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 Landscape Value-Based Purchasing 30-day readmissions Hospital-acquired conditions Market basket reductions Multifactor Productivity Adj* Documentation and Coding Adj (DCA)** Across the board cuts to finance debt *** OCT 2011 OCT 2012 1.0% OCT 2013 1% 1.0% 2% 2.0% OCT 2014 OCT 2015 1.25% 1.5% 1.75% 3.0% 1.0% 0.1% 0.1% 0.2% OCT 2016 2.0% 0.75% OCT 2017 OCT 2018 OCT 2019 1.0% 0.7% 0.5% 0.5% 0.4% 0.5% 0.65% 0.9% 0.7% 4.9% 1.9% 2.1% 2.1% 2.1% 2.1% 2.0% OCT 2020 TOTAL IMPACT 6.0% 6.7% 8.1% 10.6% 10.5% 11.4% 9.3% 10% 9.4% 8.9% 8.7% % = % OF MEDICARE INPATIENT OPERATING PAYMENTS *The Multifactor Productivity Adjustment is an estimate generated by the CMS Office of the Actuary **DCA, also known as the behavioral offset, shown here does not show the future affects of these cuts on baseline spending. Estimates FY 2014-FY 2017 impact of the American Taxpayer Relief Act of 2012 *** If Congress has not adopted the Joint Committee s report to reduce the deficit by at least $1.2 trillion, the 2% cut will be implemented April 2013 3
Polling Question What do you consider as the tipping point (as a percentage of your revenues)? A. 10% B. 15% C. 25% D. 40% E. 50% F. More than 50%
Revenue Industry Tipping Point Time How do local market conditions impact timing considerations? Can market-changing events create an urgent paradigm shift? What is my step-change business model risk? Do I have the financial tools to adequately analyze relevant states? 5
Polling Question When will you hit your tipping point? A.Less than 2 years B.3-5 years C.5-7 years D.7-10 years E.10+ years
Hierarchy of Risk and Payment Models 7
Polling Question Are you participating today (or in the application process) for a program other than the mandatory programs? A.Yes B.No
Alignment of Strategy and Metrics Questions to Ask How many metrics am I tracking? How many metrics are duplicated? Do they have the same numerator and denominator? Source? Are they aligned with our results and strategic goals? What contracts are coming up for renewal that should have new metrics or should be at risk (mgd care, medical directorships, PMAs, etc.) What are we focused on? 9
Polling Question What level of internal controls do you currently have for the non claims related quality measures that are used for your at risk metrics? A.I don t know B.Minimum level C.Moderate but not adequate given risk level D.Moderate but adequate given risk level E.High level
Reform Timeline
Mandatory Element of Reform VALUE BASED PURCHASING
VBP Shifting of Domain Weights FY 2013 FY 2014 FY 2015 FY 2016 Core Measures Patient Experience Outcomes Efficiency (MSPB) 13
New NQS Based Domains for FY 2017 HCAHPS = 25% Clinical Care - Process = 5% Clinical Care - Outcomes = 25% Safety = 20% MSPB = 25% 14
Crosswalk from FY 16 to FY 17 Measure Prior Domain (FY 16) NQS Domain (FY 17) Core Measures Clinical Process of Care Clinical Care- Process HCAHPS Patient Experience of Care Patient & Caregiver Centered Experience of Care/Care Coordination CAUTI/CLABSI/SSI Outcomes Safety Mortality 3 diagnoses Outcomes Clinical Care- Outcomes PSI- 90 Outcomes Safety Medicare Spend Per Beneficiary Efficiency Efficiency & Cost Reduction 15
VBP FY13 Domain Weights Performance Period: July 1, 2011 March 31, 2012 Reimbursement Period: October 1, 2012 September 30, 2013 Core Measures = 70% 16
VBP FY14 Domain Weights Performance Period: April 1, 2012 December 31, 2012 Reimbursement Period: October 1, 2013 September 30, 2014 Outcomes = 25% Core Measures = 45% 17
VBP FY15 Domain Weights Performance Period: January 1, 2013 December 31, 2013 Reimbursement Period: October 1, 2014 September 30, 2015 HCAHPS = 30% Core Measures = 20% Outcomes = 30% MSPB = 20% One Measure!! 18
VBP FY16 Domain Weights Performance Period: January 1, 2014 December 31, 2014 Reimbursement Period: October 1, 2015 September 30, 2016 HCAHPS = 25% Core Measures = 10% MSPB = 25% Outcomes = 40% 19
VBP FY16 Domain Weights Performance Period: January 1, 2014 December 31, 2014 Reimbursement Period: October 1, 2015 September 30, 2016 Clinical Care - Process = 5% HCAHPS = 25% Clinical Care - Outcomes = 25% Safety = 20% MSPB = 25% 20
Value Based Purchasing Outcomes = Income Mandatory Pay for Performance Program 3,500 hospitals are included in this program across the country Reimbursement Determine Two Ways: Achievement How we compare to National Top Decile (350 Hospitals) Improvement How we measure against ourselves Did we do better than a previously measured baseline period 21
Value Based Purchasing Percent of Medicare Reimbursement at Risk FY 2013 1.00% FY 2014 1.25% FY 2015 1.50% FY 2016 1.75% FY 2017 2.00% FY 2018 2.00% FY 2019 2.00% FY 20xx refers to the Federal Fiscal Year (Oct. 1 Sep. 30) when DRG payments will be affected 22
Value Based Purchasing NEW MEASURES 23
VBP FY 2016 New Measures Patient Experience No Change Same HCAHPS Measures Core Measures 5 Dropped; 1 New Outcomes 3 New Measures Efficiency No Change 24
VBP FY 2016 New Measures Patient Experience No Change Same HCAHPS Measures Core Measures 5 Dropped; 1 New Outcomes 3 New Measures Efficiency No Change 25
VBP FY 2016 Patient Experience HCAHPS Hospital Consumer Assessment of Healthcare Providers Survey An engagement survey CMS has mandated each hospital give to every discharged inpatient Consists of 27 questions that lead to the 8 categories assessed for VBP Patients score each question on scale of 4 For answers to count, patients must give hospitals a score of 4 or Always 26
VBP FY 2016 Patient Experience Communication with Nurses Communication with Doctors Responsiveness of Hospital Staff Pain Management Communication about Medicines Cleanliness and Quietness of Hospital Discharge Information Overall Rating of Hospital 27
VBP FY 2016 New Measures Patient Experience No Change Same HCAHPS Measures Core Measures 5 Dropped; 1 New Outcomes 3 New Measures Efficiency No Change 28
VBP FY 2015 Core Measures AMI-7a AMI-8a HF-1 PN-3b PN-6 SCIP-Inf-1 SCIP-Inf-2 SCIP-Inf-3 SCIP-Inf-4 SCIP-Inf-9 SCIP-Card-2 SCIP-VTE-2 29
VBP FY 2016 Core Measures AMI-7a PN-6 SCIP-Inf-2 SCIP-Inf-3 SCIP-Inf-9 SCIP-Card-2 SCIP-VTE-2 IMM-2 Note: IMM-2 Performance Period is only 6 MONTHS (Two 3 Month Periods) January 1, 2014 March 31, 2014 AND October 1, 2014 December 31, 2014 30
VBP FY 2016 Core Measures Measure ID Benchmark AMI-7a 100% IMM-2 98.875% PN-6 100% SCIP-Inf-2 100% SCIP-Inf-3 100% SCIP-Inf-9 100% SCIP-Card-2 100% SCIP-VTE-2 100% 31
VBP FY 2016 Core Measures AMI-7a PN-6 SCIP-Inf-2 SCIP-Inf-3 SCIP-Inf-9 SCIP-Card-2 SCIP-VTE-2 IMM-2 32
VBP FY 2017 Clinical Care: Process AMI-7a IMM-2 PC-01 PC-01 = Elective Delivery Prior to 39 Completed Weeks Gestation 33
VBP FY 2016 New Measures Patient Experience No Change Same HCAHPS Measures Core Measures 5 Dropped; 1 New Outcomes 3 New Measures Efficiency No Change 34
VBP FY 2015 Outcomes 30 Day Mortality AMI 30 Day Mortality HF 30 Day Mortality PN AHRQ PSI-90 CLABSI 35
VBP FY 2016 Outcomes 30 Day Mortality AMI 30 Day Mortality HF 30 Day Mortality PN AHRQ PSI-90 CLABSI CAUTI SSI Colon SSI Abdominal Hysterectomy 36
VBP FY 2016 Outcomes Measure ID Benchmark CAUTI 0.000 CLABSI 0.000 Surgical Site Infection Colon 0.000 Abdominal Hysterectomy 0.000 37
VBP FY 2016 Outcomes Outcomes 30 Day Mortality AMI 30 Day Mortality HF 30 Day Mortality PN AHRQ PSI-90 CLABSI CAUTI SSI-Colon SSI-Abdominal Hyster. 38
VBP FY 2017 Clinical Care and Safety Clinical Care- Outcomes 30 Day Mortality AMI 30 Day Mortality HF 30 Day Mortality PN AHRQ PSI-90 CLABSI CAUTI SSI-Colon SSI-Abdominal Hyster. Safety MRSA C. Diff 39
Reform Timeline
Outcomes 30 Day Mortality Currently in 3 Performance Periods FY 2016 ended June 30, 2014 FY 2019 began July 1, 2014 30 Day Mortality Measures Assess deaths: AMI, HF, and PN that occur within 30 days after admission; which, depending on the length of stay, may occur postdischarge. 41
CMS 30 Day Risk-Standardized Mortality Rate Calculation Facility Predicted Deaths Facility Expected Deaths = X Measure (AMI, HF, PN) National Crude Rate 42
VBP FY 2016 New Measures Patient Experience No Change Same HCAHPS Measures Core Measures 5 Dropped; 1 New Outcomes 3 New Measures Efficiency No Change 43
VBP FY 2016 - Efficiency Medicare Spend Per Beneficiary (MSPB) Captures total Medicare Spending Per Beneficiary relative to a hospital stay, bundling hospital sources (Part A) with post acute care (Part B) Bundles the cost of care delivered to a beneficiary for an episode across the continuum of care: 3 Days Prior Hospital Inpatient Stay 30 Days post Discharge 44
Polling Question Are you aware and using your Qnet reports? A.Yes aware and using. B.Yes aware but not using. C.Not aware.
PROPOSED MSPB Measures Additional Efficiency Measures proposed to be added Medical Kidney/Urinary Tract Infection Cellulitis Gastrointestinal hemorrhage Surgical Hip replacement/revision Knee replacement/revision Lumbar spine fusion/refusion Risk Adjusted similarly to MSPB Proposed to facilitate alignment with the Physician Value Based Payment Modifier program Includes Part A and B and 3 days prior to admission and 30 days post discharge SOURCE: May 1, 2014 Federal Register 46
VBP FY'13 FY'15 TOTAL PERFORMANCE Earned Back Unearned Available $$ % Earned CGH System $4,925,357 $288,853 $6,187,541 $540,406 $11,112,898 $829,259 34.83% 44.32% $288,853 $4,925,357 Breakeven Point: $5,301,360 Breakeven Point: $451,333 $0 $0 $829,259 $11,112,898 Chesapeake Overall General Performance Performance System was penalized $376,003 in FY 15 VBP Program Must acknowledge the amount UNEARNED Of the programs dollars made available: System did not capitalize on $6,187,541 47
Facility Bonus / (Penalty) Total Score State Average National Average National Δ Facility A $97,593 42.03 41.81933117 41.70169535 0.325577377 Core Measures HCAHPS Measure Score Amount Earned by Measure Amount Unearned by Measure % of Measure Earned AMI-8a 6 $ 32,712 $ 21,808 60.00% SCIP-Inf-1 9 $ 49,068 $ 5,452 90.00% SCIP-Inf-2 7 $ 38,164 $ 16,356 70.00% SCIP-Inf-3 5 $ 27,260 $ 27,260 50.00% SCIP-Inf-4 9 $ 49,068 $ 5,452 90.00% SCIP-Inf-9 5 $ 27,260 $ 27,260 50.00% HF-1 8 $ 43,616 $ 10,904 80.00% PN-3b 5 $ 27,260 $ 27,260 50.00% PN-6 8 $ 43,616 $ 10,904 80.00% SCIP-Card-2 3 $ 16,356 $ 38,164 30.00% SCIP-VTE-2 5 $ 27,260 $ 27,260 50.00% Core Measures TOTAL $ 381,643 $ 218,077 63.64% Comm. w/ Nurses 2 $ 17,994 $ 71,966 20.00% Comm. w/ Doctors 1 $ 8,998 $ 80,962 10.00% Resp. of Hosp. Staff 2 $ 17,994 $ 71,966 20.00% Pain Management 2 $ 17,994 $ 71,966 20.00% Comm. Re: Medicines 1 $ 8,998 $ 80,962 10.00% Clealiness & Quietness 2 $ 17,994 $ 71,966 20.00% Discharge Information 3 $ 26,990 $ 62,970 30.00% Overall Rating 1 $ 8,998 $ 80,962 10.00% Consistency Score 17 $ 152,933 $ 26,987 85.00% HCAHPS TOTAL $ 278,896 $ 620,704 31.00% Outcomes AMI 10 $ 179,920 $ (0) 100.00% HF 3 $ 53,980 $ 125,940 30.00% PN 8 $ 143,934 $ 35,986 80.00% AHRQ PSI-90 9 $ 161,928 $ 17,992 90.00% CLABSI 0 $ 0 $ 179,920 0.00% Outcomes TOTAL $ 539,763 $ 359,837 60.00% Efficiency MSPB 1 $ 59,974 $ 539,746 10.00% Efficiency TOTAL $ 59,974 $ 539,746 Facility TOTAL $ 1,260,277 $ 1,738,363 42.03% 48
Core Measures Earned Back Unearned Measure Value % Earned Facility $381,643 $218,077 $599,720 63.64% Core Measures Breakeven Earned Point: $232,525 Back Unearned Measure Value % Earned Facility $381,643 $218,077 $599,720 $381,643 63.64% Breakeven Point: $232,525 $381,643 $0 $599,720 Outcomes Earned Back Unearned Measure Value % Earned Facility $539,763 $359,837 $899,600 60.00% Outcomes Breakeven Earned Point: $348,788 Back Unearned Measure Value % Earned Facility $539,763 $359,837 $539,763 $899,600 60.00% Breakeven Point: $348,788 $539,763 $0 $899,600 $0 $599,720 $0 $899,600 HCAHPS Earned Back Unearned Measure Value % Earned Facility $278,896 $620,704 $899,600 31.00% HCAHPS Breakeven Point: $348,788 Earned $278,896 Back Unearned Measure Value % Earned Facility $278,896 $620,704 $899,600 31.00% $278,896 Breakeven Point: $348,788 Efficiency Earned Back Unearned Measure Value % Earned Facility $59,974 $539,746 $599,720 10.00% Efficiency Breakeven Point: $232,535 Earned Back Unearned Measure Value % Earned Facility $59,974 $539,746 $599,720 10.00% $59,974 Breakeven Point: $232,535 $0 $899,600 $0 $899,600 $59,974 $0 $599,720 $0 $599,720 49
Mandatory Element of Reform READMISSION REDUCTION PROGRAM 50
Reform Timeline
Readmission Reduction Program 9% of Current and Future Medicare Reimbursement at Risk 3% penalty of Medicare Reimbursement at risk each program year Measured Populations 30 days from DISCHARGE AMI, HF, PN, COPD, THA & TKA August 2014: CABG Added to FY 2017 Performance Periods: 3 Year Rolling Program FY 15: July 1, 2010 June 30, 2013 3% FY 16: July 1, 2011 June 30, 2014 3% FY 17: July 1, 2012 June 30, 2015 3% FY 18: July 1, 2013 June 30, 2016 3% FY 19: July 1, 2014 June 30, 2017 3% Currently participating in 3 performance periods simultaneously 52
How are Readmissions Measured? Scoring Index based at 1.0 Calculate Excess Readmission Ratio Facility Predicted Value Facility Expected Value Excess Readmission Ratio > 1 = BAD Excess Readmission Ratio < 1 = GOOD 53
Penalties & Your DRG Payment SAMPL IPPS Reimbursement Letter PPS EFFECTIVE 10/1/2014 DRG Weight 1.00 Facility CMI 1.54 OPERATING INFORMATION Federal National Standardized Labor Rate 3,329.57 Wage Index 0.8994 Labor Rate x Wage Index 2,994.62 Federal National Standardized Non-Labor Rate 2,040.71 PPS Blended Rate 5,035.33 FY 2015 Hospital Readmissions Reduction (HRR) Adjustment Factor 0.9994 5,032.30 ($3.02) RRP Reduction FY 2015 Value-Based Purchasing (VBP) Adjustment Factor 0.994348 5,003.86 ($28.44) VBP Reduction ($31.46) Per DRG Reduction ($31.46) x 1.54 Disproportionate Share Adjustment (Operating) (Empirically Justified Amount 25%) 0.0691 0.02 5,090.43 Disproportionate Share Adjustment (Operating) (Uncompensated Care Amount) 507.71 5,598.14 Fully Loaded Operating Rate adjusted for CMI 8,346.97 FY 2015 Hospital Acquired Condition (HAC) Adjustment Factor 0.99 8,263.50 ($48.45) ($83.47) VBP & RRP Per DRG Red. CMI Adj HAC Per DRG CMI Adjusted ($131.92) Total Per DRG Reduction
Readmissions South Carolina FY 14 Hospital Performance Penalized on VBP Bonused on VBP Value Based Purchasing Penalized on Readmissions 55
Readmissions South Carolina Change: FFY 13-14 Value Based Purchasing 0.8 0.6 0.4 0.2 0-0.8-0.6-0.4-0.2 0 0.2 0.4 0.6-0.2-0.4-0.6 56
Polling Question What is the extent of the facility education of VBP and RRP in your facility as of today? A. To a small extent. B. Limited to the finance team C. Limited to the finance and leadership team D. Broad across the leadership team and including medical staff but not where it needs to be E. Broad across the leadership team and including medical staff and appropriate for results F. Deep into all levels of the organization
Mandatory Element of Reform HOSPITAL ACQUIRED CONDITIONS 58
Hospital Acquired Conditions (1% at Risk*) 12 Hospital Acquired Conditions Identified Divided in to 2 Domains If a hospital is in the BOTTOM QUARTILE (worst performing 25% in the country), it will be penalized a FULL 1% of Medicare Reimbursement Penalties will begin FY 15 (beginning October 1, 2014) *1% After DSH, Uncompensated Care, and IME 59
Hospital Acquired Conditions: FY 15 First Domain: PSIs Performance Period: 7/1/11-6/30/13 Second Domain: CDC Performance Period: CY 2012 & 2013 Pressure Ulcer Rate Foreign Object Left in Body CLABSI CAUTI Iatrogenic Pneumothorax Rate Postoperative Physiologic and Metabolic Derangement Rate Postoperative Pulmonary Embolism and Deep Vein Thrombosis Rate Accidental Puncture and Laceration Rate 60
HAC Domain Weightings: FY 15 DOMAIN 1: 35% DOMAIN 2: 65% Pressure Ulcer Rate: 8.33% CLABSI: 32.5% Foreign Object Left In Body: 8.33% CAUTI: 32.5% 61
So what does the Preliminary HAC Analysis say? 25% SOURCE:May 1, 2014 Proposed Rules Federal Register, Table 17 62
So what does the Preliminary HAC Analysis say? 25% SOURCE:May 1, 2014 Proposed Rules Federal Register, Table 17 63
Hospital Acquired Conditions: FY 2016 First Domain: PSIs 25% Second Domain: CDC 75% Pressure Ulcer Rate Foreign Object Left in Body CLABSI CAUTI Iatrogenic Pneumothorax Rate SSI Following Colon Surgery (FY 2016) Postoperative Physiologic and Metabolic Derangement Rate SSI Following Abdominal Hysterectomy (FY 2016) Postoperative Pulmonary Embolism and Deep Vein Thrombosis Rate Accidental Puncture and Laceration Rate 64
HAC Domain Weightings: FY 16 DOMAIN 1: 25% DOMAIN 2: 75% Pressure Ulcer Rate: 5.83% CLABSI: 32.5% SSI: 32.5% CAUTI: 32.5% 65
Hospital Acquired Conditions: FY 2017 First Domain: PSIs Second Domain: CDC Pressure Ulcer Rate CLABSI Foreign Object Left in Body CAUTI Iatrogenic Pneumothorax Rate SSI Following Colon Surgery (FY 2016) Postoperative Physiologic and Metabolic Derangement Rate Postoperative Pulmonary Embolism and Deep Vein Thrombosis Rate SSI Following Abdominal Hysterectomy (FY 2016) Methicillin-Resistant Staphylococcus Aureus (MRSA) Bacteremia (FY 2017) Accidental Puncture and Laceration Rate Clostridium Difficile (FY 2017) 66
Duplicate Measures VBP - Outcomes Individual Measure CLABSI CAUTI SSI - Colon SSI - Abdominal Hysterctomy HAC CLABSI CAUTI SSI - Colon SSI - Abdominal Hysterectomy AHRQ: PSI-90 Pressure Ulcer Rate Iatrogenic Pneumothorax Rate Postoperative Pulmonary Embolism and DVT Rate Accidental Puncture and Laceration Rate Pressure Ulcer Rate Iatrogenic Pneumothorax Rate Postoperative Pulmonary Embolism and DVT Rate Accidental Puncture and Laceration Rate 67
Mandatory Elements of Reform CURRENT DOLLARS AT RISK 68
VBP FY 2016 Sample Current $$ at Risk VBP FY 2016 Domain Weight At Risk On the Table Medicare Spend Per Beneficiary 25% $ 745,471 $ 1,562,507 Outcomes 40% $ 1,192,753 $ 2,500,011 Patient Experience 25% $ 745,471 $ 1,562,507 Core Measures 10% $ 298,188 $ 625,003 TOTAL 100% $ 2,981,883 $ 6,250,028 69
VBP Sample Total Current $$ at Risk VBP Current Dollars At Risk (Active Performance Periods) Domain Weight At Risk On the Table FY 2016 Medicare Spend Per Beneficiary 25% $ 745,471 $ 1,562,507 Outcomes 40% $ 1,192,753 $ 2,500,011 Patient Experience 25% $ 745,471 $ 1,562,507 Core Measures 10% $ 298,188 $ 625,003 FY 2017 Outcomes - 30 Day Mortality 25% $ 851,967 $ 1,785,722 Outcomes - AHRQ 3.75% $ 127,795 $ 267,858 FY 2018** Outcomes - 30 Day Mortality 25% $ 851,967 $ 1,785,722 Outcomes - AHRQ 3.75% $ 127,795 $ 267,858 FY 2019** Outcomes - 30 Day Mortality 25% $ 851,967 $ 1,785,722 TOTAL $ 5,793,374 $ 12,142,911 70
All Reform Sample Total Current $$ at Risk All Active Mandatory Reform Domain On the Table FY 2016 Value Based Purchasing $ 6,250,028 Readmissions COMPLETE Hospital Acquired Conditions $ 1,703,933 FY 2017 Value Based Purchasing $ 2,053,581 Readmissions $ 5,111,800 Hospital Acquired Conditions $ 1,703,933 FY 2018** Value Based Purchasing $ 2,053,581 Readmissions $ 5,111,800 FY 2019** Value Based Purchasing** $ 1,785,722 Readmissions $ 5,111,800 TOTAL $ 30,886,178 71
Mandatory Elements of Reform OPPORTUNITIES 72
New NQS Based Domains for FY 2017 HCAHPS = 25% Clinical Care - Process = 5% Clinical Care - Outcomes = 25% Safety = 20% MSPB = 25% 73
50% of VBP is Mortality and MSPB Clinical Care - Outcomes = 25% 74
Opportunities VBP: Outcomes 1 2 3 30 Day Mortality Rate - PN 30 Day Mortality Rate - AMI 30 Day Mortality Rate - HF FY14 FY14 FY14 Performance 87.40% Performance 83.81% Performance 85.21% Baseline 89.58% -2.18% Baseline 84.76% -0.95% Baseline 88.94% -3.73% Threshold 88.18% -0.78% Threshold 84.77% -0.96% Threshold 88.61% -3.40% Benchmark 90.21% -2.81% Benchmark 86.73% -2.92% Benchmark 90.42% -5.21% Score 0 Score 0 Score 0 Improvement Dollar Value Score Improvement Dollar Value Score Improvement Dollar Value Score +1% $ 13,209 1 +1% $ 13,209 1 +1% $ - 0 +1.5% $ 52,836 4 +1.5% $ 39,627 3 +1.5% $ - 0 +2.5% $ 105,673 8 +2.5% $ 105,673 8 +2.5% $ - 0 +3.5% $ 132,091 10 +3.5% $ 132,091 10 +3.5% $ 13,209 1 +4.5% $ 132,091 10 +4.5% $ 132,091 10 +4.5% $ 79,254 6 +5.5% $ 132,091 10 +5.5% $ 132,091 10 +5.5% $ 132,091 10 +6.5% $ 132,091 10 +6.5% $ 132,091 10 +6.5% $ 132,091 10 +7.5% $ 132,091 10 +7.5% $ 132,091 10 +7.5% $ 132,091 10 +8.5% $ 132,091 10 +8.5% $ 132,091 10 +8.5% $ 132,091 10 Top 50 th = Δ1 Patient Top 50 th = Δ1 Patient Top 50 th = Δ8 Patients Top 10 th = Δ3 Patient Top 10 th = Δ3 Patient Top 10 th = Δ11 Patients 75
Polling Question Are aware and using your Medicare Spend Per Beneficiary MSPB Qnet files? A.Aware and analyzing them. B.Aware but not analyzing them. C.Not aware.
Opportunities VBP: MSPB 77
Opportunities VBP: MSPB Sample US 78
VBP CMS Proposed Future Measures FY 2018 Program (Performance Period: CY 2016) Patient Experience: Care Transition FY 2019 Program (Performance Period: CY 2017) Surgical Complication: Total Hip and Total Knee Arthroplasty 79
VBP Other Possible Metrics to Follow Emergency Department Care Preventative Care Pneumonia Vaccine Children s Asthma Care Stroke Care Blood Clot Prevention Care Preventative Care Pregnancy and Delivery % of Newborns whose deliveries were scheduled too early (1-3 weeks) deemed unnecessary 80
FY 19 New Measure Added THA/TKA for 30 month performance period. January 1, 2015-June 30, 2017 Baseline of July 1, 2010-June 30, 2013 Risk standardized measure for complications after Total Hips and Knees surgeries for up to 90 days post surgery One of eight complications: AMI, pneumonia, sepsis, SSI, PE, death, mechanical complication or periprosthetic joint infection/wound infection. Each has a defined time frame Each is a Yes or No Risk adjusted for patient age, sex and comorbidities SOURCE: August 2014 Proposed Rules Federal Register 81
Readmissions Proposed Future Measures Percutaneous Coronary Intervention (PCI) Stroke 82
Opportunities HAC SSI Following Colon Surgery (FY 16) SSI Following Abdominal Hysterectomy (FY 16) MRSA (FY 17) C Diff (FY 17) 83
Contact Information: Melinda Hancock Melinda.Hancock@dhgllp.com (804) 474-1249 Walter Coleman Walter.Coleman@dhgllp.com (804) 474-1248 THANK YOU!