HOSPITAL ENGAGEMENT MEETING Friday, July 13, 2018 9:00 AM 10:30 AM - - PowerPoint PPT Presentation
HOSPITAL ENGAGEMENT MEETING Friday, July 13, 2018 9:00 AM 10:30 AM Location: The Department of Health Care Policy & Financing, 303 East 17 th Avenue, Denver, CO 80203. 7 th Floor Rooms B&C. Conference Line: 1-877-820-7831 Passcode:
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Location: The Department of Health Care Policy & Financing, 303 East 17th Avenue, Denver, CO 80203. 7th Floor Rooms B&C. Conference Line: 1-877-820-7831 Passcode: 294442# For more information contact: Elizabeth Quaife at elizabeth.quaife@state.co.us
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**Special Note: The webinar room will change for the EAPG meeting. The link to EAPG Webinar room is shared under ‘Shared Links’ on the right side of this webinar room. Please log in during the break if you wish to stay for the EAPG portion of the day.
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Colorado Department of Health Care Policy and Financing
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HOSPITAL ENGAGEMENT MEETING TOPICS 7/13/2018 9am-10:30am
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PARTICIPANTS CAN ALSO UTILIZE THE WEBINAR CHAT WINDOW
name and hospital
lines will be hard muted. Thank you for your cooperation
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If you wish to request a topic for our next meeting. Please submit the request by the week prior to the meeting to ensure enough time is allowed to gather correct personnel and information on the topic. If a topic is submitted the week of the meeting, we cannot guarantee enough research will be completed to present at the meeting. However it will be carried over to the following meeting and any actionable items will be followed up with the Provider as soon as possible. Send all requests to Elizabeth Quaife at elizabeth.quaife@state.co.us The Meeting Agenda is posted on Monday the week of the meeting to
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Meetings for the Budget Neutral Per Diems have concluded and any additional status updates for implementation will be provided through email . The Department wishes to pick up meetings by the end of the year to begin discussing future components of Specialty Per Diems such as quality measures, rebasing per diems and adding a severity of illness component. These meetings will be announced in advanced via Hospital Engagement Meeting, Provider Bulletin, Hospital Engagement Meeting Website AND Email.
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***Final Draft: Awaiting Department Approval
CLASSIFICATION T1 Days Tier 1 Rate T2 Days Tier 2 Rate T3 Days Tier 3 Rate T4 Days Tier 4 Rate LTAC 1-21 $2,125.50 22-35 $2,019.22 56 $1,918.26 >56 $1,822.35 REHAB 1-6 $985.71 7-10 $936.42 11-14 $936.42 >14 $845.12 SPINE 1-28 $2,807.61 29-49 $2,667.23 50-77 $2,533.87 >77 $2,407.17 CLASSIFICATION T1 Days Tier 1 Rate T2 Days Tier 2 Rate T3 Days Tier 3 Rate T4 Days Tier 4 Rate LTAC 1-21 $2,176.81 22-35 $2,067.97 36-56 $1,964.57 >56 $1,866.34 REHAB 1-6 $1,009.50 7-10 $959.03 11-14 $911.08 >14 $865.52 SPINE 1-28 $2,875.38 29-49 $2,731.61 50-77 $2,595.03 >77 $2,465.28 FINAL RATE
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Matt Haynes Special Finance Projects Manager
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toward adding value into the system over time.
goal of HCPF.
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integration of care across settings;
ensuring appropriate care in appropriate settings;
costs through reductions in avoidable hospital utilization and increased effectiveness and efficiency in care delivery;
readiness for value-based payment; and
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The HTP envisions transforming care across the following populations and priority areas:
the elderly)
Health and Total Cost of Care
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Colorado’s hospitals have a critical role to play in the HTP, and will be asked to:
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August, 2017 – October, 2018 – Planning period
with urban and rural providers to finalize the HTP.
system for input and feedback that will inform program development
processes for engaging with their communities.
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October, 2018 – October, 2019 – Ramp-up period
with the provider fee year to establish critical relationships and identify HTP initiatives.
process to further determine the needs of the community and the roles hospitals can play to support those needs.
application
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October 1, 2019 – HTP implementation
forward with an 1115 Waiver with an implementation date beginning October 1, 2019.
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driven
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resources
providers
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State Activities Hospital Activities
relationships with
represent the community
represent a broad cross- section of the community
collaborations
gaps, including recruiting as needed
Action Plan outlining the hospital’s engagement strategy and approach to the process
engaged; forums to be utilized; strategies and activities; sources of information to be leveraged; and expected challenges and solutions
key community organizations
discussions to complete and gather input on an environmental scan
sources of information, including CHNAs
and describe the community and its challenges and needs, including specific to HTP priorities
bidirectional dialog scheduled at regular intervals, leverage a range of venues and pathways, and provide notice and follow- up communication
the C/HN Engagement process, with a focus on engagement to-date, environmental scan findings, and plans going forward
C/HN Engagement process, with a focus on engagement
HTP participation, and plans for ongoing C/HN Engagement
June – October 2018 August 2018 – October 2018 October 2018 – April 2019 April –September 2019 April - October 2019
and trade associations, health alliances, and
expectations to community organizations; identify potential risks to C/HN Engagement process and mitigation strategies
June – October 2018
Engagement
TA calls as needed
Plans for the C/HN Engagement process
ensure expectations are met and assist with navigating challenges and obstacles
August 2018 - September 2019
and findings from the environmental scan and provide recommendations
informed plans for HTP participation and provide recommendations
April - September 2019
Build partnerships Create an Action Plan Discuss needs &
community Report on activities & findings Develop initiatives & an application
discussions for providing input on needs and opportunities for HTP initiatives
community needs, identify target populations and initiatives, and build partnerships for initiatives via an evidence-based and stakeholder-informed decision- making process
bidirectional dialog scheduled at regular intervals, leverage a range
provide notice and follow-up communication
Outreach and Stakeholder Engagement Provide Guidance and Technical Assistance Review Reporting
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Hospital Activities
relationships with
serve and represent the community
that represent a broad cross-section of the community
forums and collaborations
addressing gaps, including recruiting as needed
proactive Action Plan
engagement strategy and approach to the process
be engaged; forums to be utilized; strategies and activities; sources of information to be leveraged; and expected challenges and solutions
from key community
complete and gather input on an environmental scan
data and sources of information, including CHNAs
identify and describe the community and its challenges and needs, including specific to HTP priorities
for bidirectional dialog scheduled at regular intervals, leverage a range of venues and pathways, and provide notice and follow-up communication
report on the C/HN Engagement process, with a focus on engagement to-date, environmental scan findings, and plans going forward
Engagement process, with a focus on engagement overall, progress in planning HTP participation, and plans for ongoing C/HN Engagement
June – October 2018 August 2018 – October 2018 October 2018 – April 2019 April –September 2019 April - October 2019
providing input on needs and opportunities for HTP initiatives
prioritize community needs, identify target populations and initiatives, and build partnerships for initiatives via an evidence-based and stakeholder-informed decision-making process
bidirectional dialog scheduled at regular intervals, leverage a range of venues and pathways, and provide notice and follow-up communication
Report on activities and findings Develop initiatives and an application Discuss community and needs Create an Action Plan Build partnerships
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State Activities
RAEs, provider and trade associations, health alliances, and other government agencies
communicate expectations to community organizations; identify potential risks to C/HN Engagement process and mitigation strategies
June – October 2018
Guidebook
revise Action Plans for the C/HN Engagement process
expectations are met and assist with navigating challenges and
August 2018 - September 2019
progress and findings from the environmental scan and provide recommendations
stakeholder-informed plans for HTP participation and provide recommendations
April - September 2019
Outreach and Stakeholder Engagement Provide Guidance and Technical Assistance Review Reporting
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PFMY18: C/HN Engagement Action Plan Development
2018 2019
Au g Ju n Jul Se p Oc t No v De c Ja n Fe b Ma r Apr Ma y Au g Ju n Jul Se p
Q1 Q2 Q3 Q4
PFMY 19 Pre-Waiver Period
Apr Ma y
Q3 Q4
PFMY*18
PFMY*18Q4 8/1/2018 Kickoff and Training PFMY19Q1 October 2018 Action Plans PFMY19Q3 April 2019 C/HN Engagement Midpoint Reports
Hospitals
PFMY19Q4 September – October 2019 C/HN Engagement Final Reports PFMY19: Pre-Waiver C/HN Engagement Process PFMY19Q3: Review Midpoint Reports and Work with Hospitals to Finalize PFMY19Q4: Review C/HN Engagement Final Reports PFMY19Q1: Review Action Plans and Work with Hospitals to Finalize *Provider Fee Model Year
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he/she doesn’t get admitted as inpatient until February 12, 2018. Discharge date is February 20, 2018.
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From Date: February 10, 2018
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Admit Date: February 12, 2018
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Reporting Covered (Inpatient) Days: 8 days (February 12, 2018 - February 20, 2018)
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Reporting Non-covered Days: 2 days 40
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A. FY16-17 discharges are adjusted by the claim Volume Inflator designated by The Department for FY16-17 (1 + -0.8%) and FY17-18 (1 + 1.13%) which is .32% this year. B. Case Mix Index (CMI) is calculated for each hospital’s FY16-17 discharges (Total DRG Weights/Total Discharges). C. FY2002-03 DRG Base Rates (adjusted by prior Budget Actions)
Long Bill.
Calculation = A*B*C
Budget Year & Type of Action Total SFY 18-19 (Budget Neutral Amount) $828,205,765
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A. Input 10/1/2017 Medicare Base Rates – DSH + Medicaid Add-Ons for all PPS Hospitals. B. Average peer group rates are calculated and attributed to all Critical Access Hospitals (CAH), low discharge hospitals and new hospitals as necessary. C. Non-PPS Hospital Rates are entered with budget increase (1.0%) since we currently have no instituted methodology to update these rates. D. Run Goal Seek to find % of Medicare Rate that allows us to remain Budget Neutral to FY2002-03 Budget which is $828,205,765.
Percent of Initial Medicare Rate SFY 18-19 At the Budget Neutral Amount 84.49%
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A. Apply Budget Action of 1.0% to Budget Neutral Amount B. Distribute resulting amount to all PPS Hospitals to arrive at total budget for FY2018-19 of $836,487,823.
Budget Year & Type of Action Total SFY 18-19 Budget Action (1.0% increase) $8,282,058 Percent of Initial Medicare Rate SFY 18-19 With Budget Action/Legislative Increase of 1.0% 85.50%
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The SFY 18-19 Long Bill included a 1.0% rate increase effective this July 1. This 1.0% increase was added to the budget neutrality amount for SFY 18-19. The methodology for calculating the inpatient rates remains the same as previous years. Inpatient: Percent of Initial Medicare Rate: 85.50% State Plan Amendment Approval – Sometime in September/October
Percent of Initial Medicare Rate SFY 17-18 SFY 18-19 At the Budget Neutral Amount 83.27% 84.49% With Budget Action/Legislative Increase of 1.0% NA 85.50%
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Medicaid and the Budget Neutrality amount for SFY 2018-19 is ~$828 million.
(Case Mix Index – so higher rated DRGs) rather than a significant increase in expected discharges for FY2018-19. Discharges were expected to grow by 9.5% last year while this year’s expected growth is only .32%.
the Medicare rate effective October 1, 2017.
Budget Year & Type of Action Total SFY 17-18 (w/1.4% Budget Action) $802,699,519 SFY 18-19 (Budget Neutral Amount) $828,205,765 SFY 18-19 Budget Action (1.0% increase) $8,282,058 Total SFY 18-19 w/Budget Action $836,487,823
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change in Medicare base rates between FFY 16 and FFY 17.
until the Department receives approval from
to reprocess affected claims.
be kept in place.
Decreases and increases for PPS hospitals are mostly due to fluctuations in the Initial Medicare base rate from last
that contribute to the peer group average experienced a decrease, while urban hospitals
The peer group average for specialty hospitals increased more than 1% because a hospital in the group closed.
Peer Group Avg 2017-18 Avg 2018-19 % Change Rural $7,054.07 $6,987.34
Urban $5,129.51 $5,390.68 5.09% Specialty $7,644.91 $7,870.53 2.95%
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were on July 3rd posting. We have added rates for two hospitals that were inadvertently missed in the first posting.
rate by contacting Diana Lambe at diana.lambe@state.co.us or 303.866.5526.
day review period on 7/13/2018.
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to ICD-10. Resulting in increased payments of ~$40,000.
Reprocess INPATIENT ICD-10 PAID LEGACY CLAIMS Claim Type Claim Status Count % of Total I = Inpatient P 3,462 88.4% I = Inpatient S 325 8.3% A = Medicare Crossover P 130 3.3% A = Medicare Crossover S 14 0.4% Total 3,917 100.0% Paid ~92%
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possible starting point for Medicaid Base Rate
Overhaul
rate:
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Hospital Name HOSPITAL 1 HOSPITAL 2 HOSPITAL 3 HOSPITAL 4
MEDICARE FEDERAL BASE RATE
OPERATING Labor Related Amount 3,805.30 3,760.40 3,389.78 3,349.79 Wage Index 1.0006 1.0006 0.9615 0.9615 Adjusted Labor Amount 3,807.58 3,762.66 3,259.27 3,220.82 Non-Labor Amount 1,662.09 1,642.48 2,077.61 2,053.09 OPERATING TOTAL 5,469.67 5,405.14 5,336.88 5,273.91 CAPITAL Standard Federal Rate 438.75 438.75 438.75 438.75 GAF 1.0004 1.0004 0.9735 0.9735 CAPITAL TOTAL 438.93 438.93 427.12 427.12
MEDICARE FEDERAL BASE RATE $5,908.60 $5,844.06 $5,764.01 $5,701.04 MEDICAID SPECIFIC ADD-ONS
Nursery $27.00 $6.00 $10.00 $0.00 NICU $0.00 $40.00 $0.00 $0.00 GME $40.00 $8.00 $0.00 $0.00 ?? $500.00 $0.00 $0.00 $400.00 ?? $0.00 $900.00 $0.00 $0.00 ?? $0.00 $0.00 $0.00 $2,000.00 ?? $0.00 $0.00 $1,500.00 MEDICAID ADD-ON SUBTOTAL $567.00 $954.00 $1,510.00 $2,400.00
MEDICAID BASE RATE $6,475.60 $6,798.06 $7,274.01 $8,101.04
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Hospital Peer Groups: A grouping of hospitals for the purpose of cost comparison and determination of efficiency and economy. The peer groups are defined as follows: a. Pediatric Specialty Hospitals: all hospitals providing care exclusively to pediatric populations. b. Rehabilitation and Specialty-Acute Hospitals: all hospitals providing rehabilitation
days). c. Rural Hospitals: Colorado Hospitals not located within a federally designated Metropolitan Statistical Area (MSA). d. Urban Hospitals: all Colorado hospitals in MSA's including those in the Denver MSA. Also included would be the Rural Referral Centers in Colorado, as defined by HCFA. (SSAS, 1886 (d) (5) (c) (I); Reg. 412.90 (c) and 412.96). Facilities which do not fall into the peer groups described in a. or b. will default to the peer groups described in c. and d. based on geographic location. Source: Colorado State Plan Attachment 4.19A
➢ Medicaid Base Rate Examples to come in Novembers
meeting.
➢ Please send thoughts/examples ASAP of what kind of
base rate you think would work for inpatient.
➢ Also – any thoughts you have on what should be used to
determine peer groups and urban/rural designations.
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The final poll is now an external survey to provide anonymity, please take a few moments to complete it. Thank you
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Elizabeth Quaife Specialty Hospital Rates Analyst Elizabeth.Quaife@state.co.us Ana Lucaci Hospital Policy Specialist Ana.Lucaci@state.co.us Raine Henry Hospital Policy Specialist Raine.Henry@state.co.us Jeremy Oat Operations Section Manager Jeremy.Oat@state.co.us Shane Mofford Payment Reform Section Manager Shane.Mofford@state.co.us Kevin Martin Fee for Service Rates Manager Kevin.Martin@state.co.us Diana Lambe Inpatient Hospital Rates Analyst Diana.Lambe@state.co.us Andrew Abalos Outpatient Hospital Rates Analyst Andrew.Abalos@state.co.us