Driving Change in Rural Hospitals

Kathy WhitmireHomeTown Health, LLC

Spending for health care in the United States has been growing faster than the economy for many years, posing a challenge not only for the federal government’s two major health insurance programs, Medicare and Medicaid, but also for the private sector. Measured as a percentage of the nation’s gross domestic product, total spending for health care increased from 4.7 percent in 1960 to 15.2 percent in 2007,

The Key Driver

What is driving change?

The growth of health care spending in the long term will be determined primarily by growth in the cost of medical care per person /per capita.

Georgia = $6550Florida = $16,000+

The Scary Truth

Payment Incentives and penalties for quality and patient satisfaction – VBP Payment reductions for readmissions, Payment reductions for HAI’s and HAC’s Meaningful Use – Quality + CPOE – Erx HIPAA 5010 and ICD-10 HCAPHS – penalty for not reporting

What is changing?

Value-based purchasing (VBP), a program authorized by the Patient Protection and Accountable Care Act of 2010, gives the Centers for Medicare & Medicaid Services (CMS) the power to base a portion of hospital reimbursement payments on how well hospitals perform in 25 core measures.

Quality + Patient Satisfaction (HCAPHS)

http://www.the-hospitalist.org/details/article/1056049/Value-Based_Purchasing_Raises_the_Stakes.html

Value Based Purchasing

Hospitals’ baseline scores already have been set, and the initial nine-month performance evaluation period begins July 1.

Beginning with discharges on Oct. 1, 2012 (fiscal year 2013), the payment phase will kick in. CMS will start by withholding 1% of the base DRG reimbursement paid to hospitals. That money can be earned back based on how well each hospital scores on the performance measures during the evaluation period.

The amount initially withheld will rise by 0.25 percentage points per year until it is capped at 2% in 2017 and beyond.

Value Based Purchasing IS NOW!

The move is intended to help CMS flex its muscles and move from being a passive bystander to an active buyer of what its officials have deemed higher-quality healthcare.

Value Based Purchasing

Measuring value in VBP

October 26th – Medicare Webinar◦ Learn exactly what VBP is and what it means to

your hospital next Wednesday-

2011 -2012 SHIP GRANT PROGRAM◦ Begins in Jan 2012 – Focusing on preparing our

member hospitals for VBP and ACO’s Partnering with Michelle Madison – MMM,

Mike Scribner – SHP, and Beth Spoto – Spoto & Assoc.

Value Based Purchasing

HOSPITAL READMISSIONS REDUCTION PROGRAM◦ Beginning in fiscal year 2013, inpatient

prospective payment system hospitals with higher-than expected readmissions rates will experience decreased Medicare payments for all Medicare discharges.

Reductions for Readmissions

Payment Reductions for HAI’s and HAC’s For discharges occurring on

or after October 1, 2008, Inpatient Prospective Payment System (IPPS) hospitals do not receive the higher payment for cases when one of the selected conditions is acquired during hospitalization (i.e., was not present on admission). The case is paid as though the secondary diagnosis is not present.

Example

The American Recovery and Reinvestment Act of 2009 specifies three main components of Meaningful Use:◦ The use of a certified EHR in a meaningful manner, such as

e-prescribing.◦ The use of certified EHR technology for electronic exchange

of health information to improve quality of health care.◦ The use of certified EHR technology to submit clinical

quality and other measures. Simply put, "meaningful use" means providers need

to show they're using certified EHR technology in ways that can be measured significantly in quality and in quantity.

What is "Meaningful Use"?

Medicare will be reducing Physician fee schedule to 99% in 2015, 98% in 2016 and 97% in 2017.  

Hospitals will receive a 1% reduction beginning in 2015 and continue to max 2%

Further penalties could be imposed if 75% of EP's have not met meaningful use by 2018.  The Secretary will be able to reduce the regular fee schedule to 96% and then 95% but no further.

Meaningful Use Penalties

Begins November 9th with training and checklists to ensure that all hospitals are ready! ◦ Discuss Example of changes

ICD-1012 month - ICD-10 Readiness Program

will be led by Sherry Milton, Coding & Documentation Expert will begin in January

Countdown to HIPAA 5010

HCAPHS

HCAPHS – Hospital Compare

http://www.hospitalcompare.hhs.gov/

NEWS: New Members – Elbert Memorial & Chatuge Regional New Partners – VendorMate and Data Rx – 340B for hospitals New DCH Commissioner David Cook confirms keynote at Fall

ConferenceEVENTS: Oct 12th – Medicare Monthly Webinar Oct 12th – Medicaid Redesign First Meeting – SAVANNAH Oct 13th – CNO – Case Mgr Workshop Oct 18th - Physicians’ Lunch and Learn – MU Series – Session 2 Oct 19th – Interqual Cerme User Group Webinar Nov 9th, 30th, Dec 7th, 14th – Countdown to HIPAA 5010 Nov 16th -18th – HTH Fall Conference Dec 12th -13th – HIPAA Compliance Officer Training Jan 25th – 26th – GA Rural HIT Conference – Macon

HomeTown News & Events

Medicaid & CHIP Redesign The Georgia Department of Community Health (DCH) issued

a Request for Proposal for a comprehensive assessment and recommended redesign of Georgia's Medicaid Program and Children's Health Insurance Program (CHIP/PeachCare for Kids®).

The redesign initiative will focus on solution planning, innovation and strategic options for managing the care and financing of Georgia's Medicaid and CHIP populations. On July 26, 2011, DCH awarded the consulting contract to Navigant Consulting, Inc.

SAVANNAH – Oct 12th – First Meeting

Medicaid & CHIP Redesign

 ANNOUNCING HOMETOWN HEALTH 12TH ANNUAL FALL CONFERENCENovember 16 - 18 – Callaway Gardens

SPEAKERS AND SESSIONS INCLUDE:

KEY NOTE SPEAKER: David Cook, Commissioner of the Dept of Community Health

DCH Medicaid – HP - CMO – Navigant DiscussionPANEL:  Dr Jerry Dubberly, Medicaid Director and Cheryll Collier, HP

Georgia Redistricting Update  - David Tatum, CHOA

A New Day in the Future of Health CareSPEAKER: Kirk McGhee, Vice President and Regional Counsel for Kaiser Permanente

GA Health Information Exchange – GA-HITREC – Dr Denise Hines

Value Based Purchasing / ACO Discussion – Led by Michelle Madison, Attorney

Health Insurance Exchange – What Hospitals Need to do to Prepare - Ryan Teague

4 Requirements for Survival in 2012 and Beyond – PANEL: Change -Sue Spivey, Technology- Brenda Jarrett, Leadership – Jeff Dunn, Revenue Mgmt – Lynn Byrd