SPECIALTY HOSPITAL ENGAGEMENT MEETING Friday, March 2, 2018 1:00 PM - - PowerPoint PPT Presentation

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SPECIALTY HOSPITAL ENGAGEMENT MEETING

Friday, March 2, 2018 1:00 PM – 2:00 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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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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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)

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: April 6, 2018

Timeline Update

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Review Methodology and Calculate new Per Diem Meet with other Sections of Department for Feedback File State Plan Amendment (SPA)

Budget Neutral Per Diem start goal July 1, 2019 Delay Related to:

• System Updates
• Calculations missing elements
• Per Diems failed Budget Neutral Test

Budget Neutral Calculation Changes

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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 Proposed Step Down Per Diem Rate (based on FY 17): Q1 $ Q2 $ Q3 $ Q4 $ 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 (based on FY 17):

• Over budget by $1,084,959.82
• Over budget by $346,251.62

Initial Per Diem Secondary Per Diem

Budget Neutral Calculation Changes

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Additional cases & days created from corrections and mass adjustments in the system Previous calculations should not have been affected drastically by new

• cases. This led to the review of:
• Calculation accuracy
• Stepdown Bracket methodology
• Per diem calculation
• Accuracy in data entry and referring calculations

Changes to 2017 Claims with Mass Adjustments

Test Total Cases Total Days APR-DRG Total ($) Original Test 2017 1091 16,046 $25,575,963.81 Mass Adj Test 2017 1156 17,462 $26,334,851.92 Difference: 65 1416 $758,888.11

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Current Formula: 𝑈𝑝𝑢𝑏𝑚 𝑒𝑝𝑚𝑚𝑏𝑠𝑡 𝑇𝐶1 + (1 − 𝑦)𝑇𝐶2 + (1 − 𝑦)2𝑇𝐶3 + (1 − 𝑦)3𝑇𝐶4 Total Dollars = Total dollars reimbursed to specific Classification

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

SB = Stepdown Bracket x = Percentage of stepdown (decimal form ex. 5% is 0.95)

Budget Neutral Formula

Consistent Per Diem Elements

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Stepdown Brackets

Three (3) classifications

• Long Term Acute Care (LTAC)
• Rehabilitations
• Spine/Brain

Budget Neutral in regards to Reimbursement paid out by HealthFirst Colorado Medicare Crossover Reimbursement: Coinsurance + Deductible

Per Diem Elements Under Review

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• 1. Breakdown of stepdown brackets
• Bracket days
• Revisit individual step downs
• 2. Consistent or variable stepdown percentages

between brackets

• 3. Verifications Requests of Long Term Stays
• 4. Interim Billing Rules

Questions and Discussion

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