green mountain surgery center - vermont...green mountain surgery center amy cooper, manager actd llc...
TRANSCRIPT
GreenMountainSurgeryCenterAmyCooper,ManagerACTDLLC
Rou8neOutpa8entSurgicalCareintherightse*ng,attheright-me,
fortherightprice
GreenMtnSurgeryCenterKeyStats:• ProjectCost:$1.8M
• Loca8on:Colchester(GreaterBurlington)
• Ini8alproceduretypes:GI,Ob/Gyn,PainManagement,GeneralSurgery,Orthopedics
• Size:12,879Q
• Opera8ngRooms:2,ProcedureRooms:4
• NumberofPhysiciansPlanningtoU8lizeGMSC:16Vermont-licensedindependentphysicians(membersofHealthFirst)
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SurgeryCentersprovideasuperiorpa8entexperienceatlowercost
• Smallerenvironmentbasedoutinthecommunity,improvedaccess,shorterwait8mesforpa8ents
• Rou8ne,predictableproceduresandmorespecializednursingstaffensureORs/PRsrunon8me
• ChargesforprocedureswillbeabouthalfofhospitalratesforMedicare/MedicaidandCommercial
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Vermontersdonothavesuitableaccesstohigh-quality,low-costsurgerycenters• 1singlespecialtyEyeSurgeryCenterinSouthBurlington
• VTranks50out50statesinprocedurespercapitadoneinsurgerycenters
• 5,000–6,000surgerycentersna8onwide• 125inNewEngland;23inNewHampshire,17inMaine
• Stateswithpopula8onlessthan1millionhave16ASCseach,onaverage
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GreenMountainSurgeryCenterwillserveallVermonters
1) Financialprojec8onsassume12%MedicaidCasesand2%CharityCarecases
2) Strictnon-discrimina8onlanguageaspartofsubscrip8on/ownershipdocumentsandopera8ngagreement
3) QualityImprovementCommiieewithPeerReviewfunc8onforcaseappropriateness
4) An8cipatedregularrepor8ngtoGMCBonFreeCare/CharityCareandMedicaidamounts
5) ReviewedandmatchedlanguagefromcharitycarepoliciesatlocalhospitalsforGMSC’scharitycarepolicy
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GMSChelpsVermontmeetkeygoalsoftheHealthReformPlan
Thereare14principlesforhealthcarereform(VSA§9371),GMSChelpsVermontachieveitsgoalsforatleast7ofthem:(1)ThestateofVermontmustensureuniversalaccesstoandcoverageforhigh-quality,medicallynecessaryhealthservicesforallVermonters.Systemicbarriers,suchascost,mustnotpreventpeoplefromaccessingnecessaryhealthcare.AllVermontersmustreceiveaffordableandappropriatehealthcareattheappropriate<meintheappropriatese=ng.(2)OverallhealthcarecostsmustbecontainedandgrowthinhealthcarespendinginVermontmustbalancethehealthcareneedsofthepopula8onwiththeabilitytopayforsuchcare.
(5)EveryVermontershouldbeabletochoosehisorherhealthcareproviders.
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GMSChelpsVermontmeetkeygoalsoftheHealthReformPlan
(6)Vermontersshouldbeawareofthecostsofthehealthservicestheyreceive.Costsshouldbetransparentandeasytounderstand.(9)Vermont'shealthdeliverysystemmustseekcon<nuousimprovementofhealthcarequalityandsafetyandofthehealthofthepopula8onandpromotehealthylifestyles.(10)Vermont'shealthcaresystemmustincludemechanismsforcontainingallsystemcostsandelimina8ngunnecessaryexpenditures,includingbyreducingadministra8vecostsandbyreducingcoststhatdonotcontributetoefficient,high-qualityhealthservicesorimprovehealthoutcomes.Effortstoreduceoverallhealthcarecostsshouldiden8fysourcesofexcesscostgrowth.(13)Vermont'shealthcaresystemmustoperateasapartnershipbetweenconsumers,employers,healthcareprofessionals,hospitals,andthestateandfederalgovernment.
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BasisForU8liza8onProjec8ons
8Note:Applica-onatpage28
• Theprojec8onsarebasedonactualhistoricaloutpa8entcasevolumeperformedbythephysicianswhohaveexpressedinterestintheproject;collectedthroughastandardizedsurveyissuedini8allyinsummer2014
• Annualcasegrowthof1%,anes8matetypicallyusedforASCfinancialmodeling
U8liza8onProjec8onsRela8vetoNumberofPRsandORs
• Byyear4,GreenMountainSurgeryCenteres8matestotalvolumeof~6,000cases;~4,000willbeperformedinProcedureRoomsand~2,000inOpera8ngRooms
– Generallyspeaking,GIcasesare“non-invasive”andwillbeperformedinprocedurerooms(Es8mated3,709GIcasesbyYear4)
– Mostoftheproceduresfromtheotherini8alspecial8es(OB/GYN,Ortho,PainMgmt,andGenSurgery)willbeperformedintheOpera8ngRooms,howeveraminorityofthesecaseswillusePRs(Es8mated2,334casesbyYear4)
• ASCBenchmarkingDatafromAvanzaStrategiesandVMGHealth(whichregularlycollectsbenchmarkingdatafromapanelofover200opera8onalASCs),showarangeofapprox.700–1200casesperformedannuallyinORsand900–1400casesperformedannuallyinPRs
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Note:VMGHealthIntellimarkerMul--SpecialtyASCStudies(2012&2016),AvanzaASCOpera-onalBenchmarks(2014)
GMSCPricingPhilosophy• Thepricefortheserviceand“cost”forthepayeror
pa8entshouldbethesame-->1rate
• GMSCdoesnotplantohavea“chargemaster”or“pricelist”
• Wewillseektosimplifysothatactualreimbursementamounts=prices=coststopayersandpa8ents
• Weplantoofferpricetransparencytoolsforpa8entsonourwebsitesopa8entswillknowinadvancehowmuchtheyortheirinsurancewillbebilled
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MedicareOverallCostSavings
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YEAR 1 YEAR 2 YEAR 3 YEAR 4 TOTAL
(4 YEARS) PROJECTED MEDICARE REVENUE $2,221,818 $2,604,440 $2,668,195 $2,736,866 $10,231,319
ADJUSTMENT FACTOR (ASC as % HOPD) 56.00% 56.00% 56.00% 56.00% 56.00%
HOPD REVENUE $3,967,532 $4,650,786 $4,764,634 $4,887,261 $18,270,213
ASC MEDICARE SAVINGS $1,745,714 $2,046,346 $2,096,439 $2,150,395 $8,038,894
Medicarewillsave$2Mperyear
CommercialOverallCostSavings
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YEAR 1 YEAR 2 YEAR 3 YEAR 4 TOTAL
(4 YEARS) PROJECTED COMMERCIAL REVENUE $2,435,229 $2,852,448 $2,925,109 $2,998,647 $11,211,433
ADJUSTMENT FACTOR (ASC as % HOPD) 50.00% 50.00% 50.00% 50.00% 50.00%
HOPD NET REVENUE $4,870,458 $5,704,896 $5,850,218 $5,997,294 $22,422,866
ASC COMMERCIAL SAVINGS $2,435,229 $2,852,448 $2,925,109 $2,998,647 $11,211,433
CommercialPayerswillsave$3Mperyear
MedicaidOverallCostSavings
13Note:*WeassumeMedicarecostra-oof56%forVTMedicaid
YEAR 1 YEAR 2 YEAR 3 YEAR 4 TOTAL
(4 YEARS) PROJECTED MEDICAID REVENUE $566,720 $664,074 $681,023 $697,878 $2,609,695
ADJUSTMENT FACTOR (ASC as % HOPD) 56.00% 56.00% 56.00% 56.00% 56.00%
HOPD REVENUE $1,012,000 $1,185,846 $1,216,113 $1,246,211 $4,660,170
ASC MEDICAID SAVINGS $445,280 $521,772 $535,090 $548,333 $2,050,475
Medicaidwillsave$500Kperyear
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GMSCwillimprovetheQualityofCareonapa8ent&systemwidebasis
• 7na8onalpeer-reviewedstudiesfrom1999-2014showASCshaveequalto(4)orbeier(3)qualityoutcomesthanHOPDs,usingoutcomemarkersofadverseevents,same-dayERadmissions,andcomplica8onsfromsurgery
• Pa8ent-Sa8sfac8onscoresarealsobeierinASCsaccordingtothesamepeer-reviewedliterature,MedPac,andMVPHealthcarepertheirleierofsupport
• Since2012,ASCshavebeenrequiredtoreportqualitymeasurestoMedicareorfacepenal8es,justlikehospitals
– 10measuresincludingburns,falls,andhospitaltransferrate
– ScoresforeachASCarereportedpubliclyonCMSwebsitessince2014
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GMSCisontracktoraisetargeteddebtandequitybyfall2017
• Ini8alEquityRaisedpriortoapplica8on:$240,000
• TotalEquityRaisedtodate:$291,000
– Addi8onalEquityTarget:$841,838fromcurrentandnewinvestors
– Timeline:June–September2017
• Loantobesecuredfromcommercialbankinamountof:$680,000
– Timeline:Summer2017
– Apre-approvalleiersecuredfromonelocalbank;havehadtalkswithtwoaddi8onallocalinterestedlendersoverthepastfewmonths
– LoanwillbesecuredassoonasCONisapproved(pleasenote:interestratesarerising)
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BreakdownofCostsAllocatedforEMR
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• Approximately$200KcapitalizedleaseforEMRcontainedin‘EquipmentLease’lineiteminIncomeStatement
– AmKaiSolu8onsquoteprovidedtotheBoardonJuly15,2016.Costes8mate:$111,000plus$23,000annualmaintenance,subscrip8onandsupport.Components:AmkaiOffice,AmkaiCharts
– $30,000inlaptophardwarealsoin‘EquipmentLease’
• $20KforEMRHardwareProfessionalServicesImplementa8onalsocontainedin‘EquipmentLease’lineiteminIncomeStatement
• $24KforLocalITandEMRSupportincludedin‘ComputerExpenses’onIncomeStatement
• Addi8onalHardware&SoQware,notquoted,butincludedin‘MiscellaneousExpenses’onIncomeStatement
Facili<es/EquipmentCosts: Year1BuildingLease $489,402
EquipmentLeases $638,843TotalFacili8esExpenses $1,128,245
Administra<veExpenses:LegalandAccoun8ng $15,000
Insurance-D&O $40,000Marke8ngandPR $5,000
TelephoneandCommunica8ons $12,000OfficeSuppliesandExpenses $41,054
Transcrip8on $35,922EquipmentMaintenance $10,000
ComputerExpenses $24,000Mgt/BillingFee $584,871
MiscellaneousExpenses $36,000TotalAdministra8veExpenses $803,847
GMSC’sEMRPoliciesandPlansAreConsistentwithVT’sHITPlanPrinciples• GMSChasmadeclearintheApplica8on(p72),andinresponseto
ques8ons,itsinten8ontosubmitdataonsurgicaloutcomestotheVermontProgramforQualityinHealthcare(VPQHC).ThegoalsofVPQHC’sStatewideSurgicalServicesCollabora8vearetoimprovesurgicaloutcomes,enhancepa8entsafetyandreducecosts.
– GMSC’spar8cipa8oninVPQHCwill“(1)supporttheeffec8ve,efficient,statewideuseofelectronichealthinforma8oninpa8entcare,healthcarepolicymaking,clinicalresearch,healthcarefinancing,andcon8nuousqualityimprovements””HITPlanb(1)
• GMSChas12draQpoliciesthatwillbeadoptedtoensurebestprac8ceuseoftheEMR
– Thesepolicieswill“(8)addressissuesrelatedtodataownership,governance,andconfiden8alityandsecurityofpa8entinforma8on”HITPlanb(8)
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GMSCWillHaveExtensiveEMRPoliciesinPlacetoEnsureBestUse
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GMSCEMRPoliciesTableofContents
Note:DraXpoliciessubmiYedtotheboardtoday
GMSC’sPlansConsistentwithVTHITPlan’sfocusonIntegra-on
• Accordingto18VSA9351,theHITPlan“(a)shallincludetheimplementa8onofanintegratedelectronichealthinforma8oninfrastructureforthesharingofelectronichealthinforma8on…”
• AmajorreasontheproposedEMRtobeusedattheGMSC(AmkaiSolu8ons)wasselectedisbecauseintegra8onandinteroperabilityarepartofthevendor’scorephilosophy
– Amkai’sparentcompanySurgicalInforma8onSystemsisamemberoftheCommonWellHealthAlliancewhosemembersrepresenttwo-thirdsoftheacutecareEHRmarket,andmorethanone-thirdoftheambulatorycareEHRmarket.
– CommonWellisanon-profittradeassocia8onwhosemissionis“crea8ngandexecu8ngavendor-neutralpla{ormthatbreaksdownthetechnologicalandprocessbarriersthatcurrentlyinhibiteffec8vehealthdataexchange.Andwearecommiiedtodefiningandpromo8ngana8onalinfrastructurewithcommonstandardsandpolicies.”hip://www.commonwellalliance.org/about/
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HowwillGMSCPar8cipateintheAllPayerModelandACOs?
• GMSCwillnotemployanyphysicians
• GMSCwillnothaveany“aiributedpa8ents”inanyACOprogram.PrimaryCareproviderswithaiributedpa8entsplaythecentralroleinACOsresponsibleformostcarecoordina8onandqualitymeasureperformance
• However,GMSCwillplayanac8verolecollabora8ngwithACOs,sharingdata,andadop8ngbestprac8cecarecoordina8onprotocols
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GMSCWillPar8cipateinACOsasanAffiliatedProviderandPartner
• BoardofACTDhasreviewedproviderpar8cipa8onagreementsofACOscurrentlyopera8nginVermontandintendstosignthem
• Responsibili8esofaffiliatepar8cipantsinclude:
– Datasharing
– Carecoordina8on
– Suppor8ngtheprimarycaremedicalhome
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GMSCWillHelpACOsMeetHealthSpendingTargets
• Reducedpaymentsbyinsurersforthesameamountofoutpa8entprocedures,offeredatthesameorhigherquality,willreduceexpendituresandhelpVermontmeetexpendituretargetsintheAPMAgreementwithCMS
• Timelyaccessandshorterwai8ng8mesduetoASCaddi8onalcapacityandefficiencywillimproveACOQualityPerformanceScores
– Pa8entsa8sfac8onsscores(MSSPMeasureACO-4AccesstoSpecialists)andcolorectalcancerscreeningscores(MSSPACO-19)inthePreven8veCareDomain
• ItisuptotheACOstodecidehowtoreducehospital“globalbudgets”ifsomeoutpa8entprocedurevolumeshiQsoutofthehospitaltotheASC
– ACOswillhavetoadjustglobalbudgetsforchangesinmarketshareamonghospitalsanywaysotheywillhavemechanismsforadjus8nghospitalbudgets
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HowwillGMSCImpactOverallCostsofHealthCareinVermont?
• GMSCwillloweroverallcostsbyprovidingequalqualityservices,atlowercost.Thisisthedefini8onofVALUE
• ThosewhoclaimGMSCwillraiseoverallcostspointtothe‘SacredCows’
Ø ‘SacredCow’:Afirmlyheldmainstreambeliefthatisconsideredtobetruewithoutindependentverifica8on.
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The‘SacredCows’1. ProvidingERServicesisnotprofitableforhospitals
2. Trea8ngMedicaidpa8entsisnotprofitableforhospitals
3. Mosthospitalcostsarefixedcosts
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Recentindependentstudiessuggestthatthetruthcouldbedifferent
1. ProvidingERServicescanbeprofitableforhospitals,especiallypostPa8entProtec8onandAffordableCareAct(ACA)
– EmergencyDepartmentProfitsAreLikelyToCon-nueAsTheAffordableCareActExpandsCoverage(HealthAffairs.2014May;33(5):792–799.)
2. Trea8ngMedicaidpa8entsisprofitableforhospitalswhenalltheextrapublicsubsidiesthathospitalsreceiveareaccountedfor
– ContrarytoPopularBelief,MedicaidAdmissionsAreOXenProfitableBecauseofAddi-onalMedicarePayments(JeffreyStensland,etal,HealthAffairs.2016December)
3. Upwardsof95%ofwhathealthcaremanagersthinkofasfixedcostsareactuallyundertheircontrolandnotreallyfixed
– TheBigIdea:HowtoSolvetheCostCrisisinHealthCare(RobertSKaplan,MichaelEPorter,HarvardBusinessReviewSeptember2011)
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