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 Medicare Medicaid Workers Compensation Other VHHA Advocacy VHHA Data & Research Department VHHA Communications Department 2
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
Readmission Reduction Penalty Ranking 4Q 2013 July 1, 2009 - June 30, 2012 4Q 2014 July 1, 2010 - June 30, 2013 State Rank 2Q 2015 July 1, 2011 - June 30, 2014 2Q 2016 July 1, 2012 - June 30, 2015 READM_30_AMI: Acute Myocardial Infarction (AMI) 30-Day Readmission Rate 38 of 51 40 of 51 46 of 51 40 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 51 34 of 51 38 of 51 37 of 50 42 of 51 45 of 51 46 of 51 45 of 50 34 of 51 43 of 51 49 of 51 49 of 50 No Data 41 of 51 42 of 51 39 of 50 READM_30_CABG: Coronary Artery Bypass Graft (CABG) 30-Day Readmission Rate No Data 38 of 51 36 of 50 4Q 2013 July 1, 2009 - June 30, 2012 4Q 2014 July 1, 2010 - June 30, 2013 State Rates 2Q 2015 July 1, 2011 - June 30, 2014 2Q 2016 July 1, 2012 - 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
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 4 0.8830-0.3069 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 8 0.9223 0.3446 HAI_2a: Catheter Associated Urinary Tract Infection (CAUTI) (ICU-Only) 71st-80th 8 61st-70th 7 0.8617 0.4547 SSI: Pooled Surgical Site Infection (SSI) Standardized Infection Ratio 71st-80th 8 71st-80th 8-0.9007 0.6505 HAI_5: Methicillin-resistant Staphylococcus Aureus (MRSA) Does Not Apply 61st-70th 7-0.9522-0.1225 HAI_6: Clostridium difficile (C.diff.) Does Not Apply 71st-80th 8-0.9163 1.0324 -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 5.00 25% 4.00 15% -0.3069 15% Domain 2: CDC Chart Abstracted Measures 7.67 75% 7.60 85% 0.4720 85% Total HAC Score 7.00 7.06 0.3551 Annual Program Impact Estimates: Actual FFY 2016 Performance Actual FFY 2017 Performance Estimated FFY 2018 Performance Hospital Total HAC Score 7.00 7.06 0.3551 75th Percentile Total HAC Score 6.75 6.57 0.3345 Payment Penalty Determination Receives Penalty Receives Penalty Receives Penalty Estimated Annual Impact ($1,781,400) ($1,797,300) ($1,764,600) 5
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-6 97.8% 4 $ 2,900 SCIP-Inf-2 99.4% 4 $ 2,900 Process of Care Clinical Care: Process (FFY 2017) SCIP-Inf-3 100.0% 10 $ 46,400 Measure Not Evaluated for VBP 2017 SCIP-Inf-9 99.3% 7 $ 24,700 SCIP-Card-2 99.4% 7 $ 24,700 SCIP-VTE-2 100.0% 10 $ 46,400 IMM-2 93.6% 4 $ 2,900 97.4% 5 $ 28,300 Domain Not Evaluated for VBP 2018 PC-01 Measure Not Evaluated for VBP 2016 0.0% 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 $ 12,100 88.0% 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 2017 53.0% 2 $ (17,600) HCAHPS Consistency Score 19 $ 149,900 18 $ 186,500 N/A 17 $ 199,300 Unweighted Domain Score 40.0% 36.0% 29.0% MORT-30-AMI 85.3% 4 $ 11,400 86.9% 8 $ 256,700 85.8% 3 $ 1,600 Clinical Care: Outcomes (FFY 2017-2018) MORT-30-HF 87.9% 0 $ (104,800) 88.5% 2 $ (68,000) 88.6% 1 $ (118,600) MORT-30-PN 90.5% 10 $ 185,800 91.0% 10 $ 365,000 91.0% 10 $ 422,400 Unweighted Domain Score 66.7% 46.7% PSI-90 0.438 10 $ 185,800 0.448 10 $ 146,000 0.720 9 $ 155,300 Patient Outcomes Safety of Care (FFY 2017-2018) PC-01 Measure Not Evaluated for VBP 2016 Measure Not Evaluated in this Domain for VBP 2017 0.000 10 $ 181,000 HAI_1 0.657 2 $ (46,700) 0.592 0 $ (70,500) 0.592 0 $ (76,600) HAI_2 1.866 0 $ (104,800) 0.494 7 $ 81,000 0.494 7 $ 103,700 HAI_SSI N/A 2 N/A 4 N/A 5 $ (46,700) $ 16,100 HAI_SSI Submeasure: HAI_3 1.512 0 0.596 4 0.596 6 $ 52,200 HAI_SSI Submeasure: HAI_4 0.000 10 0.592 2 0.592 2 HAI_5 0.404 5 0.404 8 $ 37,800 $ 129,500 Measure Not Evaluated for VBP 2016 HAI_6 0.647 2 $ (27,200) 0.647 2 $ (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
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% $ 150,800 75.0% 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% $ 50,100 36.0% X 25.0% = 9.0% $ 55,900 29.0% X 25.0% = 7.3% $ (13,200) Clinical Care: Outcomes 66.7% X 25.0% = 16.7% $ 553,800 46.7% 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% $ 183,200 58.6% 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% $ 1,833,700 2.00% $ 2,114,300 2.00% $ 2,144,900 B VBP Slope 2.7731271496 3.0714921816 3.3631814538 C VBP Payment ( TPS X B ) 111.1% $ 2,037,600 142.06% $ 3,003,400 138.09% $ 2,961,900 VBP Adjustment Factor [ 1 + (( C x A ) - A ) ] 1.0019 1.0084 1.0076 $ 203,900 $ 889,100 Impact on IPPS Operating Payments 0.19% 0.84% 0.76% $ 817,000 7
MSPB 8
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
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 2014 3Q 2014 4Q 2014 1Q 2015 2Q 2015 3Q 2015 4Q 2015 1Q 2016 2Q 2016 3Q 2016 4Q 2016 1Q 2017 Oct.1, 2012 - Jan. 1, 2013 - Apr. 1, 2013 - July 1, 2013 - Oct.1, 2013 - Jan. 1, 2014 - Apr. 1, 2014 - July 1, 2014 - Oct.1, 2014 - Jan. 1, 2015 - Apr. 1, 2015 - July 1, 2015 - 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, 2016 0 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 3591 359 of 3575 356 of 3551 371 of 3546 370 of 3537 373 of 3536 366 of 3542 515 of 3483 395 of 3506 422 of 3496 594 of 3497 File includes trends for measures related to VBP & Readmissions 10
Scorecard 11
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
Inpatient Proposed Rule 13
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
Medicaid Inflation Impacts 15
Other Federal Policy Items AHCA Repeal, Replace, Reform??? Trump Budget Bundled Payments Uncompensated Care Model (DSH Changes) S-10 340B Pharmacy Cost 16
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
Potential COPN Impacts 18
All MRI s in Virginia 2014 19
MRI s at Freestanding Facilties 20
MRI s in Rural Locations 21
VAPricepoint Being reviewed by finance folks and should be live next week 22
VAPricepoint Con t www.vapricepoint.org 23
Questions? 24