.21 1.19 1.17 1.15 1.13 1.11 1.09 1.07 1.05 CMI at Community 0.88 Hospitals 0.86 0.84 0.82 0.80 0.78 2010 2011 2012 2013 2014 2015 2016 Source: FY2010-16 CHIA Acute Care Hospital Profiles 14

Lawrence General’s share of local community-appropriate discharges declined faster than the statewide trend after it affiliated with BIDCO. Shares of CADs in Lawrence General PSA 52% 50% 48% 46% Lawrence 44% General Share 42% of CADs 40% 38% 36% 26% 24% 22% 20% 18% All teaching/AMC 16% Share of CADs 14% 12% 10% 2009 2010 2011 2012 2013 2014 2015 2016 Source: HPC analysis of FY2009-16 CHIA Hospital Discharge Database 15

Lawrence General’s share of other local discharges rose leading up to its affiliation with BIDCO and flattened afterwards. Lawrence General Share of Non-CAD Discharges in its PSA 56% 54% 52% 50% 48% 46% 44% 42% 40% 38% 36% 34% 32% 30% 28% 26% 24% 2009 2010 2011 2012 2013 2014 2015 2016 Source: HPC analysis of FY2009-16 CHIA Hospital Discharge Database 16

Lawrence General’s case mix index has increased, particularly in the last year. Lawrence General Case Mix Index 0.88 0.86 0.84 0.82 0.80 0.78 0.76 0.74 0.72 0.70 0.68 0.66 0.64 0.62 0.60 2010 2011 2012 2013 2014 2015 2016 Source: FY2010-16 CHIA Acute Care Hospital Profiles 17

Lawrence General’s occupancy rate has declined somewhat. Lawrence General Hospital Occupancy Rate 70% 68% 66% 64% 62% 60% 58% 56% 54% 52% 50% 48% 46% 44% 42% 40% 2010 2011 2012 2013 2014 2015 2016 Source: FY2010-16 CHIA Acute Care Hospital Profiles 18

Lawrence General’s net patient service revenue per case mix adjusted discharge has been declining in recent years. Lawrence General NPSR/CMAD $12,500 $12,000 $11,500 $11,000 $10,500 $10,000 $9,500 $9,000 $8,500 $8,000 $7,500 2009 2010 2011 2012 2013 2014 2015 2016 Source: FY2009-16 CHIA Acute Care Hospital Profiles 19

Lawrence General’s inpatient costs per case mix adjusted discharge have also declined in recent years. Lawrence General Cost/CMAD $15,000 $14,500 $14,000 $13,500 $13,000 $12,500 $12,000 $11,500 $11,000 $10,500 $10,000 2010 2011 2012 2013 2014 2015 2016 Sources: FY2010-14 CHIA Acute Care Hospital Profiles; data provided by CHIA to the HPC 20

Cambridge Health Alliance’s share of local community-appropriate discharges fell faster than the statewide trend after affiliation with BIDCO. Share of CADs in Cambridge Health Alliance PSA 70% All other 68% teaching/ 66% AMC Share 64% of CADs 62% 60% 58% 56% 54% 26% 24% 22% 20% 18% 16% 14% CHA Share of CADs 12% 10% 2009 2010 2011 2012 2013 2014 2015 2016 Source: HPC analysis of FY2009-16 CHIA Hospital Discharge Database 21

Cambridge Health Alliance’s share of other local discharges decreased slightly after its affiliation with BIDCO. CHA Share of Non-CAD Discharges in its PSA 34% 32% 30% 28% 26% 24% 22% 20% 18% 16% 14% 12% 10% 8% 6% 4% 2% 0% 2009 2010 2011 2012 2013 2014 2015 2016 Source: HPC analysis of FY2009-16 CHIA Hospital Discharge Database 22

Cambridge Health Alliance’s case mix index has been increasing. Cambridge Health Alliance Case Mix Index 0.88 0.86 0.84 0.82 0.80 0.78 0.76 0.74 0.72 0.70 0.68 0.66 0.64 0.62 0.60 2010 2011 2012 2013 2014 2015 2016 Source: FY2010-16 CHIA Acute Care Hospital Profiles 23

Cambridge Health Alliance’s occupancy rate has declined somewhat. Cambridge Health Alliance Occupancy Rate 98% 96% 94% 92% 90% 88% 86% 84% 82% 80% 78% 76% 74% 72% 70% 68% 66% 2010 2011 2012 2013 2014 2015 2016 Source: FY2010-16 CHIA Acute Care Hospital Profiles 24

Cambridge Health Alliance’s net patient service revenue per case mix adjusted discharge recently declined. Cambridge Health Alliance NPSR/CMAD $15,000 $14,500 $14,000 $13,500 $13,000 $12,500 $12,000 $11,500 $11,000 $10,500 $10,000 2009 2010 2011 2012 2013 2014 2015 2016 Source: FY2009-16 CHIA Acute Care Hospital Profiles 25