Society of Vascular Ultrasound Annual Meeting

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08/07/2014UF Health Shands

Tim Goldfarb

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Hospital utilization by stateRanked by total acute-care discharges per 1,000 people based on fiscal 2012 data

Rank/StateTotal

discharges

Total discharges per 1,000 population Rank/State

Total discharges

Total discharges per 1,000 population

1 West Virginia 245,897 132.6 27 South Carolina 481,299 100.82 Kentucky 557,232 126.8 28 Iowa 310,477 100.53 Florida 2,358,180 120.6 29 Wisconsin 576,387 100.44 Mississippi 356,168 119.1 30 Kansas 286,191 98.95 South Dakota 99,803 118.1 31 Minnesota 522,143 96.36 Pennsylvania 1,504,073 117.7 32 Arizona 635,576 95.97 North Dakota 84,746 117.2 33 District of Columbia 60,934 94.38 Louisiana 539,078 116.5 34 Montana 91,302 89.99 Missouri 701,974 116.1 35 Nevada 250,458 89.8

10 Maryland 685,775 115.7 36 Virginia 740,664 89.711 Tennessee 746,570 114.9 37 Texas 2,369,605 89.6

Ohio 1,329,709 114.9 38 Georgia 836,408 83.713 Alabama 551,740 114.1 39 Washington 578,158 82.914 Michigan 1,112,050 112.4 40 Oregon 324,811 82.6

New York 2,208,264 112.4 41 New Hampshire 108,558 82.016 Massachusetts 741,886 110.8 42 California 3,121,993 81.417 Indiana 722,764 110 43 New Mexico 169,418 81.218 Arkansas 324,450 109.6 44 Idaho 124,019 76.919 Oklahoma 419,478 108.9 45 Vermont 47,349 75.620 Illinois 1,362,342 105.8 46 Delaware 69,939 75.521 New Jersey 940,702 105.7 47 Colorado 395,664 75.1

Rhode Island 111,130 105.7 48 Wyoming 41,647 71.523 Connecticut 376,802 104.8 49 Utah 206,504 71.224 Maine 135,944 102.3 50 Hawaii 91,791 65.425 North Carolina 999,434 101.5 51 Alaska 43,095 58.626 Nebraska 188,701 101.0

Sources: American Hospital Directory; U.S. Census Bureau

Note: Discharge data are summarized by state for acute-care hospitals (critical-access and short-term acute-care hospitals). Discharges are from all payers. Population figures are estimates from April 1, 2010, to July 1, 2013.

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The Environment

•Public payor rate erosion

•Private payor cost shift to employees and perhaps exchanges

•Utilization rates will fall

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Targets: FFS Payment Utilization Rates

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Public Payors Continue Shift To Risk And Utilization Controls

• Medicare• MS DRG• Medicare Advantage• Two Midnight Rule• Bundling• P4P• ACO• IME reduction or elimination

• Medicaid • MCO• Community Care Organizations• MS DRG• Discounted FFS• Shared Savings

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Private Payor Consolidation

• Most states have 4 to 5 National Payors and a few Regional Payors

• Exchanges• Bundling• P4P• PPO• MCO• Discounted FFS• ACO• Narrow Networks• Shared Savings

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Physician Consolidation

• Hospital employment

• Broad multispecialty

• Disease/Condition specific multispecialty

• Continued Expansion into ancillary services as long as FFS holds and utilization controls are lax

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Hospital Consolidation

• Vertical Integration—retail, PCP, Urgent Care, Satellite ED, ASC, Acute Care, Rehab, LTAC, Home Care, Hospice, Physician Alignment

• Mergers or Affiliation

• Not-for-Profit/For-Profit blending

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Blending of Roles

• Community Care Organizations

• PSN’s

• Direct Contracting

• Blue Zones

• ACO’s

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Patient/Customer Engagement

• Driven by high deductibles and co-payments

• Transparency of pricing and medical information

• Consumerism

• Medical Tourism

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Where is this going?

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Certainties

• Less $ on an inflation adjusted basis

• Lower overall utilization

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How Will This Affect Vascular Sonography

• One Model: Kaiser• Consolidated Imaging from administrative perspective• Radiologists for General Ultrasound• Vascular Surgeons for venous and arterial • MFMs for perinatal• Cardiologists for cardiac related• Dedicated training and certification for Sonographers in sub-

specialty areas• Additional pay for dedicated training and certification

Not a radical change in a model that we appear to be moving towards