kelly price, senior director datagen group jonathan w. pearce, cps, fhfma principal, singletrack...
DESCRIPTION
Overview Program Rules BPCI includes 48 episode “families” and 197 DRGs Participating organizations can participate in any or all episode families What criteria and analyses should be used for episode selection?TRANSCRIPT
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KELLY PRICE, SENIOR DIRECTORDATAGEN GROUP
JONATHAN W. PEARCE, CPS, FHFMAPRINCIPAL, SINGLETRACK ANALYTICS.
Evaluating Opportunities in the Medicare Bundled Payment Program
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What’s happening?
BPCI open enrollment ended April 18Hospitals will receive data this summerNeed to make decisions by November
SingleTrack/DataGenOver 20 organizations from round 1Data partner to the AAMC convened hospitals and
other "independent" awardees
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Overview
Program RulesBPCI includes 48 episode “families” and 197 DRGsParticipating organizations can participate in any or all
episode familiesWhat criteria and analyses should be used for episode
selection?
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Financial Opportunities
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Distribution of Episode Cost
Individual Episodes
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Attacking High-Cost Cases
Individual Episodes
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Moving the Cost Curve Down
Individual Episodes
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Reducing Internal Hospital Costs
Part of the strategy for mostAll of the strategy for some
Gainsharing waiver offers greater potential for savings
Length of Stay variation But sometimes an extra day is good downstream
Device costs – not easy to analyze from the administrative data
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Total Financial Risk
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Intra-Episode Variation
$0
$20,000
$40,000
$60,000
$80,000
$100,000
$120,000
$140,000
$160,000
$180,000
$200,000
469 - Major joint replacement or reattachment of lower extremity
w MCC
$0
$20,000
$40,000
$60,000
$80,000
$100,000
$120,000
$140,000
470 - Major joint replacement or reattachment of lower extremity
w/o MCC
Coefficient of Variation = .57 Coefficient of Variation = .27
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Episode Risk Decreases with Population Size
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Hospital Discount as Percent of Hospital Cost
Episode average=$25,000 Hospital portion=$10,000 2% * $25k=$500 $500/$10,000=5%
$0
$5,000
$10,000
$15,000
$20,000
$25,000
$30,000
Baseline
Average Episode Payments by Setting
Index Admit Professional Readmission_ProfessionalReadmission SNF HHAOutpatient DME IP PsychHospice IP Rehab LTC
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Hospital Discount as Percent of Hospital Cost
Target is discounted 2-3% of episode cost
Hospital frequently assumes the entire discount
Effective hospital discount depends on the hospital percentage of total episode cost
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Savings Opportunity is in Post-Acute Period
It’s NOT here:
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Savings Opportunity
Percentage of cost in post-discharge period varies by DRG
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Clinical Coordination Opportunities
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Understanding the services
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Post Acute Cost Trends
$0
$500
$1,000
$1,500
$2,000
$2,500
$3,000
$3,500
$4,000
Qtr 3 2009Qtr 4 2009Qtr 1 2010Qtr 2 2010Qtr 3 2010Qtr 4 2010Qtr 1 2011Qtr 2 2011Qtr 3 2011Qtr 4 2011Qtr 1 2012Qtr 1 2013Qtr 2 2013Qtr 3 2013
SNF
Post Acute Cost TrendsAverage Prorated Payment per Episode
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Post Acute Cost Variation by Provider
Provider NameEpisode Count
Total Prorated Payment
Average Prorated Payment Per Episode
SNF 23 $336,005 $14,609Center for Care 73 5 $71,407 $14,281Provider 459 2 $48,852 $24,426Provider 14297 5 $40,643 $8,129Provider 460 2 $33,104 $16,552Provider 14310 2 $30,506 $15,253SNF 14392 1 $26,991 $26,991Hospital 123 2 $23,954 $11,977SNF 14363 1 $21,953 $21,953SNF 14400 1 $20,814 $20,814Hospital 191 2 $17,779 $8,890
Grand Total 23 $336,005 $14,609
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Episode Costs by Admitting Physician
Index Admission Attending Episode Count
Total Net Episode Payments
Average Net
Payment Per Episode
Percent of Episodes With At Least One Readmission
High Outlier Count
Physician 39 11 $307,514 $27,956 18 % 0Physician 47 9 $237,022 $26,336 0Physician 112 9 $285,922 $31,769 33 % 0Physician 96 7 $176,502 $25,215 0Physician P 7 $184,565 $26,366 0Physician 88 5 $152,750 $30,550 20 % 0Physician 52 5 $135,484 $27,097 0Physician 42 4 $132,733 $33,183 25 % 0Physician 28 3 $79,553 $26,518 0Physician 5 3 $113,751 $37,917 0Physician Q 2 $66,188 $33,094 0Physician B 2 $59,930 $29,965 0Physician X 2 $106,525 $53,263 50 % 0Physician 25 2 $46,336 $23,168 0Physician 4 2 $62,309 $31,155 0Physician 109 2 $88,545 $44,272 0Physician 55 2 $56,497 $28,248 0Physician 38 2 $49,309 $24,654 0
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Path of Care
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Analyses of Readmissions
Readmission DRGHospital of readmissionTiming of readmissionPost-acute provider from
whom readmission originated
Reason For ReadmissionReadmission
Count
Average Days from Anchor
Discharge233 - Coronary bypass w cardiac cath w MCC 6 21
293 - Heart failure & shock w/o CC/MCC 2 13394 - Other digestive system diagnoses w CC 1 4641 - Nutritional & misc metabolic disorders w/o MCC 1 78315 - Other circulatory system diagnoses w CC 1 2372 - Major gastrointestinal disorders & peritoneal infections w CC 1 14
234 - Coronary bypass w cardiac cath w/o MCC 5 54856 - Postoperative or post-traumatic infections w O.R. proc w MCC 2 52637 - Diabetes w MCC 1 70292 - Heart failure & shock w CC 1 38606 - Minor skin disorders w MCC 1 59
235 - Coronary bypass w/o cardiac cath w MCC 7 32378 - G.I. hemorrhage w CC 2 21639 - Diabetes w/o CC/MCC 1 34287 - Circulatory disorders except AMI, w card cath w/o MCC 1 66948 - Signs & symptoms w/o MCC 1 6057 - Degenerative nervous system disorders w/o MCC 1 46392 - Esophagitis, gastroent & misc digest disorders w/o MCC 1 33
236 - Coronary bypass w/o cardiac cath w/o MCC 5 33176 - Pulmonary embolism w/o MCC 2 24313 - Chest pain 1 53812 - Red blood cell disorders w/o MCC 1 2251 - Perc cardiovasc proc w/o coronary artery stent w/o MCC 1 61
Grand Total 23 34
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Putting It All Together
Is there sufficient cost variation to create opportunities for savings
Are the drivers of variation actionableAre your clinicians sufficiently involved to drive change