Euclid Hospital CMS BPCI Episode
|
|
- Alvin Lawrence Holmes
- 5 years ago
- Views:
Transcription
1 Euclid Hospital CMS BPCI Episode
2 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 & Government Health Maintenanc e 40% Episodes 60% Source: Ohio.gov, McKinsey 2
3 Center for Medicare & Medicaid Innovation (CMMI) ACO Affordable Care Act Charged CMS to Explore Innovative Payment Models Bundled Payments for Care Improvement (BPCI) 4 Models Model 2: Retrospective Acute Care Hospital Stay & Post Acute Care 3
4 Value is Created by Care Redesign Traditional fragmented delivery Cost Value creation New Model of Care Time 4
5 Contracting through BPCI, CC Retains Most of Value Created Savings CMS cost savings contracted at 3% Cost Facility opportunity Care Improvement New model of care Time 5
6 Care Improvement is a Pre Requisite for Bundled Payment 1. Care Path Implementation 2. Care Coordination 3. Connected Care BPCI readiness was enabled by integration of enterprise care redesign efforts 6
7 Financial Evaluation of the Opportunity CMS provided historic hospital specific MSPB* for the episode and required a 3% discount Financial impact of: Reductions in post acute spend Reductions in readmissions Key Findings: Significant portion of unwarranted variation in episode spend occurs in post acute utilization Euclid s historic discharge to home rate: 22% *Medicare Spend per Beneficiary 7
8 Euclid Hospital BPCI Summary Bundle MS DRGs 469 & 470 Primarily Total hip/knee replacements Episode Duration 7 days prior, 30 days post Target Price $ (DRG 470) / $ (469) Contract 3 years (10/1/13 9/30/16) extension to
9 Key Provisions: Waivers and Gainsharing Waivers 3 day hospital stay for PAC payment Home bound status for Home Care Gainsharing Opportunity to share risk and reward among providers Our integrated system allowed us to move forward with or without gainsharing 9
10 Care Redesign Total Joint Complete Care Patient Selection Patient Optimization Operative Intervention Post Operative Hospital Stay Post Hospital Long Term Maintenance
11 Euclid Hospital s Implementation Program for BPCI Care Advocate Patient Education & Engagement Compliance Program Care Path Implementation Clinical and Financial Database Quality Score Card Monitor Financial Performance Optum Bundling Tool 11
12 Episode value scorecard Clinical Outcomes Patient Safety Process measures Physical Therapy day of surgery Decrease in pain medications needed Compliance with Care Path Core measures Patient optimization prior to surgery Outcomes measures PRO, Koos/Hoos Return to work/sports Range of motion PT test, Pain free Pt safety indicators, SSI, Readmissions, Reoperations, Post Operative falls, Post Op Nausea/vomiting Transfusion Process measures Outcomes measures Patient Experience Patient and family education Engaged and activated patients Family/Support person involvement Quality shared decision making Appt. when wanted Feel prepared for discharge Joint Class HCAHPs Return/second surgery Efficiency Resource utilization Cost of care Utilization Review: avoiding unnecessary tests, Reduced LOS, Discharge disposition Rapid Recovery program Total cost of care Contributions to cost (acute, post acute venue, complications, readmissions) 12
13 Care Coordinator As the Orthopaedic Care Coordinator I reach out to patients prior to surgery and introduce myself I ensure we have accurate information on: Their care partner Their Home environment Their understanding of the journey they are about to embark on The home care agency or skilled nursing facility they would prefer
14 Care Coordinator Educate the patients during the Total Joint Replacement Group Class. Visit with the patients while they are in the hospital and address any needs that arise. Works very closely with the Nurse Manager, Nurses, Physical and Occupational Therapists, Case manager and the Social Worker. There is a Huddle Meeting every morning on the orthopaedic floor and discuss the patients and what their needs are.
15 Follow Up Phone Calls After the patient is discharged I conduct a follow up phone call asking about their: Pain Level Physical therapy at the home Appetite, Nausea, Vomiting Constipation Chest Pain/SOB Incision Site Any additional questions that they may have are also addressed
16 The Orthopaedic Surgeon s Office How things have changed..
17 The Office Visit The surgeon will discuss the patient s options with the patient and decide if surgery is right for that patient. The surgeon will determine the patient s readiness for surgery
18 Patient Optimization BMI Under 40 is a MUST HgA1C Less than 7 and being managed by primary care Anemia management Identifies patients early for time to choose treatment options, other than transfusion MRSA decolonization Completed preoperatively to allow for prophylaxis Smoking Cessation Referrals are given to assist cessation Information about infection risk, increased risk of clots and wound healing given to patients Some surgeons refuse to operate on smokers
19 Patients need to understand that is an Elective Surgery The patient will be able to plan and prepare their body and mind for a successful outcome. Medical conditions can be optimized Education is not at the time of surgery, but in advance for preparation and time to consider any additional questions We encourage our patient s to attend one of our Total Joint Replacement Group Classes. This is a 2 hour class conducted with a physical therapist and a nurse. The class goes through important information about presurgery preparation, the hospital stay and rehabilitation needs.
20 The Total Joint Replacement Group Class The class walks the patient through the knee or hip replacement surgery using models Precautions to follow after surgery Preparing the body (exercises to do prior to surgery and healthy eating before surgery helps the patient heal and recover after surgery) Preparing the home
21 Joint Class Continued: The class also offers an opportunity for the patients and family members or friends to ask questions. The Total Joint Replacement Group Class was designed to optimize the success of surgery, rehabilitation and function for years to come. The Total Joint Class information is consistent throughout the Cleveland Clinic Enterprise in content and structure
22 EDUCATIONAL BINDER We also provide our patients with an educational binder called THE PATIENT S GUIDE TO TOTAL JOINT REPLACEMENT AND COMPLETE CARE. The binder is given to the patients in the physician's office. We encourage our patients to bring this binder with them to the Joint Class and to the hospital the day of surgery. The Guide is also standardized and used throughout the Enterprise
23 DVD We supply the patient with a DVD called THE TOTAL EXPERIENCE. It is also available as a web link The DVD is taken home and viewed by the patient and their care partner s at their leisure. The DVD reinforces education on expectations and processes beginning in the surgeon s office all the way through discharge.
24 EMMI Patients are assigned a computer program called EMMI. The patient or family can sign into a smart device and view videos about: What to Expect During Your Hospital Stay What to Expect During Knee or Hip Surgery These are all tools that we are providing our patients to use prior to having surgery.
25 The Surgery and Stay Other cultural changes All staff are aware of the plan of care for each patient, whether they are planning to go home in 2 days or to a facility Pain medications have significantly evolved over the last few years from every patient having PCA pumps to oral medications The surgeons are not the only ones that have changedanesthesia care for these patients have also changed modalities. Spinals and nerve blocks are now the norm Equipment changes also evolved CPM machines and ice mans to name a few Physical therapy now sees patients the day of surgery
26 Goals for Acute Physical Therapy Safety Promote Early Mobility Ambulate at least 150ft. Perform functional mobility at supervised level or better D/C Home POD #2 except UKA POD #1 Home PT D/C SNF early if needed POD #2
27 POD # 0 Evaluation bedside Discuss home environment, assist available at d/c and barriers to d/c Anti embolics and ROM therapeutic exercise Education WB, Precautions, POC, safety Attempt ambulation (minimally dangle at EOB) Out of bed in bedside chair Build confidence Address pt and family concerns
28 POD # 1 BID PT, Bedside and Department Decide appropriate ambulation device Gait training, therapeutic exercise, ROM, stairs Possibly issue equipment, car transfer Pt and family education and review D/C home for UKA Adductor block still affective for pt with TKA
29 POD # 2 Reinforce education Continue functional mobility training promoting independence 1 2 sessions depending on needs D/C home vs. requiring more time If appropriate, d/c to SNF (7 10 days) Adductor block no longer working for TKA
30 POD # 3 PT as needed to D/C can be BID OT usually 1 2 treatments through Acute stay
31 Barriers Limited to no Assist at D/C Poor prior functional level Decreased pain tolerance Medical Complications (i.e.: infection, confusion) not common Physiologic response Hypotensive Nausea Poor pain tolerance\comorbidities Fear
32 Assist Level Needed at d/c Minimally for transportation and lifting objects (laundry, shopping) Ideally assist 1 2 times per day for ADLs and IADLs Typically do not need assist for mobility of the pt Set up assist for exercise, and ADLs ideal Set up home safety prior to d/c home i.e.: RTS, throw rugs
33 Ways to promote home going Prepare before the surgery Exercise before the surgery Attend Joint Class Joint DVD has examples of exercises to be done after surgery for reference Ask questions
34 Transition the Continuum of care to Home Use of SNF risk assessment tool to predict referrals for homecare discharge disposition Internal process to track orthopedic patients in hospital Communication to hospital case managers during transition to home
35 Ongoing complete care Therapeutic exercise program strengthening/range of motion balance training ambulation training stair training Medication review Incision care Fall prevention
36 Ongoing complete care DVT management/edema control Vital signs Constipation education Pain management Pain medication prior to visit Ice area following visit Discharge planning Arrange outpatient services
37 Ongoing Care Preparing The Home for THA/TKA Recovery Adaptive equipment Ambulation aids Easy access /Traffic pattern Stair climbing
38 Integrated Team Communication Encourage family/caregiver involvement Interconnected electronic documentation To the surgical team for patient updates To the patient care advocates
39 But. Not all patients go Home. Why? No care partners Non conducive home environments Additional therapy requirements (Not Safe) Medical Conditions preclude it
40 Skilled Nursing Facilities Have met with our local SNF s to educate on the BPCI project and bundling Case Management works closely with the patients preferred facilities for early discharge (waiver) Care Coordinator reaches out to Skilled Nursing Facilities for updates on patient s progress The goal is to decrease LOS in these facilities as the patient condition allows. Target is 7 10 days. Historically stays were 23 days.
41
42 The Future of Bundles Commercial Payers Medicaid SIMS project Medicare Expansion
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 informationRedesigning 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 informationBundled 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 informationPartnerships: 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 informationCPAs & 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 informationHip Replacement Modern Total Hip Replacement in an Ambulatory Surgery Center. A Brief History of Total Hip Replacement
Modern Total Hip Replacement in an Ambulatory Surgery Center James T. Caillouette, M.D. Chairman Newport Orthopedic Institute 1 A Brief History of Total Hip Replacement Hip replacement 1990: LOS 7 Days
More informationHOSPITALS & 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 informationBUNDLE PAYMENT CARE INITIATIVE: Improved Care with Less Expense Joseph L. Verzal, MPAS, PA-C DISCLOSURES
BUNDLE PAYMENT CARE INITIATIVE: Improved Care with Less Expense Joseph L. Verzal, MPAS, PA-C DISCLOSURES I have no financial disclosures pertinent to this presentation. 1 GOALS Define the Bundle Payment
More information4/9/2016. 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 informationCare Redesign: An Essential Feature of Bundled Payment
Issue Brief No. 11 September 2013 Care Redesign: An Essential Feature of Bundled Payment Jett Stansbury Director, New Payment Strategies, Integrated Healthcare Association Gabrielle White, RN, CASC Executive
More informationPatient 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 informationThe National ACO, Bundled Payment and MACRA Summit. Success in Physician Led Bundles
The National ACO, Bundled Payment and MACRA Summit Success in Physician Led Bundles Disclaimer This material and/or presentation is provided for guidance and/or illustrative purposes only and should not
More informationBundled 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 informationMaking 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 informationTotal Knee Replacement
Total Knee Replacement Pre-operative Joint Class Updated: November 2017 Where to Begin Thank you for attending the UNC REX Joint Replacement Class today This presentation is designed to prepare you for
More informationData-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 informationSummary and Analysis of CMS Proposed and Final Rules versus AAOS Comments: Comprehensive Care for Joint Replacement Model (CJR)
Summary and Analysis of CMS Proposed and Final Rules versus AAOS Comments: Comprehensive Care for Joint Replacement Model (CJR) The table below summarizes the specific provisions noted in the Medicare
More information4/26/2016. The future is not what it used to be. Driving Transformation for Comprehensive Care for Joint Replacement (CJR) Understand Redesign Align
Driving Transformation for Comprehensive Care for Joint Replacement (CJR) Redesign Align 22 ND A N N U A L M ID W E S T C A R E C O O R D IN AT IO N C O N F E R E N C E The future is not what it used to
More informationTOTAL HIP REPLACEMENT FLOW SHEET
TOTAL HIP REPLACEMENT FLOW SHEET Before Surgery: Nothing to eat or drink after midnight the night before surgery. Make sure you have a bowel movement the day before surgery. Be sure to attend your pre-op
More informationTotal Hip Replacement
Total Hip Replacement Pre-operative Joint Class Updated: November 2017 Where to Begin Thank you for attending the UNC REX Joint Replacement Class today This presentation is designed to prepare you for
More informationCJR 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 informationTransforming Payment and Care Models for Total Joint Replacement. Stephen J. Zabinski, MD
Transforming Payment and Care Models for Total Joint Replacement Stephen J. Zabinski, MD Stephen John Zabinski, M.D. Director of the Division of Orthopaedic Surgery and Total Joint Replacement Services
More informationCare Redesign: Budgeted Episodes for Total Knee Replacement
Care Redesign: Budgeted Episodes for Total Knee Replacement Wade Johannessen, PhD Director, Sg2 Allen Marsh Ortho/Neuro Service Line Director CaroMont Health October 13, 2011 Chicago London www.sg2.com
More informationJOINT REPLACEMENT & OUTPATIENT BUNDLED PAYMENTS. Chris Bishop, CEO Regent Surgical Health
JOINT REPLACEMENT & OUTPATIENT BUNDLED PAYMENTS Chris Bishop, CEO Regent Surgical Health HISTORY OF JOINTS IN THE OUTPATIENT SETTING Initial Headwinds to Change Payors Surgeons Clinical Staff Strong leadership
More informationValue model in the new healthcare paradigm: Producing value at a single specialty center.
Value model in the new healthcare paradigm: Producing value at a single specialty center. State of Spine Surgery Think Tank June 17, 2017 Catherine MacLean, MD, PhD Chief Value Medical Officer Center for
More informationQuality, 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 informationC19: Patients at Home Hours After Total Joint Surgery
C19: Patients at Home Hours After Total Joint Surgery Kaiser Permanente Santa Clara Chris Boyd, Area Manager, Senior Vice President Ashima Garg, MD, PhD, Orthopedic Surgeon Session Objectives Implement
More information6.6 million. 3,400+ physicians & scientists. Cleveland Clinic bundled payment program key learnings
If you are considering implementing or expanding a bundled payment program, the Cleveland Clinic offers four key learnings. When Cleveland Clinic sought to develop a way to automate bundled payments around
More informationPartners in the Continuum of Care: Hospitals and Post-Acute Care Providers
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
More informationOUTPATIENT JOINT REPLACEMENT & BUNDLED PAYMENTS. Chris Bishop, CEO Regent Surgical Health
OUTPATIENT JOINT REPLACEMENT & BUNDLED PAYMENTS Chris Bishop, CEO Regent Surgical Health HISTORY OF JOINTS IN THE OUTPATIENT SETTING Initial Headwinds to Change Payors Surgeons Clinical Staff Strong leadership
More informationQuestions 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 informationAdvancing 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 informationPREPARING FOR RISK-BASED OUTCOMES OF BUNDLED CARE
CPAs & ADVISORS experience support // PREPARING FOR RISK-BASED OUTCOMES OF BUNDLED CARE Jackie Nussbaum MHA, CPC, CHFP, FHFMA Director Eric Rogers M.Ed. RT Managing Consultant THE CHANGING HEALTH CARE
More informationSurgical Directions
Surgical Directions 2015 1 Sample Clients (540+) and Growing! Surgical Directions has been the trusted partner in helping over 540 hospitals transform perioperative and anesthesia services. Surgical Directions
More informationNew 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 informationMEDICARE COMPREHENSIVE CARE FOR JOINT REPLACEMENT MODEL (CCJR) Preparing for Risk-Based Outcomes of Bundled Care 8/12/2015.
MEDICARE COMPREHENSIVE CARE FOR JOINT REPLACEMENT MODEL (CCJR) Preparing for Risk-Based Outcomes of Bundled Care August 13, 2015 Eric M. Rogers MEd RT(R) Managing Consultant erogers@bkd.com Jeff Bond President
More informationOver 200 ambulatory sites
Welcome to five inpatient hospitals: Tisch Hospital Rusk Rehabilitation NYU Langone Orthopedic Hospital NYU Langone Hospital - Brooklyn Hassenfeld Childrens Hospital with locations in New York City s five
More informationThe 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 informationPost-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 informationQuality Improvement Initiative (QII): 2018 Options
Quality Improvement Implementation, Option A: Increase Surgeon Engagement Outcome Measure: SSI Summary: Surgeon Engagement is essential for the success of quality improvement programs within hospitals.
More informationHip Replacement Surgery
Hip Replacement Surgery Preparation and Healing Introduction Congratulations. By considering hip replacement surgery, you re taking a giant step toward improving your mobility and relieving your pain.
More informationSpine Center at Riverview Medical Center. Pre-operative Spine Surgery Education Guide
Spine Center at Riverview Medical Center Pre-operative Spine Surgery Education Guide Welcome Welcome and thank you for choosing Riverview Medical Center for your spinal surgery. The Spine Center of Riverview
More informationComparison 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 informationEmerging 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 informationImproving Hospital Performance Through Clinical Integration
white paper Improving Hospital Performance Through Clinical Integration Rohit Uppal, MD President of Acute Hospital Medicine, TeamHealth In the typical hospital, most clinical service lines operate as
More informationRedesigning Health Care in an Accountable Care World
Redesigning Health Care in an Accountable Care World Jack Cox, MD: Chief Quality Officer Hoag Memorial Hospital Presbyterian, Newport Beach CA Diane Laird, MPH: Chief Executive Officer Greater Newport
More informationComprehensive 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 informationPhysician Performance Analytics: A Key to Cost Savings
Physician Performance Analytics: A Key to Cost Savings Session #90, February 21, 2017 Jim Gera, SVP of Business Development, Signature Medical Group, Inc. 1 Speaker Introduction Jim Gera, MBA SVP of Business
More informationPre-Operative Patient Education Class
Pre-Operative Patient Education Class Provide you with valuable information on what you may expect after surgery An opportunity to familiarize yourself with Grandview Medical Center and the staff who will
More informationQuality 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 informationSucceeding in Value-Based Care CareConnect Journey
Succeeding in Value-Based Care CareConnect Journey Donna Mueller VP Network Development dmueller@infinityrehab.com 360-201-2703 Jake Arrastia VP Strategy Development & Innovation jrarrastia@infinityrehab.com
More informationEffect of Colon Bundle Implementation in a Community Hospital. Michael Barringer, MD, FACS CHS Cleveland
Effect of Colon Bundle Implementation in a Community Hospital Michael Barringer, MD, FACS CHS Cleveland Doug Hobson, MD, Surgeon Champion Mike Barringer, MD, Surgeon Champion No Disclosures Except for
More informationMIPS, 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 informationBundled Payments KEY CAPABILITIES. for working with the Comprehensive Care for Joint Replacement (CJR) model
Bundled Payments KEY CAPABILITIES for working with the Comprehensive Care for Joint Replacement (CJR) model CJR Takes Aim at Variations in Care Cost and Quality Hip and knee replacements are among the
More informationQuality 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 informationGoals: Hospital Medicine at the Edges: A Specialty in Evolution Robert Harrington, MD, SFHM President, SHM
Hospital Medicine at the Edges: A Specialty in Evolution Robert Harrington, MD, SFHM President, SHM Goals: Understand the expanding scope of the hospitalist, particularly as it relates to specialist shortages
More informationPhysician Executive Council. Using the Perioperative Surgical Home to Improve Joint Replacement
Physician Executive Council Using the Perioperative Surgical Home to Improve Joint Replacement 9 Today s Presenters Julie Riley Physician Executive Council Senior Consultant 202-266-5628 RileyJu@advisory.com
More informationDRIVING 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 informationAlternative 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 informationSo You re Having a Total Hip Replacement?
So You re Having a Total Hip Replacement? Your team of nurses, surgeons, therapists and social workers are here to help you every step of the way. This presentation is meant to assist you before, during
More informationObservation Coding and Billing Compliance Montana Hospital Association
Observation Coding and Billing Compliance Montana Hospital Association Sue Roehl, RHIT, CCS sroehl@eidebaill.com 701-476-8770 IP versus Observation considerations Severity of patient s signs and symptoms
More informationEpisode 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 informationSeptember 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 informationKNOW YOUR BATNA: SHARED RISK AND FUTURE PAYMENT SYSTEMS DISCLOSURES OBJECTIVES
KNOW YOUR BATNA: SHARED RISK AND FUTURE PAYMENT SYSTEMS Stanley W. Stead, M.D., M.B.A. President, Stead Health Group, Inc. Section Chair, ASA Section on Professional Practice AMA Relative Value Update
More informationThe Cleveland Clinic s Journey from Volume to Value in the Era of Healthcare Reform
The Cleveland Clinic s Journey from Volume to Value in the Era of Healthcare Reform David L. Longworth, M.D. Chair, Medicine Institute Associate Chief of Staff, Clinical Integration Development Cleveland
More informationMedicare, 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 informationramping 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 informationThe Changing Face of the Employer-Provider Relationship
The Changing Face of the Employer-Provider Relationship Cleveland Clinic Market & Network Services Shannon Schwartzenburg August 21, 2013 Cleveland Clinic Snapshot Group practice model - 120 specialties
More informationKEY QUESTIONS TO ASK when choosing an orthopaedic program
7 KEY QUESTIONS TO ASK when choosing an orthopaedic program ASK THE RIGHT QUESTIONS so you can make the best choice The vast amount of information available to you makes choosing an orthopaedic surgery
More informationHome Assessments Resulting in a Positive Effect on Outcome Score Cards
Home Assessments Resulting in a Positive Effect on Outcome Score Cards Presented by: Angela Benson, OTR/L, Clinical Specialist *graduated from Mount Aloysius College, Cresson, PA *9 years of experience
More informationA 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 informationShifting from Volume to Value: The Future is Now
Shifting from Volume to Value: The Future is Now Kevin J. Bozic, MD, MBA Professor and Chair, Department of Surgery and Perioperative Care Dell Medical School at the University of Texas at Austin Visiting
More informationEmerging Trends in Outpatient Orthopedic Strategy
Service Line Strategy Advisor Emerging Trends in Outpatient Orthopedic Strategy April 2015 Cynthia Tassopoulos Analyst Service Line Strategy Advisor TassopoC@advisory.com Road Map 2 1 2 Impetus for Outpatient
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 informationOutcome-Based Pathways Unilateral Total Hip Replacement And Unilateral Total Knee Replacement
Outcome-Based Pathways Unilateral Total Hip Replacement And Unilateral Total Knee Replacement Overview, Guidelines and Glossary of Terms Table of Contents Overview... 3 Outcome-Based Pathway Structure...
More information4/10/2013. Learning Objective. Quality-Based Payment Models
Creating Best in Class Perioperative Services under Accountable Care and Value- Based Purchasing Becker s Healthcare Jeffry Peters Learning Objective How ACA/VBP changes how we measure surgical services
More informationPatient Reported Outcomes: How They Are Changing the Care We Provide to Our Patients
Patient Reported Outcomes: How They Are Changing the Care We Provide to Our Patients Judy Baumhauer MD MPH Professor and Associate Chair of Orthopaedics Disclosure: VP PROMIS Health Organization (PHO)
More informationNew SNF Quality Measures
New SNF Quality Measures Strategies to Boost your Facility Performance Dr. Kathleen Weissberg, OTD, OTR/L Education Director Select Rehabilitation kweissberg@selectrehab.com Objectives Understand the measure
More informationHOW BPCI EPISODE PRECEDENCE AFFECTS HEALTH SYSTEM STRATEGY WHY THIS ISSUE MATTERS
HOW BPCI EPISODE PRECEDENCE AFFECTS HEALTH SYSTEM STRATEGY Jonathan Pearce, CPA, FHFMA and Coleen Kivlahan, MD, MSPH Many participants in Phase I of the Medicare Bundled Payment for Care Improvement (BPCI)
More informationRE: Medicare Program; Request for Information Regarding the Physician Self-Referral Law
1055 N. Fairfax Street, Suite 204, Alexandria, VA 22314, TEL (703) 299-2410, (800) 517-1167 FAX (703) 299-2411 WEBSITE www.ppsapta.org August 24, 2018 Seema Verma, MPH Administrator Centers for Medicare
More informationSwapping, 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 informationIs HIT a Real Tool for The Success of a Value-Based Program?
Is HIT a Real Tool for The Success of a Value-Based Program? Sally Montes, MPH, RHIA, CCHP President, SM & Associates, Inc. smontes@sm-asociados.com (787) 306-1149 President, PR HFMA Chapter INTRODUCTION
More informationThe 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 informationHealthy Aging Recommendations 2015 White House Conference on Aging
Healthy Aging Recommendations 2015 White House Conference on Aging Chronic diseases are the leading causes of death and disability in the U.S. and account for 75% of the nation s health care spending.
More informationThe Cost of Care: Understanding the Next Generation of Payment Models
The Cost of Care: Understanding the Next Generation of Payment Models Presented by: Debbie Welle Powell, MPA, Vice President Sisters of Charity Health System and Exempla Healthcare September 27 th, 2012
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 informationOutpatient Surgery Guide
Outpatient Surgery Guide ORTHOPAEDIC SURGERY ortho.keckmedicine.org Keck Hospital of USC 1516 San Pablo Street, Los Angeles, CA 90033 1-800-USC-CARE WELCOME We want to welcome you to the services of the
More informationThe Evolving Landscape of Healthcare Payment: Incentive Programs and ACO Model Optimization. Quality Forum August 19, 2015
The Evolving Landscape of Healthcare Payment: Incentive Programs and ACO Model Optimization Quality Forum August 19, 2015 Ross Manson rmanson@eidebailly.com 701.239.8634 Barb Pritchard bpritchard@eidebailly.com
More informationDetermining the Appropriate Inpatient Rehabilitation Candidate
Determining the Appropriate Inpatient Rehabilitation Candidate Brandi Damron, OTR/L, MBA Program Director Norton Community Hospital Inpatient Rehab Unit Objectives Discuss the preadmission process limitations
More informationForces of Change- Seeing Stepping Stones Not Potholes
May 19, 2014 Forces of Change- Seeing Stepping Stones Not Potholes 2 3 4 Overview Demographics Long Term Care Financing Challenges Broad Health System Challenges Payment Reform Delivery System Reform Where
More informationWashington, DC Washington, DC Washington, DC Washington, DC 20515
The Honorable Dave Camp The Honorable Fred Upton Chairman Chairman Committee on Ways and Means Energy and Commerce Committee U.S. House of Representatives U.S. House of Representatives Washington, DC 20515
More informationCreating 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 informationJULY 2012 RE-IMAGINING CARE DELIVERY: PUSHING THE BOUNDARIES OF THE HOSPITALIST MODEL IN THE INPATIENT SETTING
JULY 2012 RE-IMAGINING CARE DELIVERY: PUSHING THE BOUNDARIES OF THE HOSPITALIST MODEL IN THE INPATIENT SETTING About The Chartis Group The Chartis Group is an advisory services firm that provides management
More informationORTHOPEDIC CERTIFICATION. Pathways to excellence in patient care
ORTHOPEDIC CERTIFICATION Pathways to excellence in patient care 1 JOINT COMMISSION CERTIFICATION PATHWAYS TO EXCELLENCE IN PATIENT CARE Accreditation is Just the Beginning For health care accreditation,
More information3/19/2013. 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 informationHealthcare Leadership Council: John Perticone Golden Living 3/9/2016
Healthcare Leadership Council: Care Transitions in Post Acute Care John Perticone Golden Living 3/9/2016 Golden Living Profile Golden Living Centers and Communities 296 skilled nursing facilities 15 assisted
More informationEnhanced Recovery After Surgery in OB/GYN
Enhanced Recovery After Surgery in OB/GYN Audra Williams, MD Ashley Wright, MD University of Alabama at Birmingham Department of OB/GYN Women s Reproductive Healthcare Division Outline Brief background
More informationRehabilitative Care Alliance
Rehabilitative Care Alliance Provincial Webinar January 10, 2018 12:00 1:00 p.m. For audio, you must call in by phone: (416) 764-8673 or Toll Free: 1-888-780-5892 Passcode: 7677451# Telephone lines open
More informationThe Challenges and Opportunities in Using Data Bundled Payment, Care Improvement
The Challenges and Opportunities in Using Data Bundled Payment, Care Improvement Helen Macfie, Pharm.D., FABC For IHI Leading Population Heath Transformation February, 2017 It started with a project PHYSICIAN
More information3/16/2016. 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