Tom Lloyd: We’re doing a bunch of stuff right now, actually.

Speaker 1: We’ve got really sort of two long term goals. The two goals that we're really focusing on the all the work to get us there. One was to make sure, and this is the stuff that that the governor can go out and sell, but that was to provide meaningful information to the citizens of Florida to help them make informed health care choices.

And the other was make sure that we have the specific quality outcome measures for each individual healthcare provider that work within hospitals, physicians, laboratories, medical imaging facilities, ambulatory surgery centers, hospice, rehab, mental health facilities, home health, assisted living. This is for any other health care provider that is out there making sure that we had publicly reported specific outcome data for all of those various groups to facilitate the citizens of Florida being able to make those healthy decisions.

We’ve also thrown in there making sure that we had preventative health information on the website, which clearly the group has taken cared of for us. Some sort of overriding principles sort of go through. All the things we’re going to do is making sure that,  as we come up with each of this particular outcome sets, data sets is there's... as we saw it nicely on the website it wil be presented in general data.

But as researchers and other folks got into it, having the ability to really drill it down to specific things and be able to mine the data a little bit more carefully and a little more in depth .And then the other was making sure that we stay consistent and we're comparable to what are other national standards that are out there. CMS is putting up new ends tomorrow we need to see what those 17 things are.

JC is always giving up with a new thing that unfortunately it doesn't always jive with NQF and jive with CMS. But being mindful of the various, federal and national organizations that are out there. And hopefully we'll be far out and ahead that made you look up and follow us as opposed to making us change our course.

For our short term goals, what we wanted to do is make is make sure that on the things that we’re currently reporting that we really prove our data element collection will carefully what additional data we may need to collect for final specific topics we talked about this morning having eight to ten specific things we’re going to be looking at, and then be able to go back and say "are there additional data elements, maybe we need to collect."

Some of the things on that actual outcomes of how the procedures came out and how the patients are doing and then we will have to throw in there, this is where it may take some rule changes, a little bit of money for education potentially some changes within the IT realm to catch up with.

We have to get back and educate the abstracters who are out there, whoever is gathering the data at the hospital level to make sure that they know what the data is that we need them to collect and that stuff instead of talking about creating an online educational packet where all of those abstract since not all of them hospital based. Some of them have been outsourced, and that person may be doing it from their living room for all we know. That they can go online, get that educational process through our website or some other website if we’ve selected a vendor to do that so they can get the education that they need to get the data to us as quickly as we can.

The other things that we’d like to get up in this first year are any admissions that are coming in following somebody that had an ambulatory surgical procedure. Right now we don’t track that real well but the data is there, though we can look and see if a person had an ambulatory surgical procedure done today.

They end up being admitted to an acute any care facility tomorrow, being able to track and report that particular data as well as the other outcomes that we’d like to see from the annual toward surgical centers. We've got the data already where we can look at the procedural physician outcomes. We know what surgeon did, what particular procedure and being able to go through and refine that and make sure that that is clean and appropriately reported.

For those physicians that are not procedurally oriented, the other is we are talking is the intensives, the hospitals. Hospital based physicians may be managed more in the group-type setting where there’s a little bit harder to identify the specific physician that was involved to that particular episode of care. That must be taking a little bit more working. It’s not one that we would be able to really comfortably say we can get down that on that first year.

In the second year,the second through the fifth year which is really more on the long term goals. One of the big things that we really think we needed to focus on is trying to reduce the time from when the care is rendered and when the reports are on website. Because right now you are looking at any more conservative 9-12 month leg, between the time the care is actually delivered in the patient to one of the show up on websites as we look at it.

And there are lots of things that will change in that 12-month period of time. Hospital may have said, "We’ve identified this as an issue. We know its a problem." And they’ve already got it corrected or at least a good corrective action plan is in place and operational before the day it even hits the website. So about the time that you got the website, somebody looks at it and says, "Gee, you’ve got a 12% infection rate now in all your CABGs," and  they’ve already dropped to 2%.

Its not terribly useful and its not really accurate data for the consumer to make the decision. So we’re going to try and shorten that doubt. Obviously to do that, going with our AHCA participants on that, Beth may have felt that there may be need to be some rule changes that are done. Clearly it’s potentially requires some IT changes maybe a little but additional budgetary stuff thrown in there as well. And I’m so sure to find out some other changes its been in the next cycle.

Other data that we want to get out as quickly as we could is the age gaps data, the patients satisfaction data from the various hospitals , the their physicians. It wasn’t clear, if some of us want to complete legislated action or purely a change of rule or some rule revisions to get that done.

The next group we would like to bring up is going to be those hospital-based physicians. We know who the docs, we know that various physicians are involved in the inpatient care homes on medical side not procedural side. But this is where we need to work with the facilities; work with the various physician groups for them to identify here the tenth positions with in the hospital group.

You have five physicians that within the Intensive Care group so that we can generate data that is specific to a hospitals group that is providing services that particular facility. I will need to develop the details on that.

We also would them like to include quality outcome data and other data from the various laboratory facilities and deciding what those outcomes are going to be. This could be the turn around from the time they actually draw the sample from the laboratory result is available and I have the facts put on the website, whatever for the physician to access.

And the same with various medical imaging facilities that were out there. Again, those are ones where there was discussions, is that going to reflects what's legislative action and that again is when what lab getting grounded in the agency or to purely a revision of a rule. There will certainly be some IT requirement so that which always potentially have some financial downsides as well.

As we move towards all to being able to have made up on all the physicians and their individual practices especially those who are in the ambulatory side.

 Right now we don’t have a good source for that. In order to give that data , since fewer and fewer physicians actually practicing in a hospital setting more who were not to refrain to hospitals to be admitted  in order for them , in order for the consumer to say, "Gee, this is a good family practitioner who’s a good internist, pediatrician of years."

We’ve got to be able to use the information from their practices, how they practice. The only way that the we could come up with to really do that is that we’ve got to go to the various payers and say, "Can we get the data that you currently got ?" Obviously we can get some of the information from the medicated which I understand you’re only a floor apart but it maybe the Grand Canyon that is currently part of that floor that you need to be able to get that data from medicated and make sure the data that we get is usable.

Another thing was pointed out by our members from the health plan groups, is that the data from the self-funded health plans currently is not required to be reported. They go back to do it voluntarily or if you can find some other way to urge them to do that. Then my understanding that maybe more of a federal issue as opposed to a state legislative issue so that may take even more wrestling with it.

But if you we can go to the 'publics', the 'Disneys', the other large employers work within the second look. If we can get this data out there, makes it a lot easier to for your employees to say, "That’s the document that I want to use , which is already on my plan." That’s a good thing.

So what we would like to do is a really big project for the third year is to try and get that sort of being from the papers. And then which will clearly take legislative action, rule and regulations you to go along in that bunch of  legislated work done or take initial IT infrastructure to manage that.

It was also a lot of, that probably is going to be one the largest goal for the third years we present is going to really be the cornerstone for our ability to get down to the individual practitioner out in this office and that's what the consumers really going to be looking at as they’re primary are placed to health care.

 But what we would like to do is make sure that we are consistent again across the board nationally with these various definitions, reportings, whether it's kept or whether bloodstream infections and associated pnemonias, surgical site infections, whatever. As NQF and other groups are working on this, we too will be a part of that central and some of the infections controlled practitioners were in our group and have that expertise is that’s probably a two to-three window to get all of that data very clean , very consistent with the other national organization out there.

So that’s out third year plan. In the fourth year we wanted to add in or we have facilities now healthcare facilities , hospice nursing homes , assisted living facilities and virtually all the other groups that currently work providing data and information .

Some of that information they already exist , we just need to find out if its in the box residing in some other work in the state level certainly you’ve got licensing data and inspection that goes along with that. But it’s going to need other report up from various groups and we need to be able to access that data across other departments within the state.

Then the final group which were again were the ones that we have to get other data to get to when you are realistically saying its probably going to be five years before we're ultimately going to be able to give the consumer that detailed report on outcomes in performance for individual physician practices that out there. Otherwise really, we really don’t use in-patient facilities whether we can gather the data and review more quickly.

Man 3: At the risk of defending any of my surgical colleagues here may have a little bit of procedures also. People could do another part of the cognitive physicians. That’s already cited.

[Laughter]

14:24

The day that we talked about this in the physicians subgroup that has been meeting for over a year. Going in the doctors' offices, presiding on the outpatient cases, getting that information right now. What you’re going to get basically is building information. And that’s going be a really tough one being able. You're really going to have to go to the cognitive physician like internist and the care guys and get them to share data. We actually talk about them in the first swimlane.

We actually talked about the... that is going  have to be mandate of the state for them to share data. And right now I would like to say that most of them don’t do a lot of internal QI stuff they just practice and that’s going to be big enough to crunch.

Speaker 1: That’s why we have that out here, your five, because clearly it's going to take a lot of money. It's going to take legislative activity and what not to get us there.

Guy 4: I think that’s the 95% probability likely. There's a 5% probability that you have to consider yourself to be included on the next two years and all the rules. And if that happens seriously and then it might just work on HEO. And Bob, people are spending millions of dollars in putting this in the state of Florida. So what I’m struck with is if I’m a physician or in a hospital around any intermediary in between, I'm very worried if I share my daily works somehow want to do with the metric that's going to used against. It's the secondary in turner

And while these kids are going to be out changing healthcare, we're going to be fighting among themselves about what that means, The data that a year old any way based on claims and for purposes which is never intended . And that struggle is more than i can be and the group must go through.

But let me suggest the following. And that, at least in Memphis, we have found that we can exchange data if we have the absolute agreement that we are not going to use it for any definitive financial measure. There’s a hole on that. So it's even possible to say, quality reporting is also very scary but there's a making it boundless and we really agreed about.

The secondary thing is if I am an intermediary, I won't hold up the daily because I've got power over them, right?I want to control those mysterious members and I don’t trust anymore the people..If I’m a patient, I don’t care .I have zero tolerance for that. I do acknowledge to that..What stops me from wanting to make that push protection in my privacy and confidentiality. If you could protect confidentiality and privacy 100% hold true, then there is no reason for any inner media ever not create data that or something in the public.

17:16

Another part of that condition, if I can make data thru anonymous not just be identified, then I can share the stuff a lot sooner. And I’m just saying this, if you’re thinking through this, remember are building modules and you might just want to keep an eye on those things and see if they can give you some earliest snap shots, lab feature from your chronicle labs, all kinds of other direct fees from physicians offices, for surveillance screening,get an idea that might be some of that things you want tested. You can change a little bit but I don’t want to lose track because other focused on.

Moderator: And I throw it out to the rest of the group some sort of trying to describe. We'll have the discussions going on and leave everything out.

[Applause]