SPECIALTY HOSPITAL ENGAGEMENT MEETING Friday, May 4, 2018 3:00 PM - - PowerPoint PPT Presentation

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SPECIALTY HOSPITAL ENGAGEMENT MEETING Friday, May 4, 2018 3:00 PM - - PowerPoint PPT Presentation

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SPECIALTY HOSPITAL ENGAGEMENT MEETING Friday, May 4, 2018 3:00 PM 4:00 PM Location: The Department of Health Care Policy & Financing, 303 East 17 th Avenue, Denver, CO 80203. 7 th Floor Room A. Conference Line: 1-877-820-7831 Passcode:

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SPECIALTY HOSPITAL ENGAGEMENT MEETING

Friday, May 4, 2018 3:00 PM – 4:00 PM

Location: The Department of Health Care Policy & Financing, 303 East 17th Avenue, Denver, CO 80203. 7th 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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SLIDE 2

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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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SLIDE 3

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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)

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SLIDE 4

Specialty Hospital Meetings

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

Future Meetings: Will be announced via Provider Bulletin, Hospital Engagement Meetings, Hospital Engagement Website and Email Notification. Next Meeting: June 1, 2018 **NEW TIME: 3:00pm-4:00pm**

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SLIDE 5

Type of Bill

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Type of bill (TOB) will still be 11X will still be used for billing Reimbursement Profile will be assigned upon new will dictate payment rate not the Type of Bill Interim will still utilize TOB: 112, 113, 114

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SLIDE 6

Interim Billing Options

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** Feedback received showed preference to 30 days as it currently reflects Provider billing cycles. Do others agree?

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SLIDE 7

Provider Type

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Providers will be required to enroll in a new Provider Type:

  • The new type will be announced as we get closer

to 07/01/2019

  • Profile will link Provider to correct classification

and correct Per Diem for reimbursement

  • Working with Policy to request Provider

Enrollment Fee waiver

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SLIDE 8

Timeline & Deadlines

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Budget Neutral Per Diem will start July 1, 2019 Timeline: May 4, 2018 – Additional discussion and feedback from Meeting May 18, 2018 – Per diem to move forward for implementation, start State Plan Amendment (SPA) June 15, 2018 – Submit system changes

  • Allows for testing
  • Adequate implementation time
  • Prevent mass adjustments

November 1, 2018* – Have SPA submitted May 1, 2019* – Rule and SPA approved. Announce new Provider type for Providers to enroll for July 1, 2019 *Completed at the latest, hoping to have completed prior to date provided

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SLIDE 9

Medicare Crossover

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Application of ‘Lesser of’ Logic Two Different Calculations:

  • Coinsurance and Deductible
  • Per Diem Reimbursement amount – Medicare Reimbursement

Whichever is less. Majority of claims will utilize Coinsurance and Deductible. The later option is to ensure the reimbursed amount does not exceed what Health First Colorado would reimburse as primary payer.

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SLIDE 10

Additional Details to be Defined

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  • Construct language to define each Classification for future
  • enrollment. Possible options include:
  • Utilize Colorado Department of Public Health and

Environment License

  • Medicare Licensure
  • A decision on the Interim Bill requirements: 30, 45 or 60 days
  • Obtain approval and feedback from other groups within

Health First Colorado

  • Write State Plan Amendment (SPA), State Rule and System

documentation for implementation

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SLIDE 11

Onsite Visits

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To volunteer for an Onsite Visit please contact Elizabeth Quaife at Elizabeth.quaife@state.co.us Update: Thank you to two hospitals that reached out and scheduled a visit. We appreciate your time. Site Visits were and continue to be a helpful inspiration

  • n decisions made for current Budget Neutral Per Diem

and would like to keep the hospitals involved as we begin to look into long term reimbursement options. Goal: Would like to meet with most of the LTACs and Rehabilitations

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SLIDE 12

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Budget Neutral Formula: 𝑈𝑝𝑢𝑏𝑚 𝑒𝑝𝑚𝑚𝑏𝑠𝑡 𝐶1 + (1 − 𝑦)𝐶2 + (1 − 𝑦)2𝐶3 + (1 − 𝑦)3𝐶4 Total Dollars = Total dollars reimbursed to specific Classification

  • LTAC Total Reimbursed Dollars
  • Rehab Total Reimbursed Dollars
  • Brain/Spine Total Reimbursed Dollars

B = Stepdown Bracket x = Percentage of stepdown (decimal form ex. 5% is 0.05)

Budget Neutral Formula

**Note: Budget Neutral to Health First Colorado Reimbursed dollars for FY 2017 (7/1/2016-06/30/2017) not Provider billed amount.

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SLIDE 13

Difference from Previous Per Diems

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𝑈𝑝𝑢𝑏𝑚 $ 𝑆𝑓𝑗𝑛𝑐𝑣𝑠𝑡𝑓𝑒 𝑐𝑧 𝐼𝑓𝑏𝑚𝑢ℎ 𝐺𝑗𝑠𝑡𝑢 𝐷𝑝𝑚𝑝𝑠𝑏𝑒𝑝 𝑈𝑝𝑢𝑏𝑚 # 𝑝𝑔 𝑑𝑝𝑤𝑓𝑠𝑓𝑒 𝑒𝑏𝑧𝑡

multiplied by a variable

Received questions on cause of difference of Per Diem amounts from previous

  • Change in equation utilized for calculation
  • Equation was inaccurate and used a multiplier to manipulate results to

come close to Budget Neutral

  • Additional claims changed total amounts reimbursed and days

Old equation:

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SLIDE 14

Old Calculation Per Diem vs. New Per Diem

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Old Per Diem New Per Diem

CLASSIFICATION B1 B1 Rate B2 B2 Rate B3 B3 Rate B4 B4 Rate LTAC 14 $2,188.44 35 $2,079.02 56 $1,975.07 >56 $1,876.31 REHAB 7 $962.63 14 $914.50 21 $868.77 >21 $825.33 SPINE 28 $2,807.56 49 $2,667.18 77 $2,533.82 >77 $2,407.13 CLASSIFICATION B1 B1 Rate B2 B2 Rate B3 B3 Rate B4 B4 Rate LTAC 21 $2,172.96 35 $2,064.31 56 $1,961.09 >56 $1,863.04 REHAB 14 $944.23 21 $897.02 28 $852.17 >28 $809.56 SPINE 28 $2,807.56 49 $2,667.18 77 $2,533.82 >77 $2,407.13

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SLIDE 15

Why Custom Brackets instead of General?

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  • 1. More even day distribution between group classification
  • 2. Impact is more consistent for each class of per diem
  • 3. Better reflects the long term goals the Department is working towards

General: Custom:

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SLIDE 16

Comparison of General vs. Custom Bracket

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General Bracket Per Diems: Custom Bracket Per Diems:

CLASS BRACKET 1 DAYS % OF TOTAL DAYS BRACKET 2 DAYS % OF TOTAL DAYS BRACKET 3 DAYS % OF TOTAL DAYS BRACKET 4 DAYS % OF TOTAL DAYS TOTAL DAYS LTAC 1500 33.79% 1542 34.74% 687 15.48% 710 15.99% 4,439 REHAB 6,319 59.76% 3,015 28.51% 758 7.17% 482 4.56% 10,574 SPINE 1244 50.80% 582 23.76% 432 17.64% 191 7.80% 2,449

CLASSIFICATION

B1 B1 Rate B2 B2 Rate B3 B3 Rate B4 B4 Rate LTAC 14 2,188.44 $ 35 2,079.02 $ 56 1,975.07 $ >56 1,876.31 $ REHAB 7 962.63 $ 14 914.50 $ 21 868.77 $ >21 825.33 $ SPINE 28 2,807.56 $ 49 2,667.18 $ 77 2,533.82 $ >77 2,407.13 $

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SLIDE 17

Adjusting the First Bracket by a Week

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CLASSIFICATION

B1 B1 Rate B2 B2 Rate B3 B3 Rate B4 B4 Rate LTAC 14 2,188.44 $ 35 2,079.02 $ 56 1,975.07 $ >56 1,876.31 $ REHAB 7 962.63 $ 14 914.50 $ 21 868.77 $ >21 825.33 $ SPINE 28 2,807.56 $ 49 2,667.18 $ 77 2,533.82 $ >77 2,407.13 $ CLASS BRACKET 1 DAYS % OF TOTAL DAYS BRACKET 2 DAYS % OF TOTAL DAYS BRACKET 3 DAYS % OF TOTAL DAYS BRACKET 4 DAYS % OF TOTAL DAYS TOTAL DAYS LTAC 1500 33.79% 1542 34.74% 687 15.48% 710 15.99% 4,439 REHAB 6,319 59.76% 3,015 28.51% 758 7.17% 482 4.56% 10,574 SPINE 1244 50.80% 582 23.76% 432 17.64% 191 7.80% 2,449

CLASSIFICATION

B1 B1 Rate B2 B2 Rate B3 B3 Rate B4 B4 Rate LTAC 21 2,172.96 $ 35 2,064.31 $ 56 1,961.09 $ >56 1,863.04 $ REHAB 14 944.23 $ 21 897.02 $ 28 852.17 $ >28 809.56 $ SPINE 28 2,807.56 $ 49 2,667.18 $ 77 2,533.82 $ >77 2,407.13 $ CLASS BRACKET 1 DAYS % OF TOTAL DAYS BRACKET 2 DAYS % OF TOTAL DAYS BRACKET 3 DAYS % OF TOTAL DAYS BRACKET 4 DAYS % OF TOTAL DAYS TOTAL DAYS LTAC 2113 47.60% 929 20.93% 687 15.48% 710 15.99% 4,439 REHAB 9,334 88.27% 758 7.17% 274 2.59% 208 1.97% 10,574 SPINE 1244 50.80% 582 23.76% 432 17.64% 191 7.80% 2,449

Added a week for LTAC and Rehab Percentage Breakdown Department Per Diem Choice: Percentage Breakdown

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SLIDE 18

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Budget Neutral Formula: 𝑈𝑝𝑢𝑏𝑚 𝑒𝑝𝑚𝑚𝑏𝑠𝑡 𝐶1 + (1 − 𝑦)𝐶2 + (1 − 𝑦)2𝐶3 + (1 − 𝑦)3𝐶4 Total Dollars = Total dollars reimbursed to specific Classification

  • LTAC Total Reimbursed Dollars
  • Rehab Total Reimbursed Dollars
  • Brain/Spine Total Reimbursed Dollars

B = Stepdown Bracket Day quantity x = Percentage of stepdown (decimal form ex. 5% is 0.05) Multiplier: B2=0.95 B3=0.9025 B3=0.857375

Budget Neutral Formula

**Note: Budget Neutral to Health First Colorado Reimbursed dollars for FY 2017 (7/1/2016-06/30/2017) not Provider billed amount.

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SLIDE 19

LTAC Case Examples Option 1

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APR-DRG SEVERITY CODE WEIGHT AVG LENGTH OF STAY TRIMPOINT MINIMUM DAY MAXIMUM DAY AVERAGE DAY 130 3 5.324 16.62 45 4 89 33 130 4 6.7266 21.62 62 8 155 46 133 3 1.2009 4.66 14 18 63 35 133 4 2.3559 7.67 27 1 88 30 950 4 7.7037 21.6 56 15 87 46

Base Rate: $16,000.00 Base Rate: $7,000.00 Base Rate: $5,800.00

CLASSIFICATION B1 B1 Rate B2 B2 Rate B3 B3 Rate B4 B4 Rate LTAC 14 $2,188.44 35 $2,079.02 56 $1,975.07 >56 $1,876.31

APR-DRG SEVERITY CODE 130 3 130 4 133 3 133 4 950 4 MIN DAY MINIMUM DAY APR- DRG PAYMENT MINIMUM DAY PER DIEM TOTAL MAX DAY MAXIMUM DAY APR-DRG PAYMENT MAXIMUM DAY PER DIEM TOTAL AVG DAY AVERAGE DAY APR- DRG PAYMENT AVERAGE DAY PER DIEM TOTAL 4 $85,184.00 $8,753.76 89 $265,597.77 $177,692.21 33 $85,184.00 $71,084.47 8 $107,625.60 $17,507.51 155 $477,993.07 $301,528.85 46 $107,625.60 $96,442.18 18 $32,408.84 $38,954.21 63 $180,846.26 $128,908.08 35 $89,804.64 $75,087.53 1 $37,694.40 $2,188.44 88 $277,523.18 $175,815.90 30 $49,096.10 $63,694.51 15 $123,259.20 $32,717.16 87 $264,779.02 $173,939.58 46 $123,259.20 $95,233.20 MIN DAY MINIMUM DAY APR- DRG PAYMENT MINIMUM DAY PER DIEM TOTAL MAX DAY MAXIMUM DAY APR-DRG PAYMENT MAXIMUM DAY PER DIEM TOTAL AVG DAY AVERAGE DAY APR- DRG PAYMENT AVERAGE DAY PER DIEM TOTAL 4 $37,268.00 $8,753.76 89 $116,199.02 $177,692.21 33 $37,268.00 $71,084.47 8 $47,086.20 $17,507.51 155 $209,121.97 $301,528.85 46 $47,086.20 $96,442.18 18 $14,178.87 $38,954.21 63 $79,120.24 $128,908.08 35 $39,289.53 $75,087.53 1 $16,491.30 $2,188.44 88 $121,416.39 $175,815.90 30 $21,479.54 $63,694.51 15 $53,925.90 $32,717.16 87 $115,840.82 $173,939.58 46 $53,925.90 $95,233.20 APR-DRG SEVERITY CODE 130 3 130 4 133 3 133 4 950 4

APR-DRG SEVERITY CODE 130 3 130 4 133 3 133 4 950 4 MIN DAY MINIMUM DAY APR- DRG PAYMENT MINIMUM DAY PER DIEM TOTAL MAX DAY MAXIMUM DAY APR-DRG PAYMENT MAXIMUM DAY PER DIEM TOTAL AVG DAY AVERAGE DAY APR- DRG PAYMENT AVERAGE DAY PER DIEM TOTAL 4 $30,879.20 $8,753.76 89 $96,279.19 $177,692.21 33 $30,879.20 $71,084.47 8 $39,014.28 $17,507.51 155 $173,272.49 $301,528.85 46 $39,014.28 $96,442.18 18 $11,748.20 $38,954.21 63 $65,556.77 $128,908.08 35 $32,554.18 $75,087.53 1 $13,664.22 $2,188.44 88 $100,602.15 $175,815.90 30 $17,797.33 $63,694.51 15 $44,681.46 $32,717.16 87 $95,982.40 $173,939.58 46 $44,681.46 $95,233.20

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SLIDE 20

LTAC Case Examples Option 2

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CLASSIFICATION B1 B1 Rate B2 B2 Rate B3 B3 Rate B4 B4 Rate LTAC 21 $2,172.96 35 $2,064.31 56 $1,961.09 >56 $1,863.04

Base Rate: $16,000.00 Base Rate: $7,000.00 Base Rate: $5,800.00

MIN DAY MINIMUM DAY APR- DRG PAYMENT MINIMUM DAY PER DIEM TOTAL MAX DAY MAXIMUM DAY PER DIEM TOTAL MAXIMUM DAY APR- DRG PAYMENT AVERAG E DAY AVERAGE DAY PER DIEM TOTAL AVERAGE DAY APR-DRG PAYMENT 4 $85,184.00 $8,691.82 89 $177,195.54 $265,597.77 33 $71,342.07 $85,184.00 8 $107,625.60 $17,383.64 155 $300,156.02 $477,993.07 46 $96,520.37 $107,625.60 18 $32,408.84 $39,113.19 63 $128,756.56 $180,846.26 35 $75,316.80 $89,804.64 1 $37,694.40 $2,172.96 88 $175,332.50 $277,523.18 30 $64,004.40 $49,096.10 15 $123,259.20 $32,594.33 87 $173,469.46 $264,779.02 46 $95,319.94 $123,259.20

MIN DAY MINIMUM DAY APR- DRG PAYMENT MINIMUM DAY PER DIEM TOTAL MAXIMU M DAY MAXIMUM DAY PER DIEM TOTAL MAXIMUM DAY APR- DRG PAYMENT AVERAG E DAY AVERAGE DAY PER DIEM TOTAL AVERAGE DAY APR-DRG PAYMENT 4 $37,268.00 $8,691.82 89 $177,195.54 $116,199.02 33 $71,342.07 $37,268.00 8 $47,086.20 $17,383.64 155 $300,156.02 $209,121.97 46 $96,520.37 $47,086.20 18 $14,178.87 $39,113.19 63 $128,756.56 $79,120.24 35 $75,316.80 $39,289.53 1 $16,491.30 $2,172.96 88 $175,332.50 $121,416.39 30 $64,004.40 $21,479.54 15 $53,925.90 $32,594.33 87 $173,469.46 $115,840.82 46 $95,319.94 $53,925.90 MIN DAY MINIMUM DAY APR- DRG PAYMENT MINIMUM DAY PER DIEM TOTAL MAXIMU M DAY MAXIMUM DAY PER DIEM TOTAL MAXIMUM DAY APR- DRG PAYMENT AVERAG E DAY AVERAGE DAY PER DIEM TOTAL AVERAGE DAY APR-DRG PAYMENT 4 $30,879.20 $8,691.82 89 $177,195.54 $96,279.19 33 $71,342.07 $30,879.20 8 $39,014.28 $17,383.64 155 $300,156.02 $173,272.49 46 $96,520.37 $39,014.28 18 $11,748.20 $39,113.19 63 $128,756.56 $65,556.77 35 $75,316.80 $32,554.18 1 $13,664.22 $2,172.96 88 $175,332.50 $100,602.15 30 $64,004.40 $17,797.33 15 $44,681.46 $32,594.33 87 $173,469.46 $95,982.40 46 $95,319.94 $44,681.46 APR-DRG SEVERITY CODE 130 3 130 4 133 3 133 4 950 4 APR-DRG SEVERITY CODE 130 3 130 4 133 3 133 4 950 4 APR-DRG SEVERITY CODE 130 3 130 4 133 3 133 4 950 4

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SLIDE 21

Rehab Case Examples Option 1

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Base Rate: $7,500.00 Base Rate: $5,500.00

APR-DRG SEVERITY CODE 58 2 58 3 860 1 860 2 860 3 860 4 862 1 862 2 862 3 APR-DRG SEVERITY CODE 58 2 58 3 860 1 860 2 860 3 860 4 862 1 862 2 862 3

CLASSIFICATION B1 B1 Rate B2 B2 Rate B3 B3 Rate B4 B4 Rate REHAB 7 $962.63 14 $914.50 21 $868.77 >21 $825.33

APR-DRG SEVERITY CODE WEIGHT AVG LENGTH OF STAY TRIMPOINT MINIMUM DAY MAXIMUM DAY AVERAGE DAY 58 2 0.8046 2.8 8 7 24 10 58 3 1.2725 5.31 19 1 24 9 860 1 0.8574 8.74 20 1 14 7 860 2 1.5256 11.75 26 1 30 9 860 3 2.141 15.36 39 1 57 12 860 4 2.4919 17.44 44 2 42 14 862 1 1.4019 5.69 21 1 7 3 862 2 0.705 9.06 29 1 8 5 862 3 1.1069 11.16 36 1 14 8

MIN DAY MINIMUM DAY APR- DRG PAYMENT MINIMUM DAY PER DIEM TOTAL MAX DAY MAXIMUM DAY APR-DRG PAYMENT MAXIMUM DAY PER DIEM TOTAL AVG DAY AVERAGE DAY APR- DRG PAYMENT AVERAGE DAY PER DIEM TOTAL 7 $6,034.50 $6,738.40 24 $33,620.79 $21,697.29 10 $9,770.14 $9,634.31 1 $9,543.75 $962.63 24 $16,733.02 $21,697.29 9 $9,543.75 $8,567.39 1 $6,430.50 $962.63 14 $6,430.50 $13,139.88 7 $6,430.50 $7,017.83 1 $11,442.00 $962.63 30 $14,558.12 $26,649.29 9 $11,442.00 $8,462.45 1 $16,057.50 $962.63 57 $31,111.41 $48,933.30 12 $16,057.50 $11,715.66 2 $18,689.25 $1,925.26 42 $18,689.25 $36,553.30 14 $18,689.25 $13,336.39 1 $10,514.25 $962.63 7 $10,514.25 $6,738.40 3 $10,514.25 $3,080.41 1 $5,287.50 $962.63 8 $5,287.50 $7,652.90 5 $5,287.50 $5,250.70 1 $8,301.75 $962.63 14 $8,301.75 $13,139.88 8 $8,301.75 $7,271.86 MIN DAY MINIMUM DAY APR- DRG PAYMENT MINIMUM DAY PER DIEM TOTAL MAX DAY MAXIMUM DAY APR-DRG PAYMENT MAXIMUM DAY PER DIEM TOTAL AVG DAY AVERAGE DAY APR- DRG PAYMENT AVERAGE DAY PER DIEM TOTAL 7 $4,425.30 $6,738.40 24 $24,655.24 $21,697.29 10 $7,164.77 $9,634.31 1 $6,998.75 $962.63 24 $12,270.88 $21,697.29 9 $6,998.75 $8,567.39 1 $4,715.70 $962.63 14 $4,715.70 $13,139.88 7 $4,715.70 $7,017.83 1 $8,390.80 $962.63 30 $10,675.95 $26,649.29 9 $8,390.80 $8,462.45 1 $11,775.50 $962.63 57 $22,815.03 $48,933.30 12 $11,775.50 $11,715.66 2 $13,705.45 $1,925.26 42 $13,705.45 $36,553.30 14 $13,705.45 $13,336.39 1 $7,710.45 $962.63 7 $7,710.45 $6,738.40 3 $7,710.45 $3,080.41 1 $3,877.50 $962.63 8 $3,877.50 $7,652.90 5 $3,877.50 $5,250.70 1 $6,087.95 $962.63 14 $6,087.95 $13,139.88 8 $6,087.95 $7,271.86

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SLIDE 22

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Rehab Case Examples Option 2

REHAB 14 $944.23 21 $897.02 28 $852.17 >28 $809.56

APR-DRG SEVERITY CODE WEIGHT AVG LENGTH OF STAY TRIMPOINT MINIMUM DAY MAXIMUM DAY AVERAGE DAY 58 2 0.8046 2.8 8 7 24 10 58 3 1.2725 5.31 19 1 24 9 860 1 0.8574 8.74 20 1 14 7 860 2 1.5256 11.75 26 1 30 9 860 3 2.141 15.36 39 1 57 12 860 4 2.4919 17.44 44 2 42 14 862 1 1.4019 5.69 21 1 7 3 862 2 0.705 9.06 29 1 8 5 862 3 1.1069 11.16 36 1 14 8

Base Rate: $7,500.00 Base Rate: $5,500.00

APR-DRG SEVERITY CODE 58 2 58 3 860 1 860 2 860 3 860 4 862 1 862 2 862 3

APR-DRG SEVERITY CODE 58 2 58 3 860 1 860 2 860 3 860 4 862 1 862 2 862 3

MINIMUM DAY MINIMUM DAY APR- DRG PAYMENT MINIMUM DAY PER DIEM TOTAL MAXIMU M DAY MAXIMUM DAY PER DIEM TOTAL MAXIMUM DAY APR- DRG PAYMENT AVERAG E DAY AVERAGE DAY PER DIEM TOTAL AVERAGE DAY APR-DRG PAYMENT 7 $6,034.50 $6,609.64 24 $22,054.95 $33,620.79 10 $9,599.72 $9,770.14 1 $9,543.75 $944.23 24 $22,054.95 $16,733.02 9 $8,498.11 $9,543.75 1 $6,430.50 $944.23 14 $13,219.28 $6,430.50 7 $6,898.16 $6,430.50 1 $11,442.00 $944.23 30 $27,082.76 $14,558.12 9 $8,389.75 $11,442.00 1 $16,057.50 $944.23 57 $48,940.96 $31,111.41 12 $11,748.75 $16,057.50 2 $18,689.25 $1,888.47 42 $36,797.52 $18,689.25 14 $13,422.18 $18,689.25 1 $10,514.25 $944.23 7 $6,609.64 $10,514.25 3 $3,021.55 $10,514.25 1 $5,287.50 $944.23 8 $7,553.87 $5,287.50 5 $5,150.37 $5,287.50 1 $8,301.75 $944.23 14 $13,219.28 $8,301.75 8 $7,160.44 $8,301.75 MINIMUM DAY MINIMUM DAY APR- DRG PAYMENT MINIMUM DAY PER DIEM TOTAL MAXIMU M DAY MAXIMUM DAY PER DIEM TOTAL MAXIMUM DAY APR- DRG PAYMENT AVERAG E DAY AVERAGE DAY PER DIEM TOTAL AVERAGE DAY APR-DRG PAYMENT 7 $4,425.30 $6,609.64 24 $22,054.95 $24,655.24 10 $9,599.72 $7,164.77 1 $6,998.75 $944.23 24 $22,054.95 $12,270.88 9 $8,498.11 $6,998.75 1 $4,715.70 $944.23 14 $13,219.28 $4,715.70 7 $6,898.16 $4,715.70 1 $8,390.80 $944.23 30 $27,082.76 $10,675.95 9 $8,389.75 $8,390.80 1 $11,775.50 $944.23 57 $48,940.96 $22,815.03 12 $11,748.75 $11,775.50 2 $13,705.45 $1,888.47 42 $36,797.52 $13,705.45 14 $13,422.18 $13,705.45 1 $7,710.45 $944.23 7 $6,609.64 $7,710.45 3 $3,021.55 $7,710.45 1 $3,877.50 $944.23 8 $7,553.87 $3,877.50 5 $5,150.37 $3,877.50 1 $6,087.95 $944.23 14 $13,219.28 $6,087.95 8 $7,160.44 $6,087.95

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SLIDE 23

Spine/Brain Specialty Case Examples

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CLASSIFICATION B1 B1 Rate B2 B2 Rate B3 B3 Rate B4 B4 Rate SPINE 28 $2,807.56 49 $2,667.18 77 $2,533.82 >77 $2,407.13

APR-DRG SEVERITY CODE WEIGHT AVG LENGTH OF STAY TRIMPOINT MINIMUM DAY MAXIMUM DAY AVERAGE DAY 40 3 1.6653 6.46 20 21 87 61 40 4 3.8818 12.92 41 56 98 79 55 3 2.2882 8.96 28 4 117 43 55 4 3.8221 11.37 32 12 78 46 57 3 1.4054 4.12 12 21 39 39

APR-DRG SEVERITY CODE 40 3 40 4 55 3 55 4 57 3

MINIMUM DAY MINIMUM DAY APR- DRG PAYMENT MINIMUM DAY PER DIEM TOTAL MAXIMU M DAY MAXIMUM DAY PER DIEM TOTAL MAXIMUM DAY APR- DRG PAYMENT AVERAG E DAY AVERAGE DAY PER DIEM TOTAL AVERAGE DAY APR-DRG PAYMENT 21 $26,575.71 $58,958.69 87 $194,167.11 $219,853.63 61 $164,183.58 $142,737.69 56 $106,318.06 $152,359.08 98 $220,645.53 $249,668.24 79 $173,706.52 $183,112.80 4 $32,492.44 $11,230.23 117 $266,380.98 $290,691.29 43 $118,619.27 $76,009.10 12 $54,273.82 $33,690.68 78 $172,502.95 $229,935.79 46 $126,087.37 $106,972.41 21 $54,832.43 $58,958.69 39 $107,950.56 $124,583.93 39 $107,950.56 $124,583.93

Base Rate: $14,200

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SLIDE 24

Questions and Discussion

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SLIDE 25

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Elizabeth Quaife Specialty Hospital Rates Analyst Elizabeth.Quaife@state.co.us