CONSULTING ASSURANCE TAX. Hospital Revenue At Risk. For Leapfrog Reporting Hospitals Sample Reports

Transcription

1 CONSULTING ASSURANCE TAX Hospital Revenue At Risk For Leapfrog Reporting Hospitals Sample Reports

2 Table Of Contents

3 Sample Free Facility Summary p. Sample Basic Facility Report p. Sample Multi-Facility Report p.

4 Sample Free Facility Summary

5 FREE FACILITY SUMMARY: SAMPLE HOSPITAL NAME Overview Several measures included in the Leapfrog Hospital Survey are used in federal payment incentive and/or penalty programs. To help hospitals gain insight into how their income may be impacted, DHG Healthcare has partnered with Leapfrog to analyze hospitals Revenue at Risk based on quality and safety data. The Revenue at Risk Free Facility Summary provides your projected summary-level revenue at risk in CMS programs. How to Use This Report This hospital revenue at risk facility summary helps you begin to understand the scope of your revenue at risk, by projecting your revenue at risk across CMS Value-Based Purchasing (VBP), Hospital Readmissions Reduction (RRP), and Hospital Acquired Conditions (HAC) programs at a summary level across several performance periods. For participating hospitals, CMS has withheld a percentage of your Medicare reimbursement. Based on your hospital s performance in each program, you have the opportunity to earn-back the amount that was withheld. BREAK-EVEN: Your hospital s respective program performance allowed you to earn-back all the Medicare revenues that were withheld. MAXIMUM REWARD/: Because the financial impact to CMS is a zero sum gain, hospitals who perform better than their peers in each respective program have the opportunity to earn more than the breakeven amount. These hospitals are effectively able to capture the maximum reward dollars that penalized hospitals did not earn back, and hospitals who are not moving quickly to improve their program performance are leaving this money on the table. Your facility summary to the right is simply intended to demonstrate the magnitude of Medicare revenue at risk for your facility. The Basic and Premium Custom Engagement Revenue at Risk offerings provide greater detail into your facility s projected performance, the underlying drivers, and potential strategies to maximize the risk revenue for your hospital. DOMAIN MAX.REWARD FY 0 Value Based Purchasing $,0, $,, Readmissions $,0, $ - Hospital Acquired Conditions $,0, $ - FY 0 Value Based Purchasing $,0, $,, Readmissions $,0, $ - Hospital Acquired Conditions $,0, $ - FY 00 Value Based Purchasing $,0, $,, Readmissions $,0, $ - Hospital Acquired Conditions $,0, $ - $,,0 $,, TOTAL $,, p.

6 p. Sample Basic Facility Report

7 BASIC FACILITY REPORT: SAMPLE HOSPITAL NAME Overview Several measures included in the Leapfrog Hospital Survey are used in federal payment incentive and/or penalty programs. To help hospitals gain insight into how their income may be impacted, DHG Healthcare has partnered with Leapfrog to analyze hospitals Revenue at Risk based on quality and safety data. In addition to what is provided in the Free Facility Summary, the Revenue at Risk Basic Facility Report also includes: Breakdown of projected financial performance across relevant CMS programs Benchmarks at the national, state and local levels in those programs A Consolidated Revenue at Risk - Basic Facility PowerPoint Presentation A -Hour meeting with key hospital leaders/stakeholders to present Revenue at Risk reports by DHG subject-matter experts How to Use This Report This hospital revenue at risk basic facility provides a dashboard-like view of your revenue at risk over several performance periods, allowing you to see what you are projected to earn, what the breakeven point is, and how much is available in each respective period for CMS Value-Based Purchasing (VBP), Hospital Readmissions Reduction (RRP), and Hospital Acquired Conditions (HAC) programs. For hospitals participating in these CMS programs, a percentage of Medicare reimbursement for inpatient acute care services is withheld. Based on the hospital s performance in each program, hospitals have the opportunity to earn-back the amount that was withheld. : Based on your respective program performance, the amount of reimbursement your facility is projected to receive for that performance period. PENALTY: Based on your respective program performance, your hospital will not earn-back all that was withheld by Medicare, which is effectively a forfeiture of Medicare reimbursement that was earned under fee-for-service. BREAK-EVEN: This is the amount that was of Medicare revenues that were originally withheld for the performance period. MAXIMUM REWARD/: Because the financial impact to CMS is a zero sum gain, hospitals who perform better than their peers in each respective program have the opportunity to earn more than the breakeven amount. These hospitals are effectively able to capture a bonus of maximum reward dollars that penalized hospitals did not earn back, and hospitals who are not moving quickly to improve program performance are leaving this money on the table. p.

8 VBP FY VBP FY $,0,0 $,,0 $,, $,, $0 $,0,0 $,, $0 $,, $,, Hospitals need to understand the underlying metrics and drivers of their Value-Based Purchasing scores, not only within the four walls of their own hospitals, but relative to their peers. The pace of improvement, no matter how good relative to a hospital s own historical performance, do not matter as much the acceleration of that progress relative to the peer group. Hospitals who are at or above breakeven often don t realize how much revenue they are leaving on the table if they were to only keep striving for greater improvement. Hospitals need to have a deep understanding of what drives the relevant readmissions for their facility. For most hospitals, readmissions penalties are mounting year over year, and many have struggled with truly discovering and addressing the root causes. RRP PERFORMANCE PENALTIES $, $, $0 $0,000 $0,000 $0,000 $00,000 $0,000 $00,000 $0,000 $00,000 $0,000 $00,000 HAC PERFORMANCE SCORE.. Hospital Acquired conditions (HACs) also need to be addressed systematically/programmatically byhospitals to address underlying clinical practices. This domain in particular has seen hospitals continue to improve relative to their own historic performance, but the overall pace of improvement has picked-up simultaneously across the boards, and so hospitals are surprised that improvement from prior year where they broke-even is now a penalty. NO PENALTY PENALTY p.

9 What Next? The Revenue at Risk Basic Facility Report will help you to begin zeroing in on your projected performance relative to your breakeven, as well as total potential revenue opportunity. The Premium Custom Engagement provides a true consulting engagement that dives into greater detail on your facility s projected revenue at risk performance, the underlying drivers, and potential strategies to maximize the risk revenue for your hospital. This includes time onsite with key personnel, leadership education, and in-person presentation of the detailed findings and recommendations. The Premium Custom Engagement includes the following additional benefits: Financial scenario modeling of potential future performance based on current trajectory versus improving on quality at a more accelerated pace, utilizing hospital s individual QNET files from CMS Mapping Revenue at Risk to specific clinical conditions Consulting engagement to fully assess revenue at risk In-person findings & recommendations meeting with hospital leadership/key stakeholders Hospitals that are part of health systems or have multiple facilities/campuses may also be interested in the Multi-Facility Hospital System Report, which includes a Basic Facility Report for each hospital, as well a comparison of key revenue at risk indicators across the facilities. p.

10 p. Sample Multi-Facility Report

11 MULTI-FACILITY REPORT (FACILITY A, FACILITY B, FACILITY C, ETC.): SAMPLE HOSPITAL NAME Overview Several measures included in the Leapfrog Hospital Survey are used in federal payment incentive and/or penalty programs. To help hospitals gain insight into how their income may be impacted, DHG Healthcare has partnered with Leapfrog to analyze hospitals Revenue at Risk based on quality and safety data. In addition to what is provided in the Free Facility Summary, the Revenue at Risk Basic Facility Report also includes: Breakdown of projected financial performance across relevant CMS programs Benchmarks at the national, state and local levels in those programs A Consolidated Revenue at Risk - Basic Facility PowerPoint Presentation A -Hour meeting with key hospital leaders/stakeholders to present Revenue at Risk reports by DHG subject-matter experts How to Use This Report This hospital revenue at risk multi-facility report provides a dashboard-like view of your revenue at risk over several performance periods across several facilities, allowing you to see what you are projected to earn, what the breakeven point is, and how much is available in each respective period for CMS Value-Based Purchasing (VBP), Hospital Readmissions Reduction (RRP), and Hospital Acquired Conditions (HAC) programs. For hospitals participating in these CMS programs, a percentage of Medicare reimbursement for inpatient acute care services is withheld. Based on the hospital s performance in each program, hospitals have the opportunity to earn-back the amount that was withheld. : Based on your respective program performance, the amount of reimbursement your facility is projected to receive for that performance period. PENALTY: Based on your respective program performance, your hospital will not earn-back all that was withheld by Medicare, which is effectively a forfeiture of Medicare reimbursement that was earned under feefor-service. BREAK-EVEN: This is the amount that was of Medicare revenues that were originally withheld for the performance period. MAXIMUM REWARD/: Because the financial impact to CMS is a zero sum gain, hospitals who perform better than their peers in each respective program have the opportunity to earn more than the breakeven amount. These hospitals are effectively able to capture a bonus of maximum reward dollars that penalized hospitals did not earn back, and hospitals who are not moving quickly to improve program performance are leaving this money on the table. p.

12 FACILITY A FACILITY B FACILITY C VBP FY VBP FY VBP FY VBP FY $,0,0 $,,0 $,0,0 $,,0 $,0,0 $,,0 $0 $,0,0 $,, $0 $,0,0 $,, $0 $,0,0 $,, VBP FY VBP FY VBP FY VBP FY $,0,0 $,,0 $,0,0 $,,0 $,0,0 $,,0 $0 $,0,0 $,, $0 $,0,0 $,, $0 $,0,0 $,, Hospitals need to understand the underlying metrics and drivers of their Value-Based Purchasing scores, not only within the four walls of their own hospitals, but relative to their peers. The pace of improvement, no matter how good relative to a hospital s own historical performance, do not matter as much the acceleration of that progress relative to the peer group. Hospitals who are at or above breakeven often don t realize how much revenue they are leaving on the table if they were to only keep striving for greater improvement. FACILITY A RRP PERFORMANCE PENALTIES $, $, $0 $0,000 $0,000 $0,000 $00,000 $0,000 $00,000 $0,000 $00,000 $0,000 $00,000 FACILITY B RRP PERFORMANCE PENALTIES RRP $, PERFORMANCE PENALTIES $, $0 $0,000 $0,000 $0,000 $00,000 $0,000 $00,000 $0,000 $00,000 $0,000 $00,000 FACILITY C RRP PERFORMANCE PENALTIES $, $, $0 $0,000 $0,000 $0,000 $00,000 $0,000 $00,000 $0,000 $00,000 $0,000 $00,000 Hospitals need to have a deep understanding of what drives the relevant readmissions for their facility. For most hospitals, readmissions penalties are mounting year over year, and many have struggled with truly discovering and addressing the root causes. p.

13 Hospital Acquired conditions (HACs) also need to be addressed systematically/programmatically by hospitals to address underlying clinical practices. This domain in particular has seen hospitals continue to improve relative to their own historic performance, but the overall pace of improvement has picked-up simultaneously across the boards, and so hospitals are surprised that improvement from prior year where they broke-even is now a penalty. FACILITY A HAC PERFORMANCE SCORE HAC PERFORMANCE SCORE.. What Next? The Revenue at Risk Multi-Facility Report will help you to begin zeroing in on your projected performance relative to your breakeven, as well as total potential revenue opportunity. The Premium Custom NO PENALTY PENALTY Engagement provides a true consulting engagement that dives into greater detail on your facility s projected revenue at risk performance, the underlying drivers, and potential strategies to maximize the risk revenue for your hospital. This includes time onsite with key personnel, leadership education, and in-person presentation of the detailed findings and recommendations. The Premium Custom Engagement includes the following additional benefits: Financial scenario modeling of potential future performance based on current trajectory versus improving on quality at a more accelerated pace, utilizing hospital s individual QNET files from CMS Mapping Revenue at Risk to specific clinical conditions Consulting engagement to fully assess revenue at risk In-person findings and recommendations meeting with hospital leadership/key stakeholders FACILITY B HAC PERFORMANCE SCORE. NO PENALTY FACILITY C HAC PERFORMANCE SCORE PENALTY... NO PENALTY PENALTY p.

14 ABOUT DHG HEALTHCARE DHG Healthcare is ranked by Modern Healthcare as the th largest privately-held healthcare consulting firm and serves the industry with approximately 00 dedicated healthcare industry professionals across consulting, assurance and tax. DHG Healthcare s consulting business includes a distinctive capabilities and solutions portfolio sharply focused on critical business issues facing healthcare organizations in today s transformative environment. For more information about DHG Healthcare contact: DEBORAH HOLZMARK DIRECTOR WALTER COLEMAN MANAGER deborah.holzmark@dhgllp.com.. walter.coleman@dhgllp.com Dixon Hughes Goodman LLP. DHG Healthcare. All rights reserved. PN00