Andy Page Partner DHG LLP DHG Healthcare Session Overview Introduction Significance of PostAcute Care Impacts of PostAcute Care Performance Mandatory Elements of Reform Understanding PAC Performance ID: 640806
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Slide1
Post Acute Care Collaboration & Network Development
Andy Page, Partner
DHG LLP
DHG HealthcareSlide2
Session Overview
- Introduction
- Significance of Post‐Acute Care
- Impacts of Post‐Acute Care Performance
- Mandatory Elements of Reform
- Understanding PAC Performance
- Managing a Post‐Acute Care NetworkSlide3
Building an effective post-acute network is essential to success under the rapidly accelerating shift from traditional fee-for-service to value-based reimbursement.
Basic ConceptSlide4
Acute care providers are
significantly impacted by the performance of
its post-acute care
partners
Readmission Volumes
Clinical Outcomes & Patient Satisfaction
Mortality Rates
Financial Performance with Bundled Payments /CJR
Post-acute care providers are significantly impacted by Reform Elements and Referral Source Revenue Cycle Compressed Length of StayReferral Volumes & Backfill AdmissionsPatient Acuity / Diagnoses
Impacts of PAC Networks – 2 Way StreetSlide5
Significance of Post‐Acute CareSlide6
Importance of the Post-Acute
Care Continuum
~ 90%Slide7
Post Acute Care – Aggregate Dollars $$
Post Acute Medicare
Benefit $$
- Helicopter
View
14,500,000
Medicare Hospital Stays
x 35%
Post Acute Discharge Rate
5,075,000
Total
Medicare Post-Acute Discharges
$10,000
Average
Post-Acute Stay
$50,750,000,000 Total Post Acute Care Spending 1,015,000,000 2% Reduction Impact???
$ 1BSlide8
Post Acute Care Within the ContinuumMitigating payment reform risk and succeeding in alternative payment models
.Success in any episodic payment model is based on the ability to manage and control post‐acute care spend.Managing post‐acute care must include an effective care transition process, the ability to monitor care, and visibility into progress against expected outcomes
.Up to 60%
of episodic spending
occurs post‐acute
7Slide9
Impacts of Post‐Acute Care
Performance &
Mandatory Elements of Reform Slide10
9
Post-Acute Care Performance ImpactsSlide11
Mandatory Elements of Reform
Readmission Reduction Program9% of Current and Future Medicare Reimbursement at Risk3% penalty of Medicare Reimbursement at risk each program year
Measured Populations 30 days from DISCHARGEAMI, HF, PN, COPD, THA & TKA, CABGAugust 2014
: CABG Added to FY 2017
Performance
Periods: 3 Year Rolling
Program
–
FY’16: July 1, 2011 – June 30, 2014 – 3% – FY 17: July 1, 2012 – June 30, 2015 – 3% – FY 18: July 1, 2013 – June 30, 2016 – 3% – FY 19: July 1, 2014 – June 30, 2017 – 3% – FY 20: July 1, 2015 – June 30, 2018 – 3%10Currently Participating in 2 Performance PhasesSlide12
Value‐Based PurchasingClinical Outcomes Component (Mortality)
FY17 Performance Period – October 1, 2013 – June 30, 2015Currently in 2
Performance Periods applicable to FY 2019 & FY 2020
Assess
UNEXPECTED deaths: AMI, HF and PN that
occur within
30 days after
admission
; which, depending on the length of stay, may occur after discharge from the post acute setting.11Mandatory Elements of Reform Slide13
Value‐Based PurchasingEfficiency Component: Medicare
Spend Per Beneficiary (MSPB)Captures total Medicare Spending Per Beneficiary relative to an episode of care,
bundling hospital sources with post‐acute careBundles the cost of care delivered to a beneficiary for an episode across the continuum of care:
3
days
prior to admission to acute
Hospital Inpatient Stay
30 days
post‐discharge (including Post Acute Setting)12Mandatory Elements of Reform Slide14
MD
Home Health
SNF
IRF
OP Rehab
Readmission
Home
$3,207
$
10,129
$
8,965
$
616
+
+
+
=
$
22,927
x
98
%
$
22,468
DRG Inpatient and
PAC Fee-for-Service
Model
Bundle
Total
Joint Replacement (DRG 470)
Note:
A
ny aggregate payments
lower than $22,468 can be shared with
providers
Bundled
Payment / CJR ExampleSlide15
BPCI / CJR - Impactable Spending by EpisodeSlide16
Understanding PAC PerformanceSlide17
Discharge PracticesSlide18
ALOS vs ReadmissionSlide19
Average Length of Stay by SNFSlide20
Readmission Rates by Skilled Nursing FacilitySlide21
Evaluating SNF Performance - MSPB
Facility
Discharges
% of Discharges
Readmissions
Readmissions %
Readmissions
Avg Medicare
Cost
Avg. LOS
SNF 1
60
9.66%
23
38.3%
11.92%
$ 16,341
29.40
SNF
2
59
9.50%
18
30.5%
9.33%
$ 13,698
25.75
SNF
3
35
5.64%
15
42.9%
7.77%
$ 16,444
29.94
SNF
4
35
5.64%
8
22.9%
4.15%
$ 17,567
32.31
SNF
5
33
5.31%
7
21.2%
3.63%
$ 12,855
28.06
SNF
6
28
4.51%
5
17.9%
2.59%
$ 7,718
14.79
SNF 7
27
4.35%
10
37.0%
5.18%
$ 16,892
32.63
SNF 8
24
3.86%
7
29.2%
3.63%
$ 13,268
28.54
SNF 9
23
3.70%
7
30.4%
3.63%
$ 14,757
30.57
SNF 10
22
3.54%
10
45.5%
5.18%
$ 15,765
30.09Slide22
Developing and Managing a Post‐Acute Care NetworkSlide23
Building a Post-Acute Care
Network
Determine
Performance Guidelines
Build Care Transition Programs
Internal and External Stakeholder Education/Communication
Performance
Monitoring
Current state assessment
Market dynamicsReform Element performance
Service line trends
Discharge practicesPAC performance
Identify high-performing PAC providers
ConceptsSlide24
Think about it from the “other side”
Challenges of the PAC Providers
Different
Business Model
Different Payer
Sources
&
Revenue Streams
Less Sophisticated Technology Lower level Clinical StaffPrimarily a For-Profit Industry
Post Acute Provider PerspectiveSlide25
Policy & Regulatory Changes for PAC Providers
Medicare
Payment Advisory
Commission (MedPAC)
Medicare Hospital Readmissions Reduction Program (HRRP)
Focused on 30 Day Readmissions for:
Heart Failure, Heart Attack, Pneumonia
IMPACT Act of 2014 – Enhanced reporting of Quality Measures
Revision to FIVE STAR RATINGS (SNF) – Executive Action from President
Implementation of STAR Ratings (HHA)Slide26
Hallmarks of an Effective Post-Acute Care Network
Rigorous selection process
Staff support & buy-in at affiliates
Performance monitoring of network partners
Clear expectations for discharges
Objective rotation & measurement system for rejected cases
Real-time market availability
Quality transparency
Electronic patient information transfer
Compliant patient educationResources for case management and physicians
Staff education
High-Quality
Partners
Standardized
Transfer Protocols
IT Connectivity
Empowered
Patients and StaffSlide27
Remember the Shift In Payment Methodology
“…HHS goal of 30 percent traditional FFS Medicare payment through alternative payment models by the end of 2016… 50 percent by the end of 2018”
HHS Press Office
1-26-15
TodaySlide28
Remember….
The importance of the post-acute care continuum within the healthcare delivery system
The effect of mandatory
and voluntary elements of
Health Reform across the continuum of patient care
The key
performance
indicators to measure quality, financial metrics, and patient outcomes
The importance of an Implementation & Monitoring team to ensure accountability
Post Acute Care Collaboration – RecapSlide29
Questions…
?
?
?
?
Thank You!
Andy Page, CPA
Partner – DHG LLP
DHG Healthcare
919.526.1836
andy.page@dhgllp.com