Industry Hot Points > CMS Update

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1 3RD QUARTER 2016 Care Points Welcome to Care Points Welcome to the 3rd Quarter 2016 edition of the Care Points Newsletter. This quarter s newsletter will focus on the following items: Industry Hot Points CMS Update Differences in Medicare Plans New Quality Measures Added to Five-Star Quality Ratings What s new at Omnicare The Omnicare App Customer Focus Point New Flu Vaccine Service Medicare Part D Enrollment Infusion Focus Point 2016 The Nurses Infusion Manual for LTC Facilities Release Industry Hot Points > CMS Update CMS recently published a final rule updating payments to skilled nursing facilities (SNFs) for FY 2017, which starts October 1. Under the final rule, SNFs will receive a net payment increase of 2.4% under the SNF Prospective Payment System, resulting in an aggregate total increase of $920 million. CMS also finalized specifications for the SNF Value Based Purchasing (VBP) Program, which is among CMS initiatives aimed at shifting Medicare payments from volume to value. Under the VBP program, a 2% reduction in SNF Part A payments will fund an incentive pool, whereby SNFs are eligible to earn back this payment adjustment based on performance on the SNF 30-Day Potentially Preventable Readmission quality measure. Of note, data collection on a facility s re-hospitalization rate that will inform performance on this measure will start in January The FY 2017 payment rule also finalized the following four quality measures as part of implementing the IMPACT Act of 2014: 1. Drug Regimen Review (DRR) Conducted with Follow-up for Identified Issues; 2. Medicare Spending Per Beneficiary; 3. Potentially Preventable 30 Day Post-Discharge Readmission; and 4. Discharge to Community. The DRR measure assesses whether PAC providers are responsive to potential or actual clinically significant medication issue(s) in a timely manner. Data collection on the DRR measure begins October 1, 2018 for FY 2020 payment determinations and beyond. SNFs that do not report required quality data to CMS will be subject to a 2% reduction in payments.

2 Industry Hot Points > Differences between Original Medicare and Medicare Advantage Plans People with Medicare can get their health coverage either through Original Medicare or a Medicare Advantage Plan. Here s a look at the differences between these two options: Costs Supplemental insurance Covers extra services like vision and dental? Lets me see providers nationwide? Need referrals to see specialists? Covers drugs? Out-of-pocket limit? Original Medicare You pay Medicare premiums, deductibles, and coinsurances (usually 20 percent of the Medicareapproved cost for outpatient care). You can buy a Medigap policy. (But only at certain times, depending on where you live.) No. Covers medically-necessary inpatient and outpatient health care. Doesn t cover certain services such as routine vision, hearing or dental care. Yes. You can go to any doctor or hospital in the U.S. that accepts Medicare. No. You don t need a referral. No, but if you want Medicare prescription drug coverage, you can buy a separate Part D plan. No. There s no cap on what you spend on health care. Medicare Advantage Plans You pay Medicare premiums and your plan s premium, if it charges one. Your plan sets its own deductibles and copays (usually a fixed cost for each office visit). You may pay the full cost if you don t follow your plan s rules. You can t buy a Medigap policy to help pay your out-of-pocket costs in a Medicare Advantage plan. Maybe. May cover some services Original Medicare doesn t cover such as routine vision, hearing and dental care. All plans must cover the same inpatient and outpatient services Original Medicare covers. Usually not. Most people have HMOs, which typically have local networks of providers you must use for the plan to cover your care. PPOs and PFFS plans should cover care you get outside the network, but you will pay more. Maybe. You often need to get a referral from your Primary Care Physician if you want to see a specialist. Usually. Most plans include Part D drug coverage. You usually can t get a separate Part D plan if you have a Medicare Advantage plan (some exceptions). Yes. Plans must have an annual out-of- pocket limit, which can be high but protect you if you need expensive care. The plan pays the full cost of your care after you reach the limit. Definitions Premium Deductible Copayment/Coinsurance Part A Part B Part D Medigap The monthly fee you pay to have Medicare What you must pay before Medicare starts paying for your care The amount you pay for each service Medicare hospital insurance for inpatient care Medicare medical insurance for outpatient care Medicare drug coverage Supplemental insurance that helps pay your out-of-pocket costs in Original Medicare For additional information, please visit Medicare Rights Center, Helpline: , Industry Hot Points continued on next page.

3 Industry Hot Points > New Quality Measures Added to Five-Star Quality Ratings Data for six new quality measures, some based on Medicare claims, others on MDS data, were added to Nursing Home Compare beginning in April The new measures are: 1 Percentage of short-stay (stays of less than or equal to 100 days) residents who have had an outpatient emergency room visit (Medicare claims-based) 2 Percentage of short-stay residents who were successfully discharged to the community, and did not die or were readmitted to a hospital or skilled nursing facility within 30 days of discharge (Medicare claimsbased) 3 Percentage of short-stay residents who were rehospitalized after SNF admission, including observation stays (Medicare claims-based) 4 Percentage of short-stay residents who made improvement in physical function and locomotion (MDS data-based) 5 Percentage of long-stay (stays of greater than or equal to 101 days) residents whose ability to move independently worsened (MDS-based) 6 Percentage of long-stay residents who received an anti-anxiety or hypnotic medication (MDSbased) CMS believes these measures will be useful to consumers and to nursing homes as they provide important information about quality of care outcomes. Five of the six new measures will be phased into the Five-Star Quality Ratings systems over a nine-month period, beginning this July. The measure on anti-anxiety and hypnotic medication use will be left out of the Five-Star system due to concerns about specificity and appropriate thresholds for star ratings.

4 What s New at Omnicare > Omnicare Digital Update: Launching November 2016! The Omnicare App The New Omnicare app will set a precedent in long-term care pharmacy by empowering facility staff to complete critical pharmacy transactions and monitor status conveniently from a mobile device, saving time and providing them with the information they need to most effectively manage care for their residents. Currently, Omnicare receives the majority of requests for medication refills via fax. Although facility staff receives a confirmation that the fax communication was received, they do not receive immediate confirmation of order acceptance or notification of any potential issues that may potentially delay delivery of the medication. This lack of transparency into the pharmacy workflow results in facility staff having to call the pharmacy to confirm order status and to address any issues with the refill, costing them time that could be spent caring for residents. The initial release of the Omnicare App (Nov 2016) includes Scan-to-Refill functionality that allows nurses in your facilities to initiate medication refills by securely logging in and scanning the prescription bar code using an Android or iphone. Once the Rx is scanned and submitted, the nurse will receive immediate confirmation of submission or notification of any issues there may be in completing the refill including; refill too soon or prior authorization required. Omnicare App Secure Login Getting started is easy. For staff currently using Omniview, our industry leading pharmacy portal, users simply download the App to the device, login with their existing Omniview login and password and start scanning refills. Staff not currently registered with Omniview will need to complete the Omniview Registration in order to use the Omnicare App. Potential App functionality is currently being evaluated for future releases and includes: Visibility to order and delivery status Proactive delivery issue notifications Messaging capabilities Exception resolution Using electronic channels including the New Omnicare App to order refills helps us process pharmacy orders more efficiently, helping to improve medication availability, reduce costs and improve clinical outcomes for the residents you serve. Scan to refill functionality Instant order confirmation or notification of issues If you would like more information about the Omnicare App contact your Omnicare Representative.

5 Customer Focus Point NEW Flu Vaccine Services As part of CVS Health, we now have expanded capabilities to offer on-site flu vaccination clinics for residents and employees in assisted living communities. CVS pharmacists and interns will be administering the vaccinations. The clinics will be offering high-dose flu shots, specifically made for individuals 65 or older. Communities located within 30 miles of a CVS Pharmacy within the same state will be eligible for on-site vaccinations. This is a great opportunity for communities to ensure the health of their residents and staff during flu season. If you are interested in having an on-site clinic, contact your Omnicare representative or FluShots@Omnicare.com. Due to state-specific regulations, CVS Pharmacy is not able to conduct on-site clinics in Alabama, South Carolina, South Dakota, Wisconsin or Maine

6 Customer Focus Point Medicare Part D Enrollment Once again this year, we are approaching the Medicare Part D Annual Election Period (AEP) and Open Enrollment Period. As in past years, enrollment begins October 15 and ends on December 7. Plans will begin marketing October 1 and those who choose, or are assigned a new plan, will have an effective date of January 1, Through our online tool, OmniPlanFinder, residents can view the plans available to them and choose the one appropriate for their medication needs. Residents saved an average of over $900* by using OmniPlanFinder to switch their Medicare Part D plan last year. You can help your residents save money by directing them to log into MyOmniview or calling during the 2017 open enrollment period. As provided for in the Accountable Care Act, discounts afforded beneficiaries during the Coverage Gap (Donut Hole) will continue to increase. In the 2017 plan year, those who reach the Coverage Gap will receive a 49% discount on generic drugs purchased and a 60% discount on brand drugs purchased. We will continue our ongoing commitment to provide Medicare Part D education, an update on OmniPlanFinder and other timely information to our customers during the fall of We will once again be conducting educational webinars to provide Part D enrollment information as well as pertinent materials our valued customers will need to prepare for the 2017 enrollment. Discussion topics will be customized to targeted audiences, including Skilled Nursing Facilities, Assisted Living Communities and Resident/Families and Responsible Parties. More information will be forthcoming related to customer webinars that will be conducted in early October. Recordings of each webcast will be posted on Omniview and MyOmniview so that customers and families can have easy access for reference and training, should they be unable to attend one of the live webinars. *Based on 2016 enrollment data. Open enrollment period begins October 15 and ends December 7

7 Infusion Focus Point > 2016 Omnicare The Nurses Infusion Manual for LTC Facilities Release Omnicare/CVS is pleased to announce the upcoming release of The 2016 Nurses Infusion Manual for Long Term Care Facilities. The 2016 manual contains 92 clinical infusion procedures, 19 appendices, 28 skills checklists, 14 Infusion related care plans and 7 sample Infusion POS/MARs, all reflecting the most current infusion standards of practice in healthcare today. To support the release of the new manual, the following tools will be available on Omniview in the Infusion Reference Library, on October 1: Electronic version of the manual 2012 to 2016 Crosswalk to The Nurses Infusion Manual for LTC Facilities, crafted to assist with educating nursing staff on the changes made to the previous version of The Nurses Infusion Manual for LTC Facilities Recorded webinar to provide a review of the significant changes in the manual The Nurses Infusion Manual for Long Term Care Facilities Stay tuned for more information, including the opportunity to go green with an electronic version of the manual. Of note, for organizations that still prefer hard copy manuals, we anticipate distribution mid-late October. Looking ahead, effective January 1, 2017, The 2012 Nurses Infusion Manual for Long Term Care Facilities will become obsolete and removed from Omniview. Editorial Board Erica Burns-Grzelakowski-Senior Editor Director, Marketing Integration Beth Coryea, Pharm D-Senior Editor Senior Director, Account Management Barbara Connolly, MS, RPh Senior Director, Clinical Services Greg Sciarra, RPh Vice President, Internal Operations LTC Contributing Authors for this Issue: Nancy Losben, R.Ph. CCP, FASCP, CGP Chief Quality Officer Kelly D. Rennick Director, Digital Adoption Libby Terry Director, Government Affairs & Policy Robin Taylor Senior Director, Account Management Jim Vett, Senior Director AL Marketing and Communication