Bellagio, Las Vegas November 26-28, 2012 Claire Kapilow, Director, Regulatory Affairs Medicare s Inpatient Final Rule for 2013
|
|
- Garry Stephens
- 6 years ago
- Views:
Transcription
1 Bellagio, Las Vegas November 26-28, 2012 Claire Kapilow, Director, Regulatory Affairs Medicare s Inpatient Final Rule for 2013
2 Scan this image for a copy of this presentation to load to your QR enabled mobile device 2
3 Today s Topics Documentation and coding adjustments Coding update ICD-9, DRG, MCE, new technology changes ICD-10 Medicare status Changes in DRG weights Expiring programs (unless Congress acts) New or expanding programs Hospital acquired conditions Readmissions reduction Value based purchasing What to expect NOTE: Unless otherwise noted, all data cited in this presentation are from Medicare s 2013 Inpatient Final Rule, previous Final Rules, or studies that are cited in the Final Rule - Payment/AcuteInpatientPPS/FY-2013-IPPS-Final-Rule-Home-Page.html 3
4 Base operating amount: Total $$ = (base operating + base capital + hospital adjustments) * DRG weight 4
5 Standard Operating Rates For FY 2013, operating payments increase by almost 2.8%, adding more than $2 billion to hospital Medicare revenue Increase is based on: Market basket increase of 2.6 % Less 0.7 % productivity adjustment (from Reform legislation) Less 0.1 % sustainability adjustment (from Reform legislation) Less 1.9 % adjustment for documentation and coding changes Plus 2.9 % to back out a one-time documentation and coding adjustment from last year Total documentation and coding adjustments since 2008: -3.9% prospective/permanent, and -5.8% one-time recoupment 5
6 Thought We Would Never See Source: FY2013 IPPS Proposed Rule: 6
7 ICD-9-CM Code Changes Diagnoses: no new codes no codes deleted no code descriptions revised Procedures: 1 code added: injection or infusion of glucarpidase no codes deleted no code descriptions revised Moving towards ICD-10 FY2009: 427 new codes FY2010: 327 FY2011: 151 FY2012: 187 FY2013: 1 new code FY2014: no ICD-9 changes ever again???? 7
8 DRG Changes Respiratory System Influenza with pneumonia: Principal diagnosis influenza with pneumonia Secondary diagnosis pneumonia due to Klebsiella pneumoniae pneumonia due to Pseudomonas pneumonia due to Staphylococcus, unspecified methicillin susceptible pneumonia due to Staphylococcus aureus methicillin resistant pneumonia due to Staphylococcus aureus other Staphylococcus pneumonia pneumonia due to anaerobes pneumonia due to Escherichia coli [E. coli] pneumonia due to other gram-negative bacteria pneumonia due to Legionnaires' disease pneumonia due to other specified bacteria Move From DRGs Simple Pneumonia and Pleurisy ( ) To DRGs Respiratory Infections and Inflammations ( ) 8
9 DRG Changes Circulatory System Patients with abdominal aortic aneurysms Surgical repair: too risky Endovascular repair using endograft: poor seal may cause leaks Medical management: high risk for related morbidity and mortality Fenestrated (with holes) grafts: endovascular implantation of branching or fenestrated graft in aorta FDA approval April 2012 Cost $17,000 - $22,000 for device alone Standard grafts: DRGs Other Vascular Procedures ( ) Fenestrated: moved to DRGs 237, 238 Major Cardiovascular Procedures ( ) 9
10 DRG Changes Complications and Comorbidities Malnutrition: malnutrition of moderate degree: becomes CC malnutrition of mild degree: becomes CC unspecified protein-calorie malnutrition: already a CC Chronic occlusion of artery chronic total occlusion of artery of the extremities: becomes CC Acute kidney failure with lesions acute kidney failure with other specified pathological lesion in kidney: Moved from major CC to CC pressure ulcer unstageable move to MCC - denied 10
11 Medicare Code Edits New Edit continuous invasive mechanical ventilation for 96 hours or more Requires at least four days Impact on DRG assignment In the most recent MedPar data: Alternate codes available: continuous invasive mechanical ventilation for less than 96 hours continuous invasive mechanical ventilation of unspecified duration Claims with and LOS less than 4 days will be RTP 11
12 Medicare Code Edits Discontinued Edit NCD for Bariatric Surgery for Morbid Obesity 2009 Prohibits open or laparoscopic sleeve gastrectomy for morbid obesity New type of surgery: vertical (sleeve) gastrectomy New code laparoscopic vertical (sleeve) gastrectomy Coverage denied for obesity by CMS for FY2012 Added to MCE as non-covered Coverage decision issued June 27, 2012: covered when BMI >= 35 kg/m 2 At least one comorbidity related to obesity Previous medical treatments have been unsuccessful with principal diagnosis morbid obesity: removed from the MCE for FY
13 New Technology for FY2013 Auto Laser Interstitial Thermal Therapy: continued MRI-guided laser tipped catheter to destroy brain tumors Principal diagnosis of malignant neoplasm of brain Procedure code laser interstitial thermotherapy of lesion of brain Maximum additional payment $5,300 Glucarpidase (Voraxaze ): approved For leukemia and lymphoma patients with toxic methotrexate concentration Rapidly decreases levels of methotrexate (98% within 15 minutes) FDA approval January 2012 New technology payment for FY 2013: injection or infusion of glucarpidase (only new code for FY2013) Maximum additional payment $45,000 13
14 New Technology for FY2013 Fidaxomicin (DIFICID ): approved New treatment for diarrhea associated with Clostridium difficile Decrease hospitalizations, reduce recurrence, improve quality of life FDA approval May 2011 New technology payment FY2013 Diagnosis code intestinal infection due to Clostridium difficile NDC code (loop 2410, LIN03 of 837i) Maximum additional payment $868 Fenestrated AAA endovascular graft (Zenith F. Graft): approved DRG re-assignment and new technology payment Procedure endovascular implantation of branching/fenestrated grafts in aorta Maximum addition payment $8,
15 Medicare ICD-10 Progress Inpatient Acute Care MS DRGs draft published, updated V30 definitions posted today! V30 software early 2013 Medicare code edits draft published, updated POA coding rules draft published, updated Hospital acquired conditions draft published, updated New technology coding in process Other inpatient settings Psychiatric: ICD-10 DRGs, comorbidity tiers Rehabilitation: CMG assignment, comorbidity tiers Long Term Care: ICD-10 DRGs 15
16 Medicare ICD-10 Progress Inpatient Acute Care Medicare billing instructions published No ICD-9 codes, even for paper claims No mixed claims Cutover instructions provided across all care settings Special rules for 3-day window, critical access, anesthesia, others Claims that don t conform will be RTP, not denied For dates of service on or after October 1, 2014, claims may not contain ICD-9 codes. Please re-submit claim with the appropriate ICD-10 code. 16
17 DRG Weights Top Percentage Increases 17
18 DRG Weights Top 10 Percentage Decreases DRG MS-DRG Title 2012 Weights 2013 Weights 838 CHEMO W ACUTE LEUKEMIA SDX W CC OR HIGH DOSE CHEMO O.R. PROC W DIAGNOSES OF OTHER HEALTH SERVICES W MCC SKIN GRAFT FOR SKIN ULCER OR CELLULITIS W CC CARDIAC PACEMAKER DEVICE REPLACEMENT W MCC BILAT OR MULTI MAJOR JOINT PROCS LOWER EXTREM W MCC PROSTATECTOMY W MCC HEPATOBILIARY DIAGNOSTIC PROCEDURES W CC FRACTURES OF FEMUR W MCC ACUTE MAJOR EYE INFECTIONS W CC/MCC LIVER TRANSPLANT W/O MCC
19 DRG Weights Most Common DRGs 19
20 Expiring Programs Low Volume Previous: 25% more money for hospitals with Up to 200 total discharges No other hospitals within 25 miles Reform: up to 25% more money for hospitals with Up to 1600 Medicare discharges, Part A or Part C No other hospitals within 15 road miles Payment adjustment for each claim sliding scale, based on # discharges Temporary benefit expires effective 10/1/12 revert to previous rules 520 hospitals received increases during FY 2012 Very few qualify for FY 2013, unless Congress acts 20
21 Expiring Programs Productivity Bonus Reform: extra money for lowest Medicare spending per beneficiary Hospitals in most efficient counties get: FY2011: $150 million FY2012: $250 million 405 hospitals received bonus payments under this benefit Program expires 2013, although SPB measure lives on States with largest total benefit: 21
22 Expiring Programs Medicare Dependent Hospitals Small rural hospitals, with 60% Medicare discharges Not classified as a sole community hospital Paid based on eligible costs (75% of difference) Since 1997, set to expire 10/1/12, unless Congress acts States with most MDH: 22
23 New or Expanding Programs
24 Medicare Maze 24
25 Hospital Acquired Conditions 261 sets of MS-DRGs involve some type of CC or MCC split Presence of secondary diagnoses that are CC or MCC increase payment Secondary diagnoses that arise during the stay may be preventable CMS is required to identify specific secondary diagnoses High-cost complication that is potentially preventable Identifiable as arising during the stay based on POA indicator Pricing rules prevent increased payment when HAC is present $24 million in savings for FY2013 Mandated for Medicaid Moving to other settings 25
26 Hospital Acquired Conditions FY2012 Foreign object retained after surgery Air embolism Blood incompatibility Stage III and IV pressure ulcers Falls and trauma Manifestations of poor glycemic control Catheter-associated urinary tract infection Vascular catheter-associated infection Surgical site infection following Coronary artery bypass graft (Mediastinitis) Bariatric surgery for obesity Certain orthopedic procedures Deep vein thrombosis /pulmonary embolism following certain orthopedic procedures 26
27 Additional Hospital Acquired Conditions FY2013 Vascular catheter-associated infection Add bloodstream infection due to central venous catheter Add local infection due to central venous catheter Surgical site infection: Add Cardiac Implantable Electronic Device (CIED) procedures infection due to cardiac device, implant, graft other post-operative infection (list of CIED procedure codes) New: Iatrogenic Pneumothorax with Venous Catheterization iatrogenic pneumothorax venous catheterization 27
28 HAC Impact on DRG Assignment 28
29 Estimated Savings from HAC Program 29
30 Hospital Readmissions Reduction One in five seniors are readmitted within 30 days of discharge Study: 80% of readmissions could be avoided Study: 30% of potentially preventable readmissions are from Heart attack Heart failure Pneumonia Chronic obstructive pulmonary disease Coronary artery bypass graft surgery Percutaneous transluminal coronary angioplasty Other vascular procedures PPACA: mandated implementation of readmissions reduction program by 10/1/
31 How It Will Work Pick a historical data period (July 2008 through June 2011) Find all Medicare discharges for target groups: heart attack, heart failure, pneumonia For these discharges, identify preventable historical readmissions within 30 days of discharge Readmitted to any IPPS hospital Regardless of reason for admission Exclude planned readmissions, transfers, deaths, LAMA Develop a measure to compare readmission rates across hospitals in the historical period Publish those readmission rates for all to see Use them to reduce payment for all discharges in current period. 31
32 Readmission Reduction Factors In historical period, calculate Total payments for preventable readmissions e.g. $15,000 Total payments for all discharges e.g. $1,000,000 Calculate an adjustment factor = 1 (preventable$ / total$) e.g. 1 (15,000/1,000,000) = = Can t be less than the statutory floor FY2013: 0.99 FY2014: 0.98 FY2015: 0.97 Publish as Table 15 in Final Rule (and correction notice) IPPS hospitals only. Puerto Rico, Maryland excluded. 32
33 Readmission Reduction Factors - Connecticut 33
34 Hospital Compare 34
35 Impact on Reimbursement Calculate final payment as normal Then calculate payment reduction = (Base Operating DRG Payment Amount) x (1 - Adjustment Factor) Base Operating DRG Payment Amount is the wage-adjusted operating base rate, adjusted for transfers, times DRG weight, plus new technology add-on Subtract this amount from your final payment Does not affect IME, DSH, low-volume payments Sole Community Hospital adjustments Capital payments Outlier payments Pass-thru payments 35
36 Example 1: Community Hospital Standardized base operating: $ Wage index: , labor portion: 62% Wage adjusted base operating: $ DSH factor Total operating base: $ Total capital base: $ Total base rate: $ DRG weight: Total payment: $ * = $11, Readmissions reduction factor: Payment reduction: ( ) * * = $93.69 Final payment: $11, $93.69 = $11,
37 Example 2: Urban Academic Medical Center Standardized base operating: $ Wage index: , labor portion: 68.8% Wage adjusted base operating: $ DSH , IME Total operating base: $ Total capital base: $ Total base rate: $ DRG weight: Total payment: $ * = $47, Pass-through (DGME): 5 days at $200 per day: $1000 High charges add outlier $20,000 Total payment $68, Readmissions reduction factor: Payment reduction: ( ) * * = $ Final payment: $68, $ = $67,
38 What to Expect $300 million impact this year not budget neutral Future: Historical timeframe will change Statutory floor will decrease to 97% Program will expand to other clinical areas Chronic obstructive pulmonary disease? Coronary artery bypass graft surgery? Percutaneous transluminal coronary angioplasty? Other vascular procedures? What else? Medicaids also implementing readmissions reduction programs 38
39 Reform Mandate title42-vol2-sec pdf 39
40 Inpatient Quality Reporting (IQR) CMS has identified a series of quality measures that providers must report to receive full reimbursement under IPPS The measures are continually updated for: Changes in medical practice Availability of more appropriate measures Program requirements Basic principles that guide measure selection: Rely on standards, process, outcomes, and patient experience Align measures across Medicare and Medicaid Minimize the burden on providers to the extent possible Measures should be nationally endorsed by a multi-stakeholder organization Hospital Compare Website: 40
41 Hospital Compare 41
42 IQR Measures Added in FY 2013 Final Rule Percent of babies electively delivered prematurely Hospital-wide readmission rate Readmission following knee or hip replacement surgery Mean 6%, range 3% to 50% Post-op complications after knee or hip replacement surgery Joint infections, septicemia, bleeding and hematoma, death HCAHPS survey items Asked at discharge Staff took patient preferences into account for discharge planning Patient had clear understanding of patient responsibilities Patient understood purpose of all medications Patient mental health 59 active measures, apply for FY 2015 payment determination 42
43 Value Based Purchasing (VBP) Program Hospital receives penalty or bonus payment today, based on quality measures from a historical performance period Based on quality measures submitted under the IQR program Hospitals with low quality in selected measures: penalty Hospitals with high or increasing quality: bonus! Value based purchasing adjustments apply to all discharges Maximum impact: 1.00% in FY % in FY % in FY % in FY % in FY 2017 Program begins in January 2013, retroactive to October 1,
44 VBP Program Measures for FY
45 45
46 46
47 47
48 How it will Work Pick a baseline data period (July 2009 through March 2010) Pick an observation data period (July 2011 through March 2012) Review all selected quality data Develop a measure to compare quality across hospitals in the historical period Must reward both high performers and improving hospitals Assign VBP adjustment factors to every hospital Publish VBP adjustment factors for all to see Use these factors to adjust payments for all discharges in the current period 48
49 Hospitals with Greatest Loss (preliminary) 49
50 Hospitals with Greatest Gain (preliminary) 50
51 Impact on Payment Calculate final payment as normal Include IME, DSH, low volume, new technology, SCH, outlier, pass-through Then calculate payment reduction = (Base Operating DRG Payment Amount) x (1 - Adjustment Factor) Base Operating DRG Payment Amount is the wage-adjusted operating base rate, adjusted for transfers, times DRG weight, plus new technology add-on Subtract this amount from your final payment (Note: can be negative) Does not affect: IME, DSH, low volume payments SCH add-on payments Capital payments Outlier payments Pass-thru payments 51
52 Example 1: Community Hospital Standardized base operating: $ Wage index: , labor portion: 62% Wage adjusted base operating: $ DSH factor Total operating base: $ Total capital base: $ Total base rate: $ DRG weight: Total payment: $ * = $11, Value Based Purchasing factor: Payment reduction: (0.0100) * * = $93.69 Final payment: $11, $93.69 = $11,
53 Example 2: Community Hospital Standardized base operating: $ Wage index: , labor portion: 62% Wage adjusted base operating: $ DSH factor Total operating base: $ Total capital base: $ Total base rate: $ DRG weight: Total payment: $ * = $11, Value Based Purchasing factor: Payment increase: (0.0100) * * = $93.69 Final payment: $11, $93.69 = $11,
54 Example 3: Community Hospital in 2017 Standardized base operating: $ Wage index: , labor portion: 62% Wage adjusted base operating: $ DSH factor Total operating base: $ Total capital base: $ Total base rate: $ DRG weight: Total payment: $ * = $11, Readmissions reduction factor: , reduction $ Value Based Purchasing factor: , reduction $ Final payment: $11, $ = $11,
55 Example 4: Community Hospital in 2017 Standardized base operating: $ Wage index: , labor portion: 62% Wage adjusted base operating: $ DSH factor Total operating base: $ Total capital base: $ Total base rate: $ DRG weight: Total payment: $ * = $11, Readmissions reduction factor: , no reduction Value Based Purchasing factor: , payment increase $ Total payment: $11,
56 What to Expect FY 2014 new measures Postoperative Urinary Catheter Removal on Postoperative Day 1 or 2 Mortality within 30 days post discharge AMI Heart failure Pneumonia FY 2015 new measures Two outcome measures AHRQ Patient Safety Indicators composite measure Central Line-Associated Blood Stream Infection One efficiency measure Medicare spending per beneficiary Timeframes of historical and observation periods change Statutory floor increases to 2% by
57 Wrap Up
58 Thank You. Claire Kapilow, MSM Director of Regulatory Affairs
Medicare s Inpatient Final Rule for Claire Kapilow, Director, Regulatory Affairs
Medicare s Inpatient Final Rule for 2013 Claire Kapilow, Director, Regulatory Affairs Publisher Notice Although we have tried to include accurate and comprehensive information in this presentation, please
More informationAugust 1, 2012 (202) CMS makes changes 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 Contact: CMS Media Relations
More informationClinical Documentation: Beyond The Financials Cheryll A. Rogers, RHIA, CDIP, CCDS, CCS Senior Inpatient Consultant 3M HIS Consulting Services
Clinical Documentation: Beyond The Financials Cheryll A. Rogers, RHIA, CDIP, CCDS, CCS Senior Inpatient Consultant 3M HIS Consulting Services Clinical Documentation: Beyond The Financials Key Points of
More informationP4P Programs 9/13/2013. Medicare P4P Programs. Medicaid P4P Programs
P4P Programs Medicare P4P Programs Hospital Quality Reporting Programs (IQR and OQR) Hospital Value-Based Purchasing (VBP) Program Hospital Readmissions Reduction Program (HRRP) Hospital-Acquired Conditions
More informationCMS Quality Program- Outcome Measures. Kathy Wonderly RN, MSEd, CPHQ Consultant Developed: December 2015 Revised: January 2018
CMS Quality Program- Outcome Measures Kathy Wonderly RN, MSEd, CPHQ Consultant Developed: December 2015 Revised: January 2018 Philosophy The Centers for Medicare and Medicaid Services (CMS) is changing
More information(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 informationFY 2014 Inpatient Prospective Payment System Proposed Rule
FY 2014 Inpatient Prospective Payment System Proposed Rule Summary of Provisions Potentially Impacting EPs On April 26, 2013, the Centers for Medicare and Medicaid Services (CMS) released its Fiscal Year
More informationReimbursement Policy Subject: Present on Admission Indicator for Health Care-Acquired Conditions 06/01/12 05/02/16 Administration Policy
Reimbursement Policy Subject: Present on Admission Indicator for Health Care-Acquired Conditions Committee Approval Obtained: Section: Effective Date: 06/01/12 05/02/16 Administration *****The most current
More informationHOSPITAL QUALITY MEASURES. Overview of QM s
HOSPITAL QUALITY MEASURES Overview of QM s QUALITY MEASURES FOR HOSPITALS The overall rating defined by Hospital Compare summarizes up to 57 quality measures reflecting common conditions that hospitals
More informationReimbursement Policy Subject: Present on Admission Indicator for Health Care-Acquired Conditions 01/01/14 Administration 05/02/16
Anthem BlueCross BlueShield Medicaid Reimbursement Policy Subject: Committee Approval Obtained: Effective Date: 01/01/14 Section: Administration 05/02/16 ***** The most current version of our reimbursement
More informationProvider Preventable Conditions: Health Care Acquired Conditions and Present on Admission Policy
Provider Preventable Conditions: Health Care Acquired Conditions and Present on Admission Policy Policy Number 2018F7002A Annual Approval Date 3/14/2018 Approved By Reimbursement Policy Oversight Committee
More informationReimbursement Policy Subject: Present on Admission Indicator for Health Care-Acquired Conditions 04/01/14 Administration 05/02/16
Reimbursement Policy Subject: Present on Admission Indicator for Health Care-Acquired Conditions Committee Approval Obtained: Effective Date: 04/01/14 Section: Administration 05/02/16 ***** The most current
More informationAnalysis of Final Rule for FY 2009 Revisions to the Medicare Hospital Inpatient Prospective Payment System
Analysis of Final Rule for FY 2009 Revisions to the Medicare Hospital Inpatient Prospective Payment System The final rule regarding fiscal year (FY) 2009 revisions to the Medicare hospital inpatient prospective
More informationOverview of Final Rule for FY 2011 Revisions to the Medicare Hospital Inpatient Prospective Payment System
Overview of Final Rule for FY 2011 Revisions to the Medicare Hospital Inpatient Prospective Payment System The final rule regarding fiscal year (FY) 2011 revisions to the Medicare hospital inpatient prospective
More informationImproving quality of care during inpatient hospital stays
DEPARTMENT OF HEALTH & HUMAN SERVICES Centers for Medicare & Medicaid Services Room 352-G 200 Independence Avenue, SW Washington, DC 20201 Office of Communications FACT SHEET FOR IMMEDIATE RELEASE Contact:
More informationDisclosure of Proprietary Interest
HomeTown Health HCCS Hospital Consortium Project: Track 3- Clinical Documentation: Strategies for Sharpening Focus Jenan Custer RHIT, CCS, CPC, CDIP AHIMA Approved ICD-10-CM/PCS Trainer Director of Coding
More informationMedicare Value Based Purchasing August 14, 2012
Medicare Value Based Purchasing August 14, 2012 Wes Champion Senior Vice President Premier Performance Partners Copyright 2012 PREMIER INC, ALL RIGHTS RESERVED Premier is the nation s largest healthcare
More informationMedicare Quality Based Payment Reform (QBPR) Program Reference Guide Fiscal Years
julian.coomes@flhosp.orgjulian.coomes@flhosp.org Medicare Quality Based Payment Reform (QBPR) Program Reference Guide Fiscal Years 2018-2020 October 2017 Table of Contents Value Based Purchasing (VBP)
More informationMedicare Hospital Inpatient Prospective Payment System for Acute Care Hospitals Final 2016 Rates & Policies 1
Medicare Hospital Inpatient Prospective Payment System for Acute Care Hospitals Final 2016 Rates & Policies 1 Cardiac Rhythm Management (CRM) Market Impacts Introduction On August 3, 2015, the Centers
More informationQuality Based Impacts to Medicare Inpatient Payments
Quality Based Impacts to Medicare Inpatient Payments Overview New Developments in Quality Based Reimbursement Recap of programs Hospital acquired conditions Readmission reduction program Value based purchasing
More informationInpatient Quality Reporting Program
Hospital Value-Based Purchasing Program: Overview of FY 2017 Questions & Answers Moderator: Deb Price, PhD, MEd Educational Coordinator, Inpatient Program SC, HSAG Speaker(s): Bethany Wheeler, BS HVBP
More informationSubject: Hospital-Acquired Conditions (Page 1 of 5)
Subject: Hospital-Acquired Conditions (Page 1 of 5) Objective: I. To facilitate safe patient care for all Health Share/Tuality Health Alliance (THA) members. II. To encourage and support provider efforts
More informationValue-Based Purchasing & Payment Reform How Will It Affect You?
Value-Based Purchasing & Payment Reform How Will It Affect You? HFAP Webinar September 21, 2012 Nell Buhlman, MBA VP, Product Strategy Click to view recording. Agenda Payment Reform Landscape Current &
More informationpaymentbasics 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 informationHospital Acquired Conditions: using ACS-NSQIP to drive performance. J Michael Henderson Jackie Matthews Nirav Vakharia
Hospital Acquired Conditions: using ACS-NSQIP to drive performance J Michael Henderson Jackie Matthews Nirav Vakharia Your Team: Quality & Patient Safety Institute Cleveland Clinic Mike Henderson: Chief
More informationThe 5 W s of the CMS Core Quality Process and Outcome Measures
The 5 W s of the CMS Core Quality Process and Outcome Measures Understanding the process and the expectations Developed by Kathy Wonderly RN,BSPA, CPHQ Performance Improvement Coordinator Developed : September
More informationEssentials for Clinical Documentation Integrity 2017
Essentials for Clinical Documentation Integrity 2017 Prepared and Published By: MedLearn Publishing A Division of Panacea Healthcare Solutions, Inc. 287 East Sixth Street, Suite 400 St. Paul, MN 55101
More informationUNIVERSITY OF ILLINOIS HOSPITAL & HEALTH SCIENCES SYSTEM HOSPITAL DASHBOARD
UNIVERSITY OF ILLINOIS HOSPITAL & HEALTH SCIENCES SYSTEM HOSPITAL DASHBOARD January 19, 2017 UI Health Metrics FY17 Q1 Actual FY17 Q1 Target FY Q1 Actual Ist Quarter % change FY17 vs FY Discharges 4,836
More informationRegulatory 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 informationAny other findings required by other provisions of law as precondition to adoption or effectiveness of rule? Yes No If Yes, explain:
RULE-MAKING ORDER Agency: Health Care Authority, Medicaid Program CR-103P (May 2009) (Implements RCW 34.05.360) Permanent Rule Only Effective date of rule: Permanent Rules 31 days after filing. Other (specify)
More informationAccreditation, Quality, Risk & Patient Safety
Accreditation, Quality, Risk & Patient Safety Accreditation The Joint Commission (TJC) Centers for Medicare & Medicaid Services (CMS) Wyoming Department of Health (DOH) Joint Commission: - Joint Commission
More informationNational Provider Call: Hospital Value-Based Purchasing
National Provider Call: Hospital Value-Based Purchasing Fiscal Year 2015 Overview for Beneficiaries, Providers, and Stakeholders Centers for Medicare & Medicaid Services 1 March 14, 2013 Medicare Learning
More informationMedicare P4P -- Medicare Quality Reporting, Incentive and Penalty Programs
Medicare P4P -- Medicare Quality Reporting, Incentive and Penalty Programs Presenter: Daniel J. Hettich King & Spalding; Washington, DC dhettich@kslaw.com 1 I. Introduction Evolution of Medicare as a Purchaser
More informationValue Based Purchasing: Improving Healthcare Outcomes Using the Right Incentives
Value Based Purchasing: Improving Healthcare Outcomes Using the Right Incentives One (1.0) Contact Hour Course Expires: 1/15/2015 Course Published: 12/10/2013 Reproduction and distribution of these materials
More informationHealth Economics: Medicare and Medicaid Hospital Reimbursement
Health Economics: Medicare and Medicaid Hospital Reimbursement Jacobi Medical Center Noon Conference Feb 14, 2011 Colin D. Cha Fong Goals Brief introduction to Medicare and Medicaid How the hospital is
More informationMedicare Inpatient Prospective Payment System
Program Summary Medicare Inpatient Prospective Payment System Program Year: FFY 2013 Proposed Rule Table of Contents Overview... 1 Inpatient Payment Rates... 1 Updates to the Federal Operating, Hospital
More informationUI Health Hospital Dashboard September 7, 2017
UI Health Hospital Dashboard September 20 September 7, 20 UI Health Metrics FY Q4 Actual FY Q4 Target FY Q4 Actual 4th Quarter % change FY vs FY Discharges 4,558 4,680 4,720 Combined Observation Cases
More informationStar Rating Method for Single and Composite Measures
Star Rating Method for Single and Composite Measures CheckPoint uses three-star ratings to enable consumers to more quickly and easily interpret information about hospital quality measures. Composite ratings
More informationPROPOSED POLICY AND PAYMENT CHANGES FOR INPATIENT STAYS IN ACUTE-CARE HOSPITALS AND LONG-TERM CARE HOSPITALS IN FY 2014
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 Contact: CMS Media Relations
More informationUniversity of Illinois Hospital and Clinics Dashboard May 2018
May 17, 2018 University of Illinois Hospital and Clinics Dashboard May 2018 Combined Discharges and Observation Cases for the nine months ending March 2018 are 1.6% below budget and 4.9% lower than last
More informationWhat should board members know about new health care reform payment structures?*
What should board members know about new health care reform payment structures?* Passage and implementation of the Patient Protection and Affordable Care Act (ACA) has driven America s health care system
More informationImpacting Quality Initiatives through Documentation Improvement. Fran Jurcak, MSN, RN, CCDS Vice President of Clinical Innovation Iodine Software
Impacting Quality Initiatives through Documentation Improvement Fran Jurcak, MSN, RN, CCDS Vice President of Clinical Innovation Iodine Software Objectives The learner will be able to: Articulate the goals
More informationUnderstanding HSCRC Quality Programs and Methodology Updates
Understanding HSCRC Quality Programs and Methodology Updates Kristen Geissler, MS, PT, CPHQ, MBA Managing Director Beth Greskovich - Director Berkeley Research Group August 19, 2016 Maryland Waiver and
More informationTransitions 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(1) Provides a brief overview of CMS Medicare payment policy for selected HACs;
DEPARTMENT OF HEALTH & HUMAN SERVICES Centers for Medicare & Medicaid Services 7500 Security Boulevard, Mail Stop S2-26-12 Baltimore, Maryland 21244-1850 Center for Medicaid and State Operations SMDL #08-004
More informationMastering the Mandatory Elements of the Affordable Care Act. Melinda Hancock Walter Coleman
Mastering the Mandatory Elements of the Affordable Care Act Melinda Hancock Walter Coleman 1 ACA Gains through 2019 Amounts in Billions Source:CBO and Joint Committee on Taxation, 2010 Projection 2 Current
More informationCME Disclosure. HCAHPS- Hardwiring Your Hospital for Pay-for-Performance Success. Accreditation Statement. Designation of Credit.
CME Disclosure Accreditation Statement Studer Group is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. Designation
More informationMedicare Value-Based Purchasing for Hospitals: A New Era in Payment
Medicare Value-Based Purchasing for Hospitals: A New Era in Payment Daniel J. Hettich March, 2012 I. Introduction: Evolution of Medicare as a Purchaser Cost reimbursement rewards furnishing more services
More informationFacility State National
Percentage Summary Report Page 1 of 5 Data As Of: 07/27/2016 Total Performance Facility State National 35.250000000000 37.325750561167 35.561361414483 Unweighted Domain Weighting Weighted Domain Clinical
More informationCenters for Medicare & Medicaid Services (CMS) Quality Improvement Program Measures for Acute Care Hospitals - Fiscal Year (FY) 2020 Payment Update
ID Me asure Name NQF # Value- (VBP) - (HACRP) (HRRP) ID Me asure Name NQF # Value- (VBP) - (HACRP) (HRRP) CMS s - Fiscal Year 2020 Centers for Medicare & Medicaid Services (CMS) Improvement s for Acute
More informationThe 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 informationMedicare Inpatient Psychiatric Facility Prospective Payment System
Medicare Inpatient Psychiatric Facility Prospective Payment System Payment Rule Brief PROPOSED RULE Program Year: FFY 2016 Overview and Resources On April 24, 2015, the Centers for Medicare and Medicaid
More informationUNIVERSITY OF ILLINOIS HOSPITAL & HEALTH SCIENCES SYSTEM HOSPITAL DASHBOARD
September 8, 20 UNIVERSITY OF ILLINOIS HOSPITAL & HEALTH SCIENCES SYSTEM HOSPITAL DASHBOARD UI Health Metrics FY Q4 Actual FY Q4 Target FY Q4 Actual 4th Quarter % change FY vs FY Average Daily Census (ADC)
More informationProposed Rule Summary. Medicare Inpatient Psychiatric Facility Prospective Payment System: Federal Fiscal Year 2015
Proposed Rule Summary Medicare Inpatient Psychiatric Facility Prospective Payment System: Federal Fiscal Year 2015 June 2014 Table of Contents Overview and Resources 1 IPF Payment Rates 1 Effect of Sequestration
More information2013 Health Care Regulatory Update. January 8, 2013
2013 Health Care Regulatory Update January 8, 2013 Quality-Based Payment Reform, ACOs and Clinical Integration Bruce Johnson and Tom Donohoe Overview Quality-based payment reform programs Major programs
More informationPayment Rule Summary. Medicare Inpatient Psychiatric Facility Prospective Payment System: Update Notice for Federal Fiscal Year 2013
Payment Rule Summary Medicare Inpatient Psychiatric Facility Prospective Payment System: Update Notice for Federal Fiscal Year 2013 August 2012 Table of Contents Overview and Resources... 2 Inpatient Psychiatric
More informationFinal Rule Summary. Medicare Skilled Nursing Facility Prospective Payment System Fiscal Year 2016
Final Rule Summary Medicare Skilled Nursing Facility Prospective Payment System Fiscal Year 2016 August 2015 Table of Contents Overview and Resources... 2 SNF Payment Rates... 2 Effect of Sequestration...
More informationQuality Reporting in the Public Domain
Quality Reporting in the Public Domain Disclaimer This material is designed and provided to communicate information about inpatient coding, clinical documentation, and/or compliance in an educational format
More informationQuality Based Impacts to Medicare Inpatient Payments
Quality Based Impacts to Medicare Inpatient Payments Brian Herdman Operations Manager, CBIZ KA Consulting Services, LLC July 30, 2015 Overview How did we get here? Summary of IPPS Quality Programs Hospital
More informationThe dawn of hospital pay for quality has arrived. Hospitals have been reporting
Value-based purchasing SCIP measures to weigh in Medicare pay starting in 2013 The dawn of hospital pay for quality has arrived. Hospitals have been reporting Surgical Care Improvement Project (SCIP) measures
More informationDate Contact
Fiscal Year (FY) 2019 Medicare Hospital Inpatient Prospective Payment System (IPPS) and Long-Term Acute Care Hospital (LTCH) Prospective Payment System Final Rule (CMS-1694-F) Date 2018-08-02 Title Fiscal
More informationFinancial Policy & Financial Reporting. Jay Andrews VP of Financial Policy
Financial Policy & Financial Reporting Jay Andrews VP of Financial Policy 1 Members & Groups Supported Center for Healthcare Excellence Hospital Leadership & Quality Departments Hospital Finance Departments
More informationpaymentbasics Defining the inpatient acute care products Medicare buys Under the IPPS, Medicare sets perdischarge
Hospital ACUTE inpatient services system basics Revised: October 2007 This document does not reflect proposed legislation or regulatory actions. 601 New Jersey Ave., NW Suite 9000 Washington, DC 20001
More information2016 HCPro, a division of BLR. All rights reserved. These materials may not be duplicated without express written permission.
Potentially Preventable Complications: Getting the Whole Picture Cheryl Manchenton, RN, BSN, CCDS Project Manager/Quality Services Lead 3M HIS Consulting Services Atlanta, GA 1 Learning Objectives At the
More informationHospital Inpatient Quality Reporting (IQR) Program Measures (Calendar Year 2012 Discharges - Revised)
The purpose of this document is to provide a reference guide on submission and Hospital details for Quality Improvement Organizations (QIOs) and hospitals for the Hospital Inpatient Quality Reporting (IQR)
More informationPOLICIES AND PROCEDURE MANUAL
POLICIES AND PROCEDURE MANUAL Policy: MP209 Section: Medical Benefit Policy Subject: Medical Error Never Events, Hospital Acquired Conditions, and Hospital Readmission Review I. Policy: Medical Error Never
More informationQuality and Health Care Reform: How Do We Proceed?
Quality and Health Care Reform: How Do We Proceed? Susan D. Moffatt-Bruce, MD, PhD Chief Quality and Patient Safety Officer Associate Dean of Clinical Affairs Quality and Patient Safety Associate Professor
More informationJune 27, Dear Ms. Tavenner:
1275 K Street, NW, Suite 1000 Washington, DC 20005-4006 Phone: 202/789-1890 Fax: 202/789-1899 apicinfo@apic.org www.apic.org June 27, 2014 Ms. Marilyn Tavenner Administrator Centers for Medicare & Medicaid
More informationThe Wave of the Future: Value-Based Purchasing & the Impact of Quality Reporting Within the Revenue Cycle
The Wave of the Future: Value-Based Purchasing & the Impact of Quality Reporting Within the Revenue Cycle Kim Charland, BA, RHIT, CCS Senior Vice President Clinical Innovation and Publisher VBPmonitor
More informationClinical Documentation Improvement: Best Practice
Revenue Cycle Solutions Consulting and Management Services Clinical Documentation Improvement: Best Practice Our mission: To help you finance yours. 2 Managing Your Audio Use Telephone Use Microphone and
More informationProgram Summary. Understanding the Fiscal Year 2019 Hospital Value-Based Purchasing Program. Page 1 of 8 July Overview
Overview This program summary highlights the major elements of the fiscal year (FY) 2019 Hospital Value-Based Purchasing (VBP) Program administered by the Centers for Medicare & Medicaid Services (CMS).
More informationFinal Rule Summary. Medicare Skilled Nursing Facility Prospective Payment System Fiscal Year 2017
Final Rule Summary Medicare Skilled Nursing Facility Prospective Payment System Fiscal Year 2017 August 2016 Table of Contents Overview and Resources... 2 Skilled Nursing Facility (SNF) Payment Rates...
More informationMEDICARE INPATIENT PSYCHIATRIC FACILITY PROSPECTIVE PAYMENT SYSTEM
MEDICARE INPATIENT PSYCHIATRIC FACILITY PROSPECTIVE PAYMENT SYSTEM PAYMENT RULE BRIEF PROPOSED RULE Program Year: FFY 2019 OVERVIEW AND RESOURCES The Centers for Medicare & Medicaid Services released the
More informationMEDICARE FFY 2017 PPS PROPOSED RULES OVERVIEW OHA Finance/PFS Webinar Series. May 10, 2016
MEDICARE FFY 2017 PPS PROPOSED RULES OVERVIEW 2016 OHA Finance/PFS Webinar Series May 10, 2016 Spring is Medicare PPS Proposed Rules Season Inpatient Hospital Long-Term Acute Care Hospital Inpatient Rehabilitation
More informationHospitals and Health Systems "To Err Is Human" And Costly: Addressing The Potential Effects On Litigation Of So-Called "Never Events"
Health Lawyers Weekly December 19, 2008 Vol. VI Issue 48 Hospitals and Health Systems "To Err Is Human" And Costly: Addressing The Potential Effects On Litigation Of So-Called "Never Events" By Lisa Frye
More informationValue Based Purchasing
Value Based Purchasing Baylor Health Care System Leadership Summit October 26, 2011 Sheri Winsper, RN, MSN, MSHA Vice President for Performance Measurement & Reporting Institute for Health Care Research
More informationCHAPTER 12 -QUALITY MANAGEMENT AND PERFORMANCE IMPROVEMENT
CHAPTER 12 -QUALITY MANAGEMENT AND PERFORMANCE IMPROVEMENT 12.0 QUALITY MANAGEMENT REQUIREMENTS Health Choice Integrated Care works in partnership with providers to continuously monitor and improve the
More informationNational Patient Safety Goals & Quality Measures CY 2017
National Patient Safety Goals & Quality Measures CY 2017 General Clinical Orientation 2017 January National Patient Safety Goals 1. Identify Patients Correctly 2. Improve Staff Communication 3. Use Medications
More informationHospital-Acquired Condition Reduction Program. Hospital-Specific Report User Guide Fiscal Year 2017
Hospital-Acquired Condition Reduction Program Hospital-Specific Report User Guide Fiscal Year 2017 Contents Overview... 4 September 2016 Error Notice... 4 Background and Resources... 6 Updates for FY 2017...
More informationUser s Guide Tenth Edition
Long-term Acute Care Program for Evaluating Payment Patterns Electronic Report User s Guide Tenth Edition Prepared by Long-term Acute Care Program for Evaluating Payment Patterns Electronic Report User
More informationThe Nexus of Quality and Finance
The Nexus of Quality and Finance Kristen Geissler Pat Ercolano March 4, 2014 Transition from Volume to Value: IHI Triple Aim IHI Triple Aim Improve patient experience of care (quality & satisfaction) Improve
More informationimplementing a site-neutral PPS
WEB FEATURE EARLY EDITION April 2016 Richard F. Averill Richard L. Fuller healthcare financial management association hfma.org implementing a site-neutral PPS Congress is considering legislation that would
More informationThe Impact of Healthcare-associated Infections in Pennsylvania 2010
The Impact Healthcare-associated Infections in Pennsylvania 2010 Pennsylvania Health Care Cost Containment Council February 2012 About PHC4 The Pennsylvania Health Care Cost Containment Council (PHC4)
More informationConnecting the Revenue and Reimbursement Cycles
Connecting the Revenue and Reimbursement Cycles Tuesday, August 19 th, 2014 Toni G. Cesta, Ph.D., RN, FAAN Consultant and Partner Case Management Concepts New York Office And Bev Cunningham, MS, RN Vice
More informationRAC Targets, Bullseyes and Near Misses: What Your CDI Program Should Know
RAC Targets, Bullseyes and Near Misses: What Your CDI Program Should Know Barbara Flynn, RHIA, CCS, Certified AHIMA ICD-10-CM/PCS Trainer, ICD10 Ambassador Vice President for Health Information Management
More informationDC Inpatient APR-DRG Payment for Acute Care Hospitals
DC Inpatient APR-DRG Payment for Acute Care Hospitals Provider Training 2014 Xerox Corporation. All rights reserved. Xerox and Xerox Design are trademarks of Xerox Corporation in the United States and/or
More informationLearning 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 informationWelcome and Instructions
Welcome and Instructions For audio, join by telephone at 877-594-8353, participant code 56350822# Your line is OPEN. Please do not use the hold feature on your phone but do mute your line by dialing *6.
More informationHACs, Readmissions and VBP: Hospital Strategies for Turning Lemons into Lemonade
HACs, Readmissions and VBP: Hospital Strategies for Turning Lemons into Lemonade Jennifer Faerberg AAMCFMOLHS Jolee Bollinger Andy Ruskin Morgan Lewis 1 Value Based Purchasing Transforming Medicare from
More informationMinnesota Statewide Quality Reporting and Measurement System: Appendices to Minnesota Administrative Rules, Chapter 4654
This document is made available electronically by the Minnesota Legislative Reference Library as part of an ongoing digital archiving project. http://www.leg.state.mn.us/lrl/lrl.asp Minnesota Statewide
More informationAnalysis of Final Rule for FY 2007 Revisions to the Medicare Hospital Inpatient Prospective Payment System
Analysis of Final Rule for FY 2007 Revisions to the Medicare Hospital Inpatient Prospective Payment System The final rule regarding fiscal year (FY) 2007 revisions to the Medicare hospital inpatient prospective
More informationPerformance Payment: Never Pay for Never Events: Including Readmissions in Medicare s s (non-payment for) Hospital Acquired Conditions Policy
Performance Payment: Never Pay for Never Events: Including Readmissions in Medicare s s (non-payment for) Hospital Acquired Conditions Policy Peter McNair and Hal Luft Palo Alto Medical Foundation Research
More informationK-HEN Acute Care/Critical Access Hospitals Measures Alignment with PfP 40/20 Goals AEA Minimum Participation Full Participation 1, 2
Outcome Measure for Any One of the Following: Outcome Measures Meeting Either A or B: Adverse Drug Events (ADE) All measures are surveillance data Hospital Collected Anticoagulant (ADE-12) Opioid (ADE-111)
More informationHealth Care Associated Infections in 2015 Acute Care Hospitals
Health Care Associated Infections in 2015 Acute Care Hospitals Alfred DeMaria, M.D. State Epidemiologist Bureau of Infectious Disease and Laboratory Sciences Katherine T. Fillo, Ph.D, RN-BC Quality Improvement
More informationMinnesota Statewide Quality Reporting and Measurement System: APPENDICES TO MINNESOTA ADMINISTRATIVE RULES, CHAPTER 4654
Minnesota Statewide Quality Reporting and Measurement System: APPENDICES TO MINNESOTA ADMINISTRATIVE RULES, CHAPTER 4654 DECEMBER 2017 APPENDICES TO MINNESOTA ADMINISTRATIVE RULES, CHAPTER 4654 Minnesota
More informationFuture of Quality Reporting and the CMS Quality Incentive Programs
Future of Quality Reporting and the CMS Quality Incentive Programs Current Quality Environment Continued expansion of quality evaluation Increasing Reporting Requirements Increased Public Surveillance/Scrutiny
More informationMedicare Value Based Purchasing Overview
Medicare Value Based Purchasing Overview Washington State Hospital Association Apprise Health Insights / Oregon Association of Hospitals and Health Systems DataGen Susan McDonough Lauren Davis Bill Shyne
More informationUnmet Medical Product Needs Trends & Opportunities
Unmet Medical Product Needs Trends & Opportunities Medical Development Group www.meddevgroup.com November 5, 2008 Presented by Thomas Forest Farb Estabrook Ventures, LLC www.estabrookventures.com tfarb@estabrookventures.com
More informationEpisode 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 informationJune 24, Dear Ms. Tavenner:
1275 K Street, NW, Suite 1000 Washington, DC 20005-4006 Phone: 202/789-1890 Fax: 202/789-1899 apicinfo@apic.org www.apic.org June 24, 2013 Ms. Marilyn Tavenner Administrator Centers for Medicare & Medicaid
More information