HOSPITAL MEETING Friday, September 1, 2017 8:00 AM 12:00 PM - PowerPoint PPT Presentation

HOSPITAL MEETING Friday, September 1, 2017 8:00 AM – 12:00 PM Location: The Department of Health Care Policy & Financing, 303 East 17 th Avenue, Denver, CO 80203. 11 th Floor Rooms A&B. For more information contact: Elizabeth Quaife at 303.866.2083 or elizabeth.quaife@state.co.us & Diana Lambe at 303.866.5526 or diana.lambe@state.co.us. 1

Overview of Meeting • General Hospital Meeting 8:00-10:00 • Break 10 min. • General Hospital Meeting cont’d 10:10-12:00 • Lunch 12:00-1:00 • CC/CCEC Stakeholder Meeting 1:00-2:00 2

HOSPITAL ENGAGEMENT MEETING TOPICS 9/1/2017 8am-12pm • General Hospital Meeting - Feedback on Future Meetings - Specialty Hospital Rates Methodology Update - Cost Settlement Updates - Innovative Medications Update • Rate Related System Issues Update - Suspended Claims a. HCPCs Annual Update b. Drug Related Revenue Code - I CD-10 10/1/2017 update on new Diagnosis Codes - Mass Adjustment & Testing Adjustments Update - EAPG Rule Change - EAPG Software Updates - Transportation - EAPG UD & 25 Modifiers - EAPG Mass Adjustment Update • CCEC/CC Stakeholder Meeting 1pm - 2pm 3 Colorado Department of Health Care Policy and Financing

GROUND RULES FOR WEBINAR • WE WILL BE RECORDING THIS WEBINAR • PLEASE MUTE YOUR LINE UNLESS SPEAKING • Please speak clearly when asking a question 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) 4

Welcome & Introductions • Thank you for participating today! • We are counting on your participation to make these meetings successful 5

Staffing Updates • Marguerite Richardson has retired: Cost Settlements have been taken over by Andrew Larson • Andrew Larson: CC/CCEC Analyst questions/concerns contact at Andrew.Larson@state.co.us • Elizabeth Quaife: Specialty Hospital Analyst. Please send all NEW inquiries for Specialty Hospitals to Elizabeth.Quaife@state.co.us. • Raine Henry is currently on leave. For questions in regards to Hospital, Lab and Telemedicine Policy please contact Ana Lucaci at Ana.Lucaci@state.co.us 6

Dates for Future Hospital Engagement Meetings in 2017 The agenda for upcoming meetings will be • 3/3/2017 available on our external website in advance of each meeting. https://www.colorado.gov/hcpf/inpatient- • 5/5/2017 hospital-payment Registration links for each session during the day • 7/7/2017 will also be available prior to the meeting. Just click on the links to register for each session • and you will receive the link to connect to the 9/1/2017 webinar. • Meetings will now begin at 9am starting with 11/3/2017 11/3/2017 meeting 7

Future Hospital Engagement Meetings in 2018 Engagement Meeting Dates for 2018 01/12/2018 07/13/2018 03/02/2018 09/07/2018 05/04/2018 11/02/2018 • Meetings will now begin at 9am • Minutes/Summary Helpful for July’s Meeting • Suggestions 8

Specialty Hospital Budget Neutral Blanket Severity of (all hospitals Peer Groups Illness combined) Stepdown by Individual Days of Service Hospital • Attempts at variety of combinations of above components • Over 30 different calculations • Calculations discarded when too costly for Hospitals or over Budget 9

Specialty Hospital Budget Neutral Challenges In Calculating Per Diem • Calculating differences in the weights from FY 16 to FY 17 • Which elements to use in Per Diem calculation • Each approach required new calculations • Making sure utilized information was accurate (removing duplicate claims and transfer logic applied to LTACs and Rehabilitations) Per diem Components • Manually calculated FY 16 using FY 17 rates • Tested against cases for FY 17 • Grouped into Peer Groups • Stepdown in Service Days ➢ Blanket Calculation – Utilized all Hospital service days ➢ Peer Group Calculation – Each peer group received their own calculated service days • Medicare Crossover tested in FY 17 10

Specialty Hospital Budget Neutral Preliminary Proposed Per Diem Rates (two options) Proposed Step Down Per Diem Rate Using Blanket Calculated Service Days and 5% Stepdown: Q1 $ Q2 $ Q3 $ Q4 - starts $ LTAC 0-21 $2,084.02 22-42 $1,979.82 43-77 $1,880.83 78 $1,786.79 REHAB 0-21 $1,082.20 22-42 $1,028.09 43-77 $976.69 78 $927.85 CRAIG 0-21 $3,070.13 22-42 $2,916.62 43-77 $2,770.79 78 $2,632.25 Proposed Step Down Per Diem Rate Using Peer Group Service Days and 5% Stepdown: Q1 $ Q2 $ Q3 $ Q4 - starts $ LTAC 0-14 $1,989.29 15-35 $1,889.83 36-63 $1,795.33 64 $1,705.57 REHAB 0-14 $1,032.70 15-21 $981.07 22-35 $932.01 36 $885.41 CRAIG 0-28 $2,930.58 29-63 $2,784.05 64-84 $2,644.85 85 $2,512.61 Per Diem Equation • Total Peer Group Reimbursement/ Total Group Days • Total Peer Group Reimbursement/ Total Peer Group Days Action Item: Interested in Feedback. Missing components? Favor one option over the other? **Implementation Goal July 1, 2018** 11

Specialty Hospital Long Term Solutions Reviewing possible combinations of: • • Per Diem Peer Group • • Stepdown System Quality • Severity of Illness Component Any budget changes that are not budget neutral must go through the Budget Process • Main details decided by Nov 2018 • Implementation Goal: July 1, 2020 12

Specialty Hospital Future Meetings/Updates Specialty Hospital Engagement • Set up Monthly Meetings for Specialty Hospitals Meetings • On a Friday, starting October 6 th , 1pm-3pm 10/06/2017 (1pm-3pm) • Obtain Feedback/ Ideas 11/3/2017 (1pm-2pm) • Understand patient’s journey 12/01/2017 (1pm-3pm) • Prior to admission to Specialty • During stay at Specialty • After discharge from Specialty • Volunteers for Onsite Visits Would like to meet with most LTACs and Rehabs at least once prior to end of the year. 13

Cost Settlement Updates • Backlog of Settlements from Marguerite’s Retirement and System implementation have been resolved • If you have received a letter from Meyers and Stauffer, but NOT from the Department, please contact Andrew Larson • Process being internally re-developed ➢ Will supply updates as they come up 14

Innovative Medication Updates • We have been researching various options but this is a very resource intensive process • Received requested information from a few hospitals • We welcome and are open to any additional feedback from hospitals • Still researching/reviewing all information • We are in the process of applying for a grant to investigate the acquisition cost of drugs 15

MASS ADJUSTMENT TESTING UPDATE 227 Claims – Scheduled Process Date 9/8/2017 Count of ICN_NBR Column Labels Row Labels ICD10_oldsystem ICD10_wrongversion LVP_3hosp Transfer_Claims Grand Total HealthOne 50 3 1 54 HealthOne North Suburban Medical Center 8 8 HealthOne Presbyterian/St. Luke's Medical Center 7 1 8 HealthOne Rose Medical Center 6 2 8 HealthOne Sky Ridge Medical Center 4 4 HealthOne Spalding Rehabilitation Hospital 1 1 2 HealthOne Swedish Medical Center 9 9 HealthOne The Medical Center of Aurora 15 15 HealthSouth 5 1 15 21 HealthSouth Littleton Rehabilitation 3 6 9 HealthSouth Rehabilitation Hospital of Colorado Springs 2 1 9 12 SCL Health 50 50 Exempla Good Samaritan 4 4 Exempla Lutheran Medical Center 14 14 Exempla Saint Joseph Hospital, Inc. 23 23 Platte Valley Medical Center 3 3 St. Mary's Hospital and Medical Center, Inc. 6 6 UC-HEALTH 50 6 56 Memorial Hospital 18 2 20 Poudre Valley Hospital 10 10 University of Colorado Hospital 22 4 26 YAMPA 7 39 46 Yampa Valley Medical Center 7 39 46 227 Grand Total 162 10 39 16 Numbers are subject to change due to adjustments made by Providers or Department staff

3M Grouper Software Updates EAPG – Current Version 3.10.17.1 • DXC to update EAPG from Version 3.10.17.1 in next month to Version 3.10.17.3. Will accommodate changes for versions 3.10.17.2 & 3.10.17.3 APR-DRG Current Version 33 • ICD-10 10/1/2017 Update: The Department is planning for the APR- DRG Version 33 Software to be updated to reflect the ICD-10 10/1/2017 Update on or shortly after 10/1/2017. Software Updates • The Department is working with DXC to create a strategy for communicating software updates to providers. 17

Suspended Claims Received access to Suspended Claims for analysis • Reviewing Data associated with claims ➢ Primary Suspension Claim causes ▪ HCPCs Annual Update ▪ Drug Related Revenue Codes ➢ Continue reviewing minor causes Edit/Audit Description Paid Amount ICN Count Drug Related Revenue Code or Procedure $1,810,962.08 5,477 HCPCS - Annual Update $6,153,009.59 14,564 $7,963,971.67 25,889 18

EAPG Rule Change • 1.4% rate increase approved by CMS ➢ Requires update to Code of Colorado Regulations ➢ Will be presented to Medical Services Board (MSB) 10/13 ➢ Rule can be reviewed on Outpatient Hospital Payment page ➢ Feedback sent to HCPF_Hospitalregulatory@state.co.us. • Rate updates will be made pending MSB Approval ➢ Mass adjustment scheduling • Increased engagement with rule-making process ➢ Further rule changes will be announced similarly 19