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SPECIALTY HOSPITALS

Friday, December 1, 20171:00 PM – 2:00 PM

Location: The Department of Health Care Policy & Financing, 303 East 17th

Avenue, Denver, CO 80203. 11th Floor Room A.

Conference Line: 1-877-820-7831 Passcode: 294442#

For more information contact: Elizabeth Quaife at elizabeth.quaife@state.co.us

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Welcome & Introductions

• Thank you for participating today!

• We are counting on your participation to make these meetings successful

• We are a small group so we highly encourage logging onto the Conference Line for discussion.

Conference Line: 1-877-820-7831 Passcode: 294442#

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GROUND RULES FOR WEBINAR

• WE WILL BE RECORDING THIS WEBINAR

• Please speak clearly when asking a question/comment and give your name and hospital

• We are going to try to avoid muting the phone lines to encourage conversation, so please don’t:

• Put us on hold• Drive in your car w/window open while listening• Sit in a noisy location• Be cautious of side conversations and language (we can

hear you and it is being recording)

Specialty Hospital Meetings

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For more information, please visit our Hospital Engagement Meeting Pagehttps://www.colorado.gov/pacific/hcpf/hospital-engagement-meetings

Future Meetings

1/12/2018 2/2/2018

3/2/2018 4/6/2018

5/4/2018 6/1/2018

Please join us starting Friday, January 12th from 1pm – 2pm at

303 East 17th Avenue, Denver in Conference Room 7A, by

phone and/or webinar.

Site Visits

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No new requests for site visits have been received:

These are important to us as it presents:

1. 1 on 1 opportunities

2. Better understanding of services provided by Hospitals

3. Ability for both Hospital and State to ask questions

4. Better informed decisions by the State

5. Hear Hospital concerns uninterrupted

6. Free form conversation and brainstorming

Please contact me at elizabeth.quaife@state.co.us to set

up a visit.

Knowledge Gained from Site Visits(from Department)

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• Desire to Increase availability for Medicaid Patients

• Extent of treatment and care involved

• Patient diversity

• Criteria for admittance

• Concern for what happens after patient’s leave

• Different quality reporting measures already in place

• Understanding difference between Rehabilitation and Long

Term Acute Care

• Encouragement/ Assistance to Employees on gaining

additional Certifications

• Assist Employees to stay up to date in their field

Knowledge Gained from Site Visits(from Hospital)

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• Hospitals are passionate

• Concern for Contracted Physicians

• Desire to Increase availability for Medicaid Patients

• Goals vary

• Concern for what happens after patient’s leave

• Thoughts on Budget Neutral Option

• Concerns/Input on what they would like to see Long Term Rates

Include

Per Diem Rate For Budget Neutral

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• Mutual agreement by Providers and Department

• Moving forward with Budget Neutral Implementation process

Implementation of Budget Neutral

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• Run final query of 7/1/2016 – 6/30/2017

• Coordinate with other Sections of Health Care

Policy & Finance:

➢Budget

➢Access to Care

➢Policy

➢Systems

➢Special Financing

• Public Notice

• State Plan Amendment Submission

• Medical Services Board?

• Build New Provider Profiles

• Implementation Goal: July 1, 2018

Additional Information

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• Provider Type Change: Re-enrollment will likely be required to

change Provider Type and allow to add to Profile the per diem

needed for billing.

• Medicare Crossovers: Currently, there is crosswalk between

Medicare and Medicaid since both utilize a form of DRGs. With the

per diem, Crossovers will be paid at Coinsurance + Deductible

Additional Case Examples

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APR-DRG SOI WEIGHT ALOS TMPT LOS

130 1 3.3629 10.87 22 3

130 3 5.324 16.62 45 15

130 4 6.7266 21.62 62 90

Long Term Acute Care (LTAC)

Case Examples (cont.)

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Rehabilitation

APR-DRG SOI WEIGHT ALOS TMPT LOS

860 1 0.8574 8.74 20 3

860 3 2.141 15.36 39 15

860 4 2.4919 17.44 44 90

Case Examples (cont.)

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APR-DRG SOI WEIGHT ALOS TMPT LOS

40 2 1.2446 4.48 13 3

40 3 1.6653 6.46 20 15

40 4 3.8818 12.92 41 90

Brain and Spine Specialist

ICD-10 Concerns

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Received from a Provider: Presented by

Louisiana **NOT COLORADO MEDICAID**

ICD 10 (cont.)

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Reviewed approximately 500 cases from 7/1/2016 – 6/30/2017

➢ All grouped correctly

Health First Colorado Numbers (7/1/2016 – 6/30/2017) :

➢ Total Rehabilitation Cases: 932

➢ APR-DRG 860 = 868 (93.1%)

➢ APR-DRG 862 = 27 (2.9%)

➢ APR-DRG Other = 37 (4.0%)

Consulted with 3M in regards to concerns:

“It should be noted that there no discrepancy with the APR DRG grouper with

regard to DRG 860 and 862. With the specificity of ICD 10, DRG 860 and 862

distribution has been impacted, hence the difference between case

distribution as noted below. Further, specific coding guidelines for the

respective DRGs has also been updated to further enhance specificity.

Please note that, the change identified below is a direct reflection of ICD 10

and updated coding guidelines.” Per 3M’s Clinical and Economic Research

Team

Long Term Research Opportunities

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• LTAC & Rehab attached to a Parent Hospital: Since these are

attached to Parent Hospitals, they will not be included in the

Budget Neutral option at this time.

Long Term – we will be researching the possibility of carving out

these hospitals from the Parent Hospital and possibly adding to

Specialty group. Additional research will be required.

• Changes to Physician payments: During onsite visits, Hospitals

have expressed concerns for Specialty Contracted Physicians

whom are critical to care of patients but are not affected by current

Budget Neutral proposal.

Long Term - would like to research the possibility of adjusting

reimbursement to caption the services being provided to Specialty

Hospitals

Long Term Research Opportunities(Continued)

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• Quality Measures:

a) HCAHPS

b) Functional Independent Measures

c) Private Insurance Measures

d) Other Hospital Measures

Goal is to utilize similar reporting measures Hospitals are

already using and semi-customizing for Medicaid

reporting

Information Request

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New Budget Neutral Per Diem: How do you believe this will impact

the intake of Medicaid patients? Increase? Decrease? No change?

Could this impact utilization of STACs?

Interim Billing: Tracking Interim Claims and noticing inconsistencies

in payments. Outlier days missing, possible double payments for 112

and 113/114 (system not voiding original payment). If seeing any of

these or additional concerns please send ICNs to me as well to

continue investigating.

Crossover Payments (Lesser Of): On several escalations, have seen

double deduction of Medicare Payment removed. If you have seen

any examples of these, please send ICNs to me as well to continue

investigating.

Email – elizabeth.quaife@state.co.us

Questions and Discussion

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Elizabeth QuaifeSpecialty Hospital Rates AnalystElizabeth.Quaife@state.co.us