Financial Policy & Financial Reporting. Jay Andrews VP of Financial Policy

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1 Financial Policy & Financial Reporting Jay Andrews VP of Financial Policy 1

2 Members & Groups Supported Center for Healthcare Excellence Hospital Leadership & Quality Departments Hospital Finance Departments Medicare Medicaid Workers Compensation Other VHHA Advocacy VHHA Data & Research Department VHHA Communications Department 2

3 Quality Support Hospital Readmissions Reductions (HRR) Program Hospital Acquired Condition (HAC) Program Value Based Purchasing Program (VBP) Medicare Spending Per Beneficiary (MSPB) Hospital Consumer Assessment of Health Plans Survey (HCAHPS) Scorecard 3

4 Readmission Reduction Penalty Ranking 4Q 2013 July 1, June 30, Q 2014 July 1, June 30, 2013 State Rank 2Q 2015 July 1, June 30, Q 2016 July 1, June 30, 2015 READM_30_AMI: Acute Myocardial Infarction (AMI) 30-Day Readmission Rate 38 of of of of 50 Readmission Ranks READM_30_HF: Heart Failure (HF) 30-Day Readmission Rate READM_30_PN: Pneumonia (PN) 30-Day Readmission Rate READM_30_HIP_KNEE: Elective Total Hip/Knee Surgery (THA/TKA) 30-Day Readmission Rate READM_30_COPD: Chronic Obstructive Pulmonary Disease (COPD) 30-Day Readmission Rate 32 of of of of of of of of of of of of 50 No Data 41 of of of 50 READM_30_CABG: Coronary Artery Bypass Graft (CABG) 30-Day Readmission Rate No Data 38 of of 50 4Q 2013 July 1, June 30, Q 2014 July 1, June 30, 2013 State Rates 2Q 2015 July 1, June 30, Q 2016 July 1, June 30, 2015 READM_30_AMI: Acute Myocardial Infarction (AMI) 30-Day Readmission Rate 18.7% 18.1% 17.5% 17.1% Readmission Rates READM_30_HF: Heart Failure (HF) 30-Day Readmission Rate READM_30_PN: Pneumonia (PN) 30-Day Readmission Rate READM_30_HIP_KNEE: Elective Total Hip/Knee Surgery (THA/TKA) 30-Day Readmission Rate READM_30_COPD: Chronic Obstructive Pulmonary Disease (COPD) 30-Day Readmission Rate 23.0% 22.9% 22.3% 22.1% 18.2% 17.9% 17.5% 17.8% 5.3% 5.3% 5.2% 4.9% No Data 21.2% 20.9% 20.6% READM_30_CABG: Coronary Artery Bypass Graft (CABG) 30-Day Readmission Rate No Data 15.3% 14.6% 4

5 HAC Program HAC Reduction Program Analysis Hospital Acquired Condition (HAC) Reduction Program: Performance Scorecard University of Virginia Health System Measure Performance: Actual FFY 2016 Performance Actual FFY 2017 Performance Estimated FFY 2018 Performance Domain 1: AHRQ Claims Based Measures Percentile Measure Points Percentile Measure Points National Mean Measure Z-Score PSI-90 Composite Measure 41st-50th 5 31st-40th Actual FFY 2016 Performance Actual FFY 2017 Performance Estimated FFY 2018 Performance Domain 2: CDC Chart Abstracted Measures Percentile Measure Points Percentile Measure Points National Mean Measure Z-Score HAI_1a: Central Line Associated Blood Stream Infection (CLABSI) (ICU-Only) 61st-70th 7 71st-80th HAI_2a: Catheter Associated Urinary Tract Infection (CAUTI) (ICU-Only) 71st-80th 8 61st-70th SSI: Pooled Surgical Site Infection (SSI) Standardized Infection Ratio 71st-80th 8 71st-80th HAI_5: Methicillin-resistant Staphylococcus Aureus (MRSA) Does Not Apply 61st-70th HAI_6: Clostridium difficile (C.diff.) Does Not Apply 71st-80th Under the HAC program, hospitals can score 1 to 10 points on each measure, where lower scores are better. Arrows are included to indicate hospital scoring trends over time, where arrows indicate hospital improvement while indicate poorer performance. Domain/Total HAC Score Performance: Actual FFY 2016 Performance Actual FFY 2017 Performance Estimated FFY 2018 Performance Domain Score Domain Weight Domain Score Domain Weight Domain Score Domain Weight Domain 1: AHRQ Claims Based Measures % % % Domain 2: CDC Chart Abstracted Measures % % % Total HAC Score Annual Program Impact Estimates: Actual FFY 2016 Performance Actual FFY 2017 Performance Estimated FFY 2018 Performance Hospital Total HAC Score th Percentile Total HAC Score Payment Penalty Determination Receives Penalty Receives Penalty Receives Penalty Estimated Annual Impact ($1,781,400) ($1,797,300) ($1,764,600) 5

6 VBP Medicare Hospital Value Based Purchasing (VBP) Impact Analysis VBP Performance Scorecard Federal Fiscal Years (FFYs) 2016 and 2017 Actual Program Performance Compared to Estimated FFY 2018 Program Performance Measure and Domain Score Comparison Hospital Performance FFY 2016 Program ACTUAL Performance FFY 2017 Program ACTUAL Performance FFY 2018 Program ESTIMATED Performance Estimated Estimated VBP Measure Score Hospital Performance VBP Measure Score Hospital Performance VBP Measure Score Impact Impact Estimated Impact Program Eligibility Eligible Eligible Projected to be Eligible AMI-7a N/A N/A N/A N/A PN % 4 $ 2,900 SCIP-Inf % 4 $ 2,900 Process of Care Clinical Care: Process (FFY 2017) SCIP-Inf % 10 $ 46,400 Measure Not Evaluated for VBP 2017 SCIP-Inf % 7 $ 24,700 SCIP-Card % 7 $ 24,700 SCIP-VTE % 10 $ 46,400 IMM % 4 $ 2, % 5 $ 28,300 Domain Not Evaluated for VBP 2018 PC-01 Measure Not Evaluated for VBP % 10 $ 109,500 Unweighted Domain Score 65.7% 75.0% Communication with Nurses 4 $ 5,000 3 $ (4,200) 80.0% 2 $ (17,600) Communication with Doctors 3 $ (7,700) 3 $ (4,200) 83.0% 3 $ 500 Responsiveness of Hospital Staff 0 $ (45,800) 0 $ (52,900) 62.0% 0 $ (53,600) Pain Management 2 $ (20,400) 3 $ (4,200) Measure Not Evaluated for VBP 2018 Patient Experience of Care Communication about Medicines 3 $ (7,700) 2 $ (20,400) 63.0% 0 $ (53,600) Not Provided By CMS Not Provided By CMS Cleanliness and Quietness of Hospital Environment 1 $ (33,100) 1 $ (36,600) 65.5% 0 $ (53,600) Discharge Information 6 $ 30,400 4 $ 12, % 3 $ 500 Overall Rating of Hospital 2 $ (20,400) 2 $ (20,400) 72.0% 2 $ (17,600) 3-Item Care Transition Measure Measure Not Evaluated for VBP 2016 Measure Not Evaluated for VBP % 2 $ (17,600) HCAHPS Consistency Score 19 $ 149, $ 186,500 N/A 17 $ 199,300 Unweighted Domain Score 40.0% 36.0% 29.0% MORT-30-AMI 85.3% 4 $ 11, % 8 $ 256, % 3 $ 1,600 Clinical Care: Outcomes (FFY ) MORT-30-HF 87.9% 0 $ (104,800) 88.5% 2 $ (68,000) 88.6% 1 $ (118,600) MORT-30-PN 90.5% 10 $ 185, % 10 $ 365, % 10 $ 422,400 Unweighted Domain Score 66.7% 46.7% PSI $ 185, $ 146, $ 155,300 Patient Outcomes Safety of Care (FFY ) PC-01 Measure Not Evaluated for VBP 2016 Measure Not Evaluated in this Domain for VBP $ 181,000 HAI_ $ (46,700) $ (70,500) $ (76,600) HAI_ $ (104,800) $ 81, $ 103,700 HAI_SSI N/A 2 N/A 4 N/A 5 $ (46,700) $ 16,100 HAI_SSI Submeasure: HAI_ $ 52,200 HAI_SSI Submeasure: HAI_ HAI_ $ 37,800 $ 129,500 Measure Not Evaluated for VBP 2016 HAI_ $ (27,200) $ (25,100) Unweighted Domain Score 40.0% 46.7% 58.6% Efficiency and Cost Reduction Medicare Spending per Beneficiary 94.0% 3 $ (77,000) 93.9% 3 $ (41,500) 94.0% 3 $ 4,800 Unweighted Domain Score 30.0% 30.0% 30.0% 6

7 VBP - Continued FFY 2016 Program ACTUAL Performance FFY 2017 Program ACTUAL Performance FFY 2018 Program ESTIMATED Performance TPS and Payment Impact Comparison Domain Score X Domain Weight = Weighted Score Estimated Impact Domain Score X Domain Weight = Weighted Score Estimated Impact Domain Score X Domain Weight = Weighted Score Estimated Impact Process of Care Domain (Clinical Care: Process) 65.7% X 10.0% = 6.6% $ 150, % X 5.0% = 3.8% $ 137,800 Domain Not Evaluated for VBP 2018 Patient Experience of Care Domain 40.0% X 25.0% = 10.0% $ 50, % X 25.0% = 9.0% $ 55, % X 25.0% = 7.3% $ (13,200) Clinical Care: Outcomes 66.7% X 25.0% = 16.7% $ 553, % X 25.0% = 11.7% $ 305,400 Patient Outcomes Domain 40.0% X 40.0% = 16.0% $ 80,100 Safety of Care 46.7% X 20.0% = 9.3% $ 183, % X 25.0% = 14.6% $ 520,100 Efficiency and Cost Reduction Domain 30.0% X 25.0% = 7.5% $ (77,000) 30.0% X 25.0% = 7.5% $ (41,500) 30.0% X 25.0% = 7.5% $ 4,800 Total Performance Score (TPS) 40.1% 46.3% 41.1% A VBP Contribution 1.75% $ 1,833, % $ 2,114, % $ 2,144,900 B VBP Slope C VBP Payment ( TPS X B ) 111.1% $ 2,037, % $ 3,003, % $ 2,961,900 VBP Adjustment Factor [ 1 + (( C x A ) - A ) ] $ 203,900 $ 889,100 Impact on IPPS Operating Payments 0.19% 0.84% 0.76% $ 817,000 7

8 MSPB 8

9 MSPB Con t Medicare Average Spending Per Beneficiary Medicare Average Spending Per Beneficiary Claim Type Hospital VA US Period Claim Type Hospital VA US Carrier $3,476 $2,975 $3,129 1 to 3 days Prior to Index Carrier $433 $526 $532 Durable Medical Equipment $157 $137 $134 Hospital Admission Durable Medical Equipment $7 $8 $9 Outpatient $537 $771 $827 Outpatient $28 $88 $117 Hospice $115 $112 $119 Hospice $0 $0 $1 Inpatient - Index $10,152 $9,100 $9,108 Inpatient $0 $5 $5 Inpatient - Other $2,670 $2,340 $2,670 Skilled Nursing Facility $0 $2 $2 Skilled Nursing Facility $2,210 $3,089 $3,253 Home Health Agency $17 $13 $13 Home Health Agency $828 $838 $784 Total $485 $642 $679 Total $20,145 $19,362 $20,024 During Index Hospital Carrier $1,988 $1,432 $1,514 Admission Durable Medical Equipment $23 $25 $24 Outpatient $0 $0 $0 Hospice $0 $0 $0 Inpatient $10,152 $9,100 $9,108 Skilled Nursing Facility $0 $0 $0 Home Health Agency $0 $0 $0 Total $12,163 $10,557 $10,646 1 through 30 days After Carrier $1,055 $1,017 $1,083 Discharge from Index Durable Medical Equipment $127 $104 $101 Hospital Admission Outpatient $509 $683 $710 Hospice $115 $112 $118 Inpatient $2,670 $2,335 $2,665 Skilled Nursing Facility $2,210 $3,087 $3,251 Home Health Agency $811 $825 $771 Total $7,497 $8,163 $8,699 All Claim Types in Episode $20,145 $19,362 $20,024 9

10 Quality Program Trends Report Patient Experience of Care Measures used for VBP Virginia Hospital Center The graphs in this analysis are set to display hospital performance relative to national performance (average and 90th percentile). As a result, the axis for each chart varies. 86% H_COMP_1_A_P: Communication with Nurses Hospital Score Best Decile Average 84% 82% 80% 78% Release Quarter 2Q Q Q Q Q Q Q Q Q Q Q Q 2017 Oct.1, Jan. 1, Apr. 1, July 1, Oct.1, Jan. 1, Apr. 1, July 1, Oct.1, Jan. 1, Apr. 1, July 1, Data Collection Dates Sept. 30, Dec. 31, 2013 Mar. 31, 2014 June 30, 2014 Sept. 30, Dec. 31, 2014 Mar. 31, 2015 June 30, 2015 Sept. 30, Dec. 31, 2015 Mar. 31, 2016 June 30, Hospital Score 83% 84% Unavailable 84% 84% 84% 84% 84% 83% 84% 84% 83% Best Decile 84% 85% 84% 85% 85% 85% 85% 85% 85% 85% 85% Average 79% 79% 79% 79% 79% 79% 80% 80% 80% 80% 80% 79% 79% 79% 79% 79% 79% 80% 80% 80% 80% 80% Rank in State 3 of 75 2 of 75 2 of 76 2 of 75 3 of 75 3 of 75 3 of 76 6 of 76 6 of 77 4 of 77 8 of 76 Rank in U.S. 472 of of of of of of of of of of of 3497 File includes trends for measures related to VBP & Readmissions 10

11 Scorecard 11

12 Medicare Policies Inpatient Outpatient Skilled Nursing Facility (SNF) Rehab Long Term Care Hospital (LTCH) Psych Home Health Wage & Occupational Mix Index Includes an analysis, analysis description and summary brief We submit a comment letters on the Proposed Rules 12

13 Inpatient Proposed Rule 13

14 Medicaid Items Rebasing & Inflation Adjustments DSH Changes IME Changes GME Changes EAPGs Outpatient payment methodology Medicaid Expansion Analyses Provider Assessments for Improved Medicaid Payments Commonwealth Coordinated Care Program (CCC Plus) 14

15 Medicaid Inflation Impacts 15

16 Other Federal Policy Items AHCA Repeal, Replace, Reform??? Trump Budget Bundled Payments Uncompensated Care Model (DSH Changes) S B Pharmacy Cost 16

17 Advocacy Related Support Third Party Payers Medicare Palmetto GBA Quarterly meetings & Q&A s Rehab Administrators Council - Quarterly Other items brought by the members Workers Compensation Fee Schedules go into place January 1, 2018 Still can have contracts Broken down by provider types and regions COPN Analyses, Maps and Other Data Pricepoint Transparency Tool 17

18 Potential COPN Impacts 18

19 All MRI s in Virginia

20 MRI s at Freestanding Facilties 20

21 MRI s in Rural Locations 21

22 VAPricepoint Being reviewed by finance folks and should be live next week 22

23 VAPricepoint Con t 23

24 Questions? 24

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