Partners in the Continuum of Care: Hospitals and Post-Acute Care Providers

Size: px
Start display at page:

Download "Partners in the Continuum of Care: Hospitals and Post-Acute Care Providers"

Transcription

1 Partners in the Continuum of Care: Hospitals and Post-Acute Care Providers Presented to the Wisconsin Association for Home Health Care November 3, 2017 By: Laura Rose WHA Vice President, Policy Development

2

3 WHA s Expanding Focus Wisconsin has a strong presence of vertically integrated hospital and health systems, aligning towards a common goal better outcomes. Wisconsin hospitals/health systems care about quality care for patients before, during, and after hospitalization. 3

4 WHA s Work Beyond the Hospital Walls Reimbursement and Payment Reform o Medicare/Medicaid targeted improvements o Hospital, Physician, Advanced Practice Clinician o MACRA - Medicare Access and CHIP Reauthorization Act Behavioral Health (including Heroin and Opioid Abuse) Workforce Physicians and Practitioners Clinical Performance Improvement Transparency, Information and Analytics Integration of Medical and Dental Care Post-Acute/Discharge Care 4

5 Example: Post-Acute Care Why are we involved? o Greater integration of hospitals with post-acute care providers is necessary as hospitals become increasingly responsible for outcomes over an episode of care. WHA s Post-Acute Work Group: o Developing policy initiatives aimed at improving the ability of hospitals and health systems to provide or locate postacute care for their patients. 5

6 Wisconsin Post-Acute Providers LTCH: 5 hospitals; 255 beds IRF: 3 facilities; 121 beds SNF: 372 facilities; 32,854 beds HHA: Approximately 154 agencies Swing bed hospitals: 58 hospitals

7 Post-Acute Discharges In 2013, 22.3% of all inpatient hospital discharges nationally (7.96 million) were to a post-acute setting. Patients whose payer is Medicare have, by far, the greatest percentage of discharges to post-acute care o Medicare: 41.7% of discharges are to P-AC o Private insurance: 11.7% o Medicaid: 8.1% o Uninsured: 4.8% *AHRQ Healthcare Cost and Utilization Project, Statistical Brief #205, An All-Payer View of Hospital Discharge to Post-Acute Care, 2013, May 2016

8 MedPAC on Post-Acute Care Medicare payments to P-AC providers are too generous. System encourages providers to increase payments by making certain patient care decisions. Biases in payments systems make certain patients and services provided to them more profitable than others. Despite increased costs, quality of care had not improved. The need for P-AC is not well defined. Medicare per capita spending on P-AC varies more than any other covered services. High Medicare margins relative to other settings. MedPAC Report to Congress, March 2015, ch.7.

9 Medicare Spending on Post-Acute Care P-AC is fastest growing major Medicare spending category. P-AC Medicare spending grew from $29 billion in 2001 to $59 billion in In 2013, 50% of P-AC services were provided by home health agencies; 41% by SNFs, and the rest by IRFs or LTACHs. MedPAC Report to the Congress, Ch. 7, March 2015

10 Wisconsin Medicaid Spending FY 2015 expenditures, Medicaid FFS, all funds, o Nursing homes: $608,800,000* o Home health AND personal care: $966,312,508** Source: *Wisconsin Legislative Fiscal Bureau, Informational Paper #41, Medical Assistance and Related Programs, January **Kaiser Family Foundation, State Health Facts: Distribution of Fee-for-Service Medicaid Spending on Long Term Care, published 12/2106.

11 Regulatory Issues LTCHs: 25 day average length of stay rule; reduced payment for certain patients transferred to an LTCH from a particular general acute care hospital. IRFs: 3 hours of therapy/5 days a week minimum; 60% rule SNFs: SNF 3 day stay requirement HHAs: Requirement that patients be homebound in order to qualify for services

12 Bundled Payments Initiatives Important for P-AC because the expressed goals of bundled approaches to payment are to improve coordination across the providers engaged in caring for a patient during an episode of care and, in turn, improve cost efficiencies or savings. Important for P-AC because payment to providers is based on predetermined expected costs for a group of related health care services, including P- AC.

13 Bundled Payments for Care Improvement (BPCI) Voluntary, three-year initiative links payments for services related to an episode of care that is triggered by a hospitalization. BPCI allows participants to choose from 48 episodes of care under four different models that provided a mix of episode structures (inpatient only, inpatient plus post-acute care, post-acute care only, etc.). BPCI also provided a mix of payment models. Conditions tested: o Acute Myocardial Infarction (AMI) Model; o Coronary Artery Bypass Graft (CABG) Model; o Surgical Hip and Femur Fracture Treatment (SHFFT) Model; and o Cardiac Rehabilitation (CR) Incentive Payment Model

14 Comprehensive Care for Joint Replacement (CJR) CJR is mandatory, and tests bundled payment and quality measurement for an episode of care associated with hip and knee replacements (the most common surgeries for Medicare beneficiaries) to encourage hospitals, physicians, and post-acute care providers to work together to improve the quality and coordination of care from the initial hospitalization through recovery. CMS has implemented the CJR model in 67 geographic areas across the U.S. Wisconsin mandatory participants (except for certain BPCI participants): o Madison, WI: Columbia, Dane, Green, Iowa Counties o Milwaukee-Waukesha-West Allis, WI: Milwaukee, Ozaukee, Washington, Waukesha Counties

15 Wisconsin CJR Example: Before CJR: 30% of joint replacement patients going home Within 1 year of implementation: Ambulated nearly all patients the day of surgery and sent 80% of patients home. Saw proportional decreases in referral to subacute rehab facilities and the rehab hospital affiliated with PHC. Before CJR: Average length of stay for TKAs was 2.16 days. Within 1 year of implementation: Average length of stay for TKAs was 1.4 days. Complication rates dropped significantly, as did readmission rates. Total costs for TKA dropped significantly. Participation in the CJR bundle drove collaboration between primary care, anesthesiology, and orthopedic surgery to develop protocols for management. We optimized the medical condition of patients prior to surgery. We improved perioperative pain management with a multi-modal approach which markedly decreased the use of opioids.

16 Next Gen Accountable Care Organizations Goal: To test whether strong financial incentives for ACOs (Accountable Care Organization) can improve health outcomes and lower expenditures in healthcare. Prepares health systems to move more quickly through the corridor from fee-for-service to pay for performance, and be able to take on total risk with certainty.

17 Wisconsin s Health Systems at the Forefront Two Next Gen ACOs in Wisconsin are working to improve quality, reduce costs and work at managing population health in their service areas. 17

18 Positive ACO Results Eleven of 18 Next Gen ACOs saw Medicare Shared Savings in 2016: 1. Baroma Health Partners (Miami) $12,254, Triad HealthCare Network (Greensboro, N.C.) $10,735, Iowa Health Accountable Care (West Des Moines) $10,527, Trinity Health ACO (Livonia, Mich.) $6,529, Deaconess Care Integration (Evansville, Ind.) $5,719, Pioneer Valley Accountable Care (Springfield, Mass.) $4,683, Henry Ford Physician ACO (Detroit) $3,938, Bellin Health Partners (Green Bay, Wis.) $1,400, ThedaCare ACO (Appleton, Wis.) $1,348, Prospect ACO (Los Angeles) $938, Steward Integrated Care Network (Boston) $272,139

19 Things are changing.. Dr. Tom Price, former Secretary of the Department of Health and Human Services, has been a vocal opponent of mandatory CMS bundled payment programs. CMS issued a proposed rule in August which, among other things: Makes CJR optional in half of the currently participating geographic regions (including Wisconsin) Cancels the Cardiac Rehab Incentive Payment Model and the Episode Payment Models Since the proposed rule was issued, Secretary Price has resigned. Now What?

20 WHA Responds to CMS Proposal

21

22 Opportunities in Post-Acute Care Under a bundled payment or shared savings program, health systems have strong financial incentives not to refer patients to high-intensity post-acute care settings that they don t need. For patients hospitalized with congestive heart failure in 2008, Medicare paid: o $2500 in the 30 days after discharge for each patient who received home health care. o $10,700 for those admitted to a SNF o $15,000 for those admitted to an IRF

23 Opportunities in Post-Acute Care

24 WHA s Post-Acute Work Group Goal: To develop a package of achievable policy initiatives aimed at improving the ability of hospitals and health systems to provide or locate post-acute care for their patients. Work Group convened in January, meetings held, to date; next meeting later this fall. Hope to finalize recommendations by year s end.

25 Issues discussed: Access to Post-Acute Care: Challenges of locating P-AC for complex patients Uneven distribution of P-AC services statewide Swing bed usage Scarcity of P-AC for pediatric patients Workforce issues: All levels Decline in private duty nurse availability Reimbursement: P-AC provider reimbursement rates Durable medical equipment reimbursement issues Impact of bundled payments Creating preferred provider relationships

26 Issues discussed: Hospital coordination with P-AC providers: Exchange of health information between hospital and P-AC providers Options for using telemedicine in P-AC Transitions of care: best practices End-of-life care planning Transportation to P-AC Regulatory environment Population health: Avoiding hospitalizations in the first place Social determinants of health

27 Potential recommendations could include: Access to Post-Acute Care: Increase complex patient incentive payments Increase ventilator facility capacity Workforce: Supporting increased reimbursement for P-AC direct care providers: Nursing homes Home health agencies Independent nurses Others Reimbursement: Medicaid reimbursement for P-AC case management, advanced care planning Examine Medicaid program performance in DME reimbursement and availability See Workforce recommendations, above

28 Potential recommendations could include: Hospital coordination with P-AC providers: Uniform transitions of care planning tool Tools to facilitate exchange of health information Regulatory: Advocate for regulatory changes at state and federal levels Education: Providing educational programming around P-AC: Webinar, toolkit?

29 Home Health Care Issues and P-AC Pediatric patient with extended hospital length of stay of 90 days. Patient is on a ventilator and private duty nursing cannot be located. Adult patient is ready for discharge from the hospital. She exhibits challenging behaviors, has no family support, and needs intravenous nutrition therapy. She has been waiting in the hospital for 5 months for an appropriate skilled nursing facility placement. 29

30 Home Health Care Issues and P-AC Private duty nursing: Trend in P-AC is discharge to home, often with home health care, rather than to P-AC facility. Big cost savings with home nursing care vs. a delayed hospital discharge, or discharge to a P-AC facility. But: home nurse pay differential is significant, making recruitment difficult.

31 Home Health Care Issues and P-AC Personal Care Workers: Decrease in hours authorized by DHS for home care. Personal care reimbursement rate frozen for 10 years; Act 59 provided 2% increase. Will it have an impact?

32 The Puzzle: How do we create financial and other incentives for for post-acute providers who provide care for complex patients?

33 Your ideas?

The Pain or the Gain?

The Pain or the Gain? The Pain or the Gain? Comprehensive Care Joint Replacement (CJR) Model DRG 469 (Major joint replacement with major complications) DRG 470 (Major joint without major complications or comorbidities) Actual

More information

Post-Acute Care. December 6, 2017 Webinar Louise Bryde and Doug Johnson

Post-Acute Care. December 6, 2017 Webinar Louise Bryde and Doug Johnson Post-Acute Care December 6, 2017 Webinar Louise Bryde and Doug Johnson Topics for Discussion Background What Is Post Acute Care? Lexicon Levels of Care Why Focus on Post Acute Care? Emerging PAC Trends

More information

Comparison of Bundled Payment Models. Model 1 Model 2 Model 3 Model 4. hospitals, physicians, and post-acute care where

Comparison of Bundled Payment Models. Model 1 Model 2 Model 3 Model 4. hospitals, physicians, and post-acute care where Comparison of Bundled Payment Models General Description Eligible awardees Retrospective bundled Retrospective bundled payment models for payment models for hospitals, physicians, and post-acute care where

More information

Furthering the agency s stated intention to pay for value over volume,

Furthering the agency s stated intention to pay for value over volume, in the news Health Care September 2016 The Future Is Now: CMS Proposes Broad Bundled Payment Expansion for Cardiac Care Episodes In this Issue: Episode Payment Models... 2 Cardiac Rehabilitation Incentives...

More information

The President s and Other Bipartisan Proposals to Reform Medicare: Post-Acute Care (PAC) Reform. Summary

The President s and Other Bipartisan Proposals to Reform Medicare: Post-Acute Care (PAC) Reform. Summary Current Law The President s and Other Bipartisan Proposals to Reform Medicare: Post-Acute Care (PAC) Reform Summary Home Health Agencies Under current law, beneficiaries who are generally restricted to

More information

Alternative Payment Models: Trends and Tactics for Success

Alternative Payment Models: Trends and Tactics for Success Alternative Payment Models: Trends and Tactics for Success James Michel Senior Director, Medicare Reimbursement & Policy American Health Care Association November 15, 2016 Discussion Review CMS priorities

More information

Emerging Issues in Post Acute Care Trends

Emerging Issues in Post Acute Care Trends Emerging Issues in Post Acute Care Trends Lavonne Elston, PT Senior Director of Operations & Strategic Initiatives Skilled Nursing & Rehabilitation Kingston HealthCare Company April 28, 2016 Disclosures

More information

Partnerships: Developing an Elective Joint Replacement Program

Partnerships: Developing an Elective Joint Replacement Program Partnerships: Developing an Elective Joint Replacement Program Amy R. Ehrlich, MD Angela Schonberg, MPT Wojciech Rymarowicz, MPT Overview Session Overview: Montefiore network Program Development Data and

More information

Redesigning Post-Acute Care: Value Based Payment Models

Redesigning Post-Acute Care: Value Based Payment Models Redesigning Post-Acute Care: Value Based Payment Models Liz Almeida-Sanborn, MS, PT President Preferred Therapy Solutions This session will address: Discussion of the emergence of voluntary and mandatory

More information

Episode Payment Models Final Rule & Analysis

Episode Payment Models Final Rule & Analysis Episode Payment Models Final Rule & Analysis February 15, 2017 Agenda Overview Changes from Proposed Rule Categorization of Episodes Episode Attribution Reconciliation Quality Performance Cardiac Rehab

More information

CPAs & ADVISORS. experience support // ADVANCED PAYMENT MODELS: CJR

CPAs & ADVISORS. experience support // ADVANCED PAYMENT MODELS: CJR CPAs & ADVISORS experience support // ADVANCED PAYMENT MODELS: CJR Andy M. Williams Partner BKD Eric M. Rogers Managing Consultant BKD Will McLeod VP of Patient Services McLeod Health Emily Adams Associate

More information

Questions and Answers on the CMS Comprehensive Care for Joint Replacement Model

Questions and Answers on the CMS Comprehensive Care for Joint Replacement Model Questions and Answers on the CMS Comprehensive Care for Joint Replacement Model MEGGAN BUSHEE, ESQ. 704.343.2360 mbushee@mcguirewoods.com 201 North Tryon Street, Suite 3000 Charlotte, North Carolina 28202-2146

More information

Advancing Care Coordination Proposed Rule

Advancing Care Coordination Proposed Rule Advancing Care Coordination Proposed Rule Released July 25, 2016 Erin Smith, JD VP and Executive Director, PACCR Jourdan Meltzer Research Associate, PACCR August 4, 2016 1 Presentation Overview Three new

More information

Distribution of Post-Acute Care under CJR Model of Lower Extremity Joint Replacements for MS-DRG 470

Distribution of Post-Acute Care under CJR Model of Lower Extremity Joint Replacements for MS-DRG 470 Distribution of Post-Acute Care under CJR Model of Lower Extremity Joint Replacements for MS-DRG 470 Introduction The goal of the Medicare Comprehensive Care for Joint Replacement (CJR) payment model is

More information

PAYMENT INNOVATION: Real Examples of Client Implementation. Craig Tolbert & Michael Wolford

PAYMENT INNOVATION: Real Examples of Client Implementation. Craig Tolbert & Michael Wolford PAYMENT INNOVATION: Real Examples of Client Implementation Craig Tolbert & Michael Wolford 2 PINNACLE SPEAKER PROFILE CRAIG TOLBERT Principal DHG Healthcare Birmingham, AL PINNACLE SPEAKER PROFILE MICHAEL

More information

The New World of Value Driven Cardiac Care

The New World of Value Driven Cardiac Care 1 The New World of Value Driven Cardiac Care Disclosures MPA Healthcare Solutions is an analytic health care consultancy that provides clients with insight into clinical performance; aids them in the evaluation,

More information

What 2017 Holds for Medicare Value-Based Transformation: Finalization of the Advancing Care Coordination Rule and Much More

What 2017 Holds for Medicare Value-Based Transformation: Finalization of the Advancing Care Coordination Rule and Much More January 19, 2017 What 2017 Holds for Medicare Value-Based Transformation: Finalization of the Advancing Care Coordination Rule and Much More HDG Webinar Series Brian Ellsworth, MA, Director, Payment Transformation

More information

MEDICARE UPDATES: VBP, SNF QRP, BUNDLING

MEDICARE UPDATES: VBP, SNF QRP, BUNDLING MEDICARE UPDATES: VBP, SNF QRP, BUNDLING PRESENTED BY: ROBIN L. HILLIER, CPA, STNA, LNHA, RAC-MT ROBIN@RLH-CONSULTING.COM (330)807-2850 MEDICARE VALUE BASED PURCHASING 1 PROTECTING ACCESS TO MEDICARE ACT

More information

Exhibit 1. Medicare Shared Savings Program: Year 1 Performance of Participating Accountable Care Organizations (2013)

Exhibit 1. Medicare Shared Savings Program: Year 1 Performance of Participating Accountable Care Organizations (2013) Exhibit 1. Medicare Shared Savings Program: Year 1 Performance of Participating Accountable Care Organizations (2013) 24 percent (52 ACOs) earned shared savings bonus 27 percent (60 ACOs) reduced spending,

More information

Post-Acute Care Networks: How to Succeed and Why Many Fail to Deliver JULY 18, 2016

Post-Acute Care Networks: How to Succeed and Why Many Fail to Deliver JULY 18, 2016 Post-Acute Care Networks: How to Succeed and Why Many Fail to Deliver HEALTH FORUM AND AHA LEADERSHIP SUMMIT JULY 18, 2016 SAN DIEGO, CALIFORNIA Please note that the views expressed are those of the conference

More information

New Models in Payment: Joint Replacements. Sharon Eloranta, MD February 18, 2016

New Models in Payment: Joint Replacements. Sharon Eloranta, MD February 18, 2016 New Models in Payment: Joint Replacements Sharon Eloranta, MD February 18, 2016 Qualis Health A leading national population health management organization The Medicare Quality Innovation Network - Quality

More information

Data-Driven Strategy for New Payment Models. Objectives. Common Acronyms

Data-Driven Strategy for New Payment Models. Objectives. Common Acronyms Data-Driven Strategy for New Payment Models Mark Sharp, CPA Partner msharp@bkd.com Objectives Understand new payment model reforms and bundling arrangements Learn how these new payment models can impact

More information

Transitions Through the Care Continuum: Discussions on Barriers to Patient Care, Communications, and Advocacy

Transitions Through the Care Continuum: Discussions on Barriers to Patient Care, Communications, and Advocacy Transitions Through the Care Continuum: Discussions on Barriers to Patient Care, Communications, and Advocacy Scott Matthew Bolhack, MD, MBA, CMD, CWS, FACP, FAAP April 29, 2017 Disclosure Slide I have

More information

Retrospective Bundles

Retrospective Bundles Bundled Payment for Care Improvement (BPCI) Overview Shawn Matheson MBA, LNHA, FACHCA Market Manager Idaho Health Care Association Annual Convention Boise, ID July 13, 2017 Retrospective Bundles Surgeon

More information

Bundled Payment Primer

Bundled Payment Primer Bundled Payment Primer CMS Opened Application February 14, 2014 Why this matters to you! Bundling is a New Business Model Bundling is a focused opportunity to manage risk and achieve gain Control of a

More information

Post-Acute Care Networks: How to Succeed and Why Many Fail to Deliver JULY 18, 2016

Post-Acute Care Networks: How to Succeed and Why Many Fail to Deliver JULY 18, 2016 Post-Acute Care Networks: How to Succeed and Why Many Fail to Deliver HEALTH FORUM AND AHA LEADERSHIP SUMMIT JULY 18, 2016 SAN DIEGO, CALIFORNIA Please note that the views expressed are those of the conference

More information

Regulatory Advisor Volume Eight

Regulatory Advisor Volume Eight Regulatory Advisor Volume Eight 2018 Final Inpatient Prospective Payment System (IPPS) Rule Focused on Quality by Steve Kowske WEALTH ADVISORY OUTSOURCING AUDIT, TAX, AND CONSULTING 2017 CliftonLarsonAllen

More information

Making CJR Work for You. A Roadmap for Successful Implementation of Medicare Bundles

Making CJR Work for You. A Roadmap for Successful Implementation of Medicare Bundles December 10, 2015 Making CJR Work for You A Roadmap for Successful Implementation of Medicare Bundles https://innovation.cms.gov/initiatives/cjr Sheldon Hamburger shamburger@thearistonegroup.com (248)

More information

HOSPITALS & HEALTH SYSTEMS: DATA-DRIVEN STRATEGY FOR BUNDLED PAYMENT SUCCESS 4/19/2016. April 20, 2016

HOSPITALS & HEALTH SYSTEMS: DATA-DRIVEN STRATEGY FOR BUNDLED PAYMENT SUCCESS 4/19/2016. April 20, 2016 HOSPITALS & HEALTH SYSTEMS: DATA-DRIVEN STRATEGY FOR BUNDLED PAYMENT SUCCESS April 20, 2016 Eddie Marmouget National Industry Partner emarmouget@bkd.com Eric Rogers Managing Consultant erogers@bkd.com

More information

A Brave New World: Lessons Learned From Healthcare Reform. Brandy Shumaker, MBA, LPTA, LNHA Regional Vice President HealthPRO/Heritage

A Brave New World: Lessons Learned From Healthcare Reform. Brandy Shumaker, MBA, LPTA, LNHA Regional Vice President HealthPRO/Heritage A Brave New World: Lessons Learned From Healthcare Reform Brandy Shumaker, MBA, LPTA, LNHA Regional Vice President HealthPRO/Heritage 1 Learning Objectives Participants will understand: The impact health

More information

The Center for Medicare & Medicaid Innovations: Programs & Initiatives

The Center for Medicare & Medicaid Innovations: Programs & Initiatives The Center for Medicare & Medicaid Innovations: Programs & Initiatives Rob Stone, Esq. American Health Lawyers Association Institute on Medicare & Medicaid Payment Issues March 30-April 1, 2012 CMMI Mission

More information

4/9/2016. The changing health care market THE CHANGING HEALTH CARE MARKET. CPAs & ADVISORS

4/9/2016. The changing health care market THE CHANGING HEALTH CARE MARKET. CPAs & ADVISORS CPAs & ADVISORS experience support // ADVANCED PAYMENT MODELS: CJR Eric. M. Rogers MEd. RT(R) Managing Consultant The changing health care market THE CHANGING HEALTH CARE MARKET HHS goal of 30% of traditional

More information

Bundled Payments to Align Providers and Increase Value to Patients

Bundled Payments to Align Providers and Increase Value to Patients Bundled Payments to Align Providers and Increase Value to Patients Stephanie Calcasola, MSN, RN-BC Director of Quality and Medical Management Baystate Health Baystate Medical Center Baystate Health Is

More information

PHCA Webinar January 30, Latsha Davis & McKenna, P.C. Kimber L. Latsha, Esq.

PHCA Webinar January 30, Latsha Davis & McKenna, P.C. Kimber L. Latsha, Esq. PHCA Webinar January 30, 2014 Latsha Davis & McKenna, P.C. Kimber L. Latsha, Esq. 1 2 Intended to: Encourage the development of ACOs in Medicare Promotes accountability for a patient population and coordinates

More information

DRIVING VALUE-BASED POST-ACUTE COLLABORATIVE SOLUTIONS. Amy Hancock, CEO Presented to: CPERI April 16, 2018

DRIVING VALUE-BASED POST-ACUTE COLLABORATIVE SOLUTIONS. Amy Hancock, CEO Presented to: CPERI April 16, 2018 DRIVING VALUE-BASED POST-ACUTE COLLABORATIVE SOLUTIONS Amy Hancock, CEO Presented to: CPERI April 16, 2018 Cross-Continuum Road-Mapping Post-acute partners are beginning to utilize tools to identify new

More information

Summary of U.S. Senate Finance Committee Health Reform Bill

Summary of U.S. Senate Finance Committee Health Reform Bill Summary of U.S. Senate Finance Committee Health Reform Bill September 2009 The following is a summary of the major hospital and health system provisions included in the Finance Committee bill, the America

More information

MCOs Revealed: Strategies for Building Strong Hospital & Referral Relationships

MCOs Revealed: Strategies for Building Strong Hospital & Referral Relationships MCOs Revealed: Strategies for Building Strong Hospital & Referral Relationships June 2014 avalerehealth.net Today s Panelists John Hackett - JHackett@extendicare.com o Vice President of Strategy & Development,

More information

Episode Payment Models:

Episode Payment Models: Episode Payment Models: Cardiac Bundle Initiative HFMA Florida Chapter (North Florida) October 25, 2016 Robert Howey MBA, MHA, CPA Revenue Cycle Manager 2016 MFMER slide-1 Objective After the session,

More information

Framework for Post-Acute Care: Current and Future Issues for Providers

Framework for Post-Acute Care: Current and Future Issues for Providers Framework for Post-Acute Care: Current and Future Issues for Providers Alan G. Rosenbloom Alliance for Quality Nursing Home Care March 2012 Overview of Presentation Post-Acute Care: Background and Trends

More information

HEALTH CARE REFORM IN THE U.S.

HEALTH CARE REFORM IN THE U.S. HEALTH CARE REFORM IN THE U.S. A LOOK AT THE PAST, PRESENT AND FUTURE Carolyn Belk January 11, 2016 0 HEALTH CARE REFORM BIRTH OF THE AFFORDABLE CARE ACT Health care reform in the U.S. has been an ongoing

More information

Key points. Home Care agency structures. Introduction to Physical Therapy in the Home Care Setting. Home care industry

Key points. Home Care agency structures. Introduction to Physical Therapy in the Home Care Setting. Home care industry Introduction to Physical Therapy in the Home Care Setting Home Health Section of APTA Key points Home care industry Client populations Prospective Payment System (PPS) Physical therapy services Assessment

More information

Quality, Cost and Business Intelligence in Healthcare

Quality, Cost and Business Intelligence in Healthcare Quality, Cost and Business Intelligence in Healthcare Maitri Vaidya Population Health Executive DBA, MHA, CPHQ May 2016 Where are we going? IHI Triple Aim Improve the patient experience of care Lower

More information

paymentbasics The IPPS payment rates are intended to cover the costs that reasonably efficient providers would incur in furnishing highquality

paymentbasics The IPPS payment rates are intended to cover the costs that reasonably efficient providers would incur in furnishing highquality Hospital ACUTE inpatient services system basics Revised: October 2015 This document does not reflect proposed legislation or regulatory actions. 425 I Street, NW Suite 701 Washington, DC 20001 ph: 202-220-3700

More information

Learning Objectives. CMS Plans to Transform Healthcare. Leveraging CDI to Improve Performance Under Alternative Payment Model (APM) Methodology

Learning Objectives. CMS Plans to Transform Healthcare. Leveraging CDI to Improve Performance Under Alternative Payment Model (APM) Methodology 1 Leveraging CDI to Improve Performance Under Alternative Payment Model (APM) Methodology Wayne Little, Partner Michelle Wieczorek, Senior Manager Ericson, Cheryl, Manager DHG Healthcare, Atlanta, GA Learning

More information

Quality Provisions in the EPM Proposed Rule. Matt Baker Scott Wetzel

Quality Provisions in the EPM Proposed Rule. Matt Baker Scott Wetzel Quality Provisions in the EPM Proposed Rule Matt Baker Scott Wetzel Overview Quality Scoring Overview Quality Metrics in AMI and CABG EPMs Quality Metrics in SHFFT EPMs COTH Performance in these programs

More information

Value Based Care: Trends for Boston Chicago Houston Los Angeles Miami San Francisco Washington, DC

Value Based Care: Trends for Boston Chicago Houston Los Angeles Miami San Francisco Washington, DC Value Based Care: Trends for 2018 Boston Chicago Houston Los Angeles Miami San Francisco Washington, DC Need head shot David Fairchild, MD Director BDC Advisors Dave Terry CEO & Co-Founder Archway Health

More information

What s Next for CMS Innovation Center?

What s Next for CMS Innovation Center? What s Next for CMS Innovation Center? A Guide to Building Successful Value-Based Payment Models Given CMMI s New Focus on Voluntary, Home-Grown Initiatives W W W. H E A L T H M A N A G E M E N T. C O

More information

Swapping, Kickbacks, Fair Market Value: Risks for a Post-Acute Provider

Swapping, Kickbacks, Fair Market Value: Risks for a Post-Acute Provider Swapping, Kickbacks, Fair Market Value: Risks for a Post-Acute Provider Alan Schabes, Partner Benesch, Friedlander, Coplan & Aronoff LLP Shannon Drake, VP, Associate General Counsel Kindred at Home Amanda

More information

Introduction 4/7/2015

Introduction 4/7/2015 The Perfect Storm: A Distinguished Post-Acute Rehabilitation Program (Session # W25) Wednesday April 29 th, 2:30-4:30 Presented by: Hilary Forman PT, RAC-CT Senior Vice President of Clinical Strategies

More information

CJR Final Rule: Policy Changes and Strategies for Bundled Payment Success

CJR Final Rule: Policy Changes and Strategies for Bundled Payment Success CJR Final Rule: Policy Changes and Strategies for Bundled Payment Success Melinda Hancock, Edward Stall, Craig Tolbert, Michael Wolford Friday, November 20, 2015 1 Agenda 1) Overview of CJR Model 2) Policy

More information

The Impact of Health Care Reform on Long- Term Care

The Impact of Health Care Reform on Long- Term Care The Impact of Health Care Reform on Long- Term Care AMY RUNGE, CPA Moss Adams LLP Partner & National Practice Leader, Long-Term Care MARCY BOYD, CPA Moss Adams LLP Partner September 22, 2014 1 The material

More information

Patient Selection, Optimization and Disposition: Tools for Success in Orthopedic Bundles

Patient Selection, Optimization and Disposition: Tools for Success in Orthopedic Bundles Patient Selection, Optimization and Disposition: Tools for Success in Orthopedic Bundles Luann Tammany Tribus, PT, MBA SVP, Clinical Strategy & Innovation Remedy Partners John Kilgore, MD Orthopedic Surgeon

More information

The Future of Post-Acute Care Under Value-Based Payment

The Future of Post-Acute Care Under Value-Based Payment The Future of Post-Acute Care Under Value-Based Payment Robert Mechanic, MBA Brandeis University Northeast Home Health Leadership Summit January 22, 2015 Medicare Margins for Freestanding Home Health Agencies

More information

Outcomes Measurement in Long-Term Care (LTC)

Outcomes Measurement in Long-Term Care (LTC) ASHA Short Course Outcomes Measurement in Long-Term Care (LTC) Bill Goulding, MS/CCC-SLP November 19, 2012 How Do We Show Value? Easy to measure! Not so easy! V $$$ A L Impact? Cost U Benefit E What do

More information

Comprehensive Care for Joint Replacement (CJR) Readiness Kit

Comprehensive Care for Joint Replacement (CJR) Readiness Kit Comprehensive Care for Joint Replacement (CJR) Readiness Kit Contents CMS Announces Shift From Volume To Value...2 Top Things To Know About CJR Final Rule...3 Proposed Timeline For CJR...4 Who Is Impacted?...5

More information

3/16/2016. Swapping, Kickbacks, Fair Market Value: Risks for a Post-Acute Provider. AKS designed to prevent improper referrals, which can lead to:

3/16/2016. Swapping, Kickbacks, Fair Market Value: Risks for a Post-Acute Provider. AKS designed to prevent improper referrals, which can lead to: Swapping, Kickbacks, Fair Market Value: Risks for a Post-Acute Provider Alan Schabes, Partner Benesch, Friedlander, Coplan & Aronoff LLP Shannon Drake, VP, Associate General Counsel Kindred at Home Amanda

More information

The Future of Healthcare Delivery; Are we ready?

The Future of Healthcare Delivery; Are we ready? The Future of Healthcare Delivery; Are we ready? Lisa K. Saladin, PT, PhD, FAPTA Dean and Professor Medical University of South Carolina copyright LisaSaladin 2016 Objectives 1. Discuss 5 of the projected

More information

Post-Acute Preferred Provider Arrangements Strategies for Partnership Transacting in the Post-Acute Care Space Crash Course November 28, 2017

Post-Acute Preferred Provider Arrangements Strategies for Partnership Transacting in the Post-Acute Care Space Crash Course November 28, 2017 Post-Acute Preferred Provider Arrangements Strategies for Partnership Transacting in the Post-Acute Care Space Crash Course November 28, 2017 2017 Epstein Becker & Green, P.C. All Rights Reserved. ebglaw.com

More information

September 6, RE: CY 2017 Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems Proposed Rule

September 6, RE: CY 2017 Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems Proposed Rule September 6, 2016 VIA E-MAIL FILING Centers for Medicare & Medicaid Services Department of Health and Human Services Attention: CMS-1656-P P.O. Box 8013 Baltimore, MD 21244-1850 RE: CY 2017 Hospital Outpatient

More information

Wound Care Reimbursement. Things Are A-Changing!

Wound Care Reimbursement. Things Are A-Changing! Wound Care Reimbursement Things Are A-Changing! Kathleen D. Schaum, MS President Kathleen D. Schaum & Assoc., Inc. kathleendschaum@bellsouth.net 561-964-2470 Disclosure No relevant financial relationships

More information

MIPS, MACRA, & CJR: Medicare Payment Transformation. Presenter: Thomas Barber, M.D. May 31, 2016

MIPS, MACRA, & CJR: Medicare Payment Transformation. Presenter: Thomas Barber, M.D. May 31, 2016 MIPS, MACRA, & CJR: Medicare Payment Transformation Presenter: Thomas Barber, M.D. May 31, 2016 Michael Porter- Value Based Care Delivery, Annals of Surgery 2008 Principals: Define Value as a Goal Care

More information

ramping up for bundled payments fostering hospital-physician alignment

ramping up for bundled payments fostering hospital-physician alignment REPRINT May 2016 Angie Curry James P. Fee healthcare financial management association hfma.org ramping up for bundled payments fostering hospital-physician alignment AT A GLANCE When hospitals embark on

More information

August 25, Dear Ms. Verma:

August 25, Dear Ms. Verma: Seema Verma Administrator Centers for Medicare & Medicaid Services Hubert H. Humphrey Building 200 Independence Avenue, S.W. Room 445-G Washington, DC 20201 CMS 1686 ANPRM, Medicare Program; Prospective

More information

Objectives. Assisted Living. O 2 : Opportunities & Outcomes in Assisted Living. Presented by: Chief Clinical Officer

Objectives. Assisted Living. O 2 : Opportunities & Outcomes in Assisted Living. Presented by: Chief Clinical Officer O 2 : Opportunities & Outcomes in Assisted Living Presented by: Leigh Ann Frick, PT, MBA Chief Clinical Officer Melissa Moffitt, MS, CCC-SLP Senior Vice President of Senior Living Objectives Identify the

More information

(202) or CMS Proposals to Improve Quality of Care during Hospital Inpatient Stays

(202) or CMS Proposals to Improve Quality of Care during Hospital Inpatient Stays DEPARTMENT OF HEALTH & HUMAN SERVICES Centers for Medicare & Medicaid Services Room 352-G 200 Independence Avenue, SW Washington, DC 20201 FACT SHEET FOR IMMEDIATE RELEASE April 30, 2014 Contact: CMS Media

More information

HCCA South Central Regional Annual Conference November 21, 2014 Nashville, TN. Post Acute Provider Specific Sections from OIG Work Plans

HCCA South Central Regional Annual Conference November 21, 2014 Nashville, TN. Post Acute Provider Specific Sections from OIG Work Plans HCCA South Central Regional Annual Conference November 21, 2014 Nashville, TN Kelly Priegnitz # Chris Puri # Kim Looney Post Acute Provider Specific Sections from 2012-2015 OIG Work Plans I. NURSING HOMES

More information

MACRA for Critical Access Hospitals. Tuesday, July 26, 2016 Webinar

MACRA for Critical Access Hospitals. Tuesday, July 26, 2016 Webinar MACRA for Critical Access Hospitals Tuesday, July 26, 2016 Webinar MACRA presenters Harold D. Miller, President & CEO CHQPR Claudia Sanders, Sr. Vice President, Policy Development Andrew Busz, Policy Director,

More information

Facing the Post-Acute Care Acuity Challenge

Facing the Post-Acute Care Acuity Challenge Post-Acute Care Collaborative Facing the Post-Acute Care Acuity Challenge Adjusting to the New Post-Acute Population Julia Burgdorf Senior Analyst burgdorj@advisory.com Road Map A Changing Population Sector

More information

Maximizing Success in a Bundled Payment Environment

Maximizing Success in a Bundled Payment Environment Maximizing Success in a Bundled Payment Environment Melinda S. Hancock, FHFMA,CPA Partner, DHG Healthcare 2015-16 Chair, HFMA Wisconsin January 2016 Go Beyond Current Experiences 2 Go Beyond the Status

More information

Leading Change: Using Quality Improvement Strategies, Data, and Culture to Drive Practice Transformation: The Power of Learning Networks

Leading Change: Using Quality Improvement Strategies, Data, and Culture to Drive Practice Transformation: The Power of Learning Networks Leading Change: Using Quality Improvement Strategies, Data, and Culture to Drive Practice Transformation: The Power of Learning Networks Annual Summer Institute hosted by Arizona State University July

More information

Reinventing Health Care: Health System Transformation

Reinventing Health Care: Health System Transformation Reinventing Health Care: Health System Transformation Aspen Institute Patrick Conway, M.D., MSc CMS Chief Medical Officer Director, Center for Clinical Standards and Quality Acting Director, Center for

More information

CRS Report for Congress Received through the CRS Web

CRS Report for Congress Received through the CRS Web CRS Report for Congress Received through the CRS Web Order Code RS20386 Updated April 16, 2001 Medicare's Skilled Nursing Facility Benefit Summary Heidi G. Yacker Information Research Specialist Information

More information

Value Based Care in LTC: The Quality Connection- Phase 2

Value Based Care in LTC: The Quality Connection- Phase 2 Value Based Care in LTC: The Quality Connection- Phase 2 Joseph J. Tomaino, M.S., R.N., Principal Healthcare Transformation Consulting ChemRx/PharmMerica Geriatric Skilled Nursing Seminar December 7, 2017

More information

How to Establish an Accountable Post-Acute Preferred Provider Network. November 14, 2016

How to Establish an Accountable Post-Acute Preferred Provider Network. November 14, 2016 How to Establish an Accountable Post-Acute Preferred Provider Network November 14, 2016 How to Establish an Accountable Post-Acute Preferred Provider Network Maura McQueeney, MPH, DNP President, Baystate

More information

April 26, Ms. Seema Verma, MPH Administrator Centers for Medicare & Medicaid Services. Dear Secretary Price and Administrator Verma:

April 26, Ms. Seema Verma, MPH Administrator Centers for Medicare & Medicaid Services. Dear Secretary Price and Administrator Verma: April 26, 2017 Thomas E. Price, MD Secretary Department of Health and Human Services Hubert H. Humphrey Building 200 Independence Avenue, SW Washington, DC 20201 Ms. Seema Verma, MPH Administrator Centers

More information

Creating a Virtual Continuing Care Hospital (CCH) to Improve Functional Outcomes and Reduce Readmissions and Burden of Care. Opportunity Statement

Creating a Virtual Continuing Care Hospital (CCH) to Improve Functional Outcomes and Reduce Readmissions and Burden of Care. Opportunity Statement Creating a Virtual Continuing Care Hospital (CCH) to Improve Functional Outcomes and Reduce Readmissions and Burden of Care Robert D. Rondinelli, MD, PhD Paulette Niewczyk, MPH, PhD AlphaFIM, FIM, SigmaFIM,

More information

Executive, Legislative & Regulatory 2018 AGENDA. unitypoint.org/govaffairs

Executive, Legislative & Regulatory 2018 AGENDA. unitypoint.org/govaffairs Executive, Legislative & Regulatory 2018 AGENDA unitypoint.org/govaffairs Dear Policy Makers and Community Stakeholders, In the midst of tumultuous times, we bring you our 2018 State Legislative Agenda.

More information

Medicare, Managed Care & Emerging Trends

Medicare, Managed Care & Emerging Trends Medicare, Managed Care & Emerging Trends LeadingAge Michigan 2015 Annual Leadership Institute August 12, 2015 Jon Lanczak, Manager Beth Sullivan, Senior Manager Plante Moran, PLLC Overall Theme Healthcare

More information

Health Reform and IRFs

Health Reform and IRFs American Medical Rehabilitation Providers Association 8 th Annual AMRPA Educational Conference New Orleans, LA Health Reform and IRFs Planning Today for Success Tomorrow October 14, 2010 Agenda Introduce

More information

Innovative Coordinated Care Delivery

Innovative Coordinated Care Delivery Innovative Coordinated Care Delivery The Arizona Readmissions Summit 2015, Mesa David W. Saÿen, MBA Regional Administrator Centers for Medicare & Medicaid Services San Francisco February 12, 2015 OUR STRATEGIC

More information

SNF * Readmissions Bootcamp The SNF Readmission Penalty, Post-Acute Networks, and Community Collaboratives

SNF * Readmissions Bootcamp The SNF Readmission Penalty, Post-Acute Networks, and Community Collaboratives SNF * Readmissions Bootcamp The SNF Readmission Penalty, Post-Acute Networks, and Community Collaboratives Lindsay Holland, MHA Associate Director, Care Transitions Health Services Advisory Group (HSAG)

More information

VALUE PAYMENT: A NEW REIMBURSEMENT SYSTEM USING QUALITY AS CURRENCY

VALUE PAYMENT: A NEW REIMBURSEMENT SYSTEM USING QUALITY AS CURRENCY VALUE PAYMENT: A NEW REIMBURSEMENT SYSTEM USING QUALITY AS CURRENCY Danielle Hansen, DO, MS (Med Ed), MHSA Healthcare Quality/ Value Challenge 1 Value-Based Programs Supports the IHI Triple Aim: 1. Better

More information

What is Value-Based Care

What is Value-Based Care Genesis HealthCare Value-Based Care Initiatives and BPCI Model 3 Aug 4, 2017 Copyright 2017 by Genesis HealthCare LLC. All Rights Reserved. What is Value-Based Care 2 Value-based care delivery is an approach

More information

Advances in Osteopathic Medicine

Advances in Osteopathic Medicine Advances in Osteopathic Medicine Moving the value of osteopathic care from patients to populations Richard Snow DO, MPH Applied Health Services - Principal Choptank Community Health System Primary Care

More information

3/19/2013. Medicare Spending Per Beneficiary: The New Link Between Acute and Post Acute Providers

3/19/2013. Medicare Spending Per Beneficiary: The New Link Between Acute and Post Acute Providers The New Link Between Acute and Post Acute Providers Carol Quiring, RN President and CEO, Home Care and Hospice Saint Luke s Health System Shauna Thompson, RHIT Senior Director, Quality & Patient Safety

More information

Risk Sharing in Medicare: Can it Work for You?

Risk Sharing in Medicare: Can it Work for You? 1 2013 CliftonLarsonAllen LLP Risk Sharing in Medicare: Can it Work for You? CLAconnect.com NAHC Financial Management Conference and Expo Nashville, TN June 29, 2015 Overview: Does the path to riskbased

More information

Post-Acute Care Alignment Strategy Management & Operations Track Tuesday, July 29, 4:45 5:45 pm

Post-Acute Care Alignment Strategy Management & Operations Track Tuesday, July 29, 4:45 5:45 pm Post-Acute Care Alignment Strategy Management & Operations Track Tuesday, July 29, 4:45 5:45 pm Lisa Lyons Executive Director St. Josephs John Knox John M. Hehn, Jr. Executive Director Florida Presbyterian

More information

Reducing Readmissions: Potential Measurements

Reducing Readmissions: Potential Measurements Reducing Readmissions: Potential Measurements Avoid Readmissions Through Collaboration October 27, 2010 Denise Remus, PhD, RN Chief Quality Officer BayCare Health System Overview Why Focus on Readmissions?

More information

Succeeding in a New Era of Health Care Delivery

Succeeding in a New Era of Health Care Delivery March 14, 2012 Succeeding in a New Era of Health Care Delivery Building Value-Based Partnerships LeadingAge Pennsylvania Kathleen Griffin, PhD, National Director Post-Acute and Senior Services 1 Your Presenter

More information

THE ALPHABET SOUP OF MEDICAL PAYMENTS: WHAT IS MACRA, VBP AND MORE! Lisa Scheppers MD FACP Margo Ferguson MT MSOM

THE ALPHABET SOUP OF MEDICAL PAYMENTS: WHAT IS MACRA, VBP AND MORE! Lisa Scheppers MD FACP Margo Ferguson MT MSOM THE ALPHABET SOUP OF MEDICAL PAYMENTS: WHAT IS MACRA, VBP AND MORE! Lisa Scheppers MD FACP Margo Ferguson MT MSOM THE REASON FOR CHANGE VOLUME TO VALUE Fee-for-service PAYMENT Bundled, Shared Patient FOCUS

More information

Quality Provisions in the EPM Final Rule. Matt Baker Scott Wetzel

Quality Provisions in the EPM Final Rule. Matt Baker Scott Wetzel Quality Provisions in the EPM Final Rule Matt Baker Scott Wetzel Overview Quality Scoring Overview Quality Metrics in AMI and CABG EPMs Quality Metrics in SHFFT EPMs COTH Performance in these programs

More information

Bundled Payments. AMGA September 25, 2013 AGENDA. Who Are We. Our Business Challenge. Episode Process. Experience

Bundled Payments. AMGA September 25, 2013 AGENDA. Who Are We. Our Business Challenge. Episode Process. Experience Bundled Payments AMGA September 25, 2013 Who Are We AGENDA Our Business Challenge Episode Process Experience 1 Cleveland Clinic is transforming Fee for service Fee for value 3 Fast Facts 41,200 employees

More information

The Future of Delivery System Reform in Medicare: Assessing the Evidence and Looking Ahead

The Future of Delivery System Reform in Medicare: Assessing the Evidence and Looking Ahead The Future of Delivery System Reform in Medicare: Assessing the Evidence and Looking Ahead Presented by the Kaiser Family Foundation November 28, 2017 Tricia Neuman Senior Vice President and Director,

More information

Connected Care Partners

Connected Care Partners Connected Care Partners Our Discussion Today Introducing the Connected Care Partners CIN What is a Clinically Integrated Network (CIN) and why is the time right to join the Connected Care Partners CIN?

More information

January 10, Glenn M. Hackbarth, J.D Hunnell Road Bend, OR Dear Mr. Hackbarth:

January 10, Glenn M. Hackbarth, J.D Hunnell Road Bend, OR Dear Mr. Hackbarth: Glenn M. Hackbarth, J.D. 64275 Hunnell Road Bend, OR 97701 Dear Mr. Hackbarth: The Medicare Payment Advisory Commission (MedPAC or the Commission) will vote next week on payment recommendations for fiscal

More information

Delivery System Reform The ACA and Beyond: Challenges Strategies Successes Failures Future

Delivery System Reform The ACA and Beyond: Challenges Strategies Successes Failures Future Delivery System Reform The ACA and Beyond: Challenges Strategies Successes Failures Future Arnold Epstein MSU 2018 Health Care Policy Conference April 6, 2018 The Good Ole Days 2 Per Capita National Healthcare

More information

10/20/2016. Working within the Value-Based World

10/20/2016. Working within the Value-Based World Working within the Value-Based World MGMA Annual Conference Roundtable Discussion Orthopedics Urology Surgery Monday, October 31, 2016 1 Learning Objectives Summarize key solutions used by other specialty

More information

Euclid Hospital CMS BPCI Episode

Euclid Hospital CMS BPCI Episode Euclid Hospital CMS BPCI Episode Two Paradigms in Health Care Reform Managing population 1 health, 2 PCMH Managing episodes of care, Bundled payments Health Status Baseline Episode Total Spend: Commercial

More information

Course Module Objectives

Course Module Objectives Course Module Objectives CM100-18: Scope of Services, Practice, and Education CM200-18: The Professional Case Manager Case Management History, Regulations and Practice Settings Case Management Scope of

More information