Readmissions HAC and VBP Penalties 3 1 15 up to 55 in Penalties for 2015 Readmissions Reduction Program Hospital Acquired Condition HAC Reduction Program Valuebased Purchasing VBP Program ID: 684203
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Slide1
October 2015
Integrating Data Analytics Technology and Services to Maximize Quality-Based Payments for HospitalsSlide2
Readmissions, HAC and VBP Penalties
3% + 1% + 1.5% = up to 5.5% in Penalties for 2015
Readmissions Reduction Program
Hospital Acquired Condition (HAC) Reduction Program
Value-based Purchasing (VBP) Program
Hospitals at risk of losing <3% of Medicare Payments
Hospitals penalized 1% of Medicare Payments if HAC Score in lowest 25%
Cuts or bonuses of <1.5% Medicare payments
2016: Only 799 of 3,400+ hospitals avoided a penalty. Hospitals lost a combined $420 million
New Jersey was the most penalized state with
97% of eligible hospitals
receiving a penalty
2015: 700+ hospitals had payments docked - CMS estimates payments lost is
~$330 million
2015: 1,714 hospitals will get bonuses, 1,375 hospitals reductions
Total VBP payment shifts for FY15 will reach
$1.4 billionSlide3
Readmissions Program
FY 2015
FY
2016
FY
2017
3-Year Total
Medicare Revenue $100K
$610,000
$610,000
$610,000
$1,830,000
Medicare Revenue $250K
$1,525,000
$1,525,000
$1,525,000
$4,575,000
VBP Program
FY 2015
FY
2016
FY
2017 CombinedMedicare Revenue $100K$300,000$300,000$300,000$900,000Medicare Revenue $250K$750,000$750,000$750,000$2,250,000HAC Reduction Program FY 2015 FY 2016 FY 2017 CombinedMedicare Revenue $100K$1,000,000$1,000,000$1,000,000$3,000,000Medicare Revenue $250K$2,500,000$2,500,000$2,500,000$7,500,000
Average 2016 Penalty: -0.61%
Average 2015 Penalty: -0.30%
HAC Penalty: -1.00%
Financial Impact of Readmissions, HAC and VBP PenaltiesSlide4
Capabilities Needed to Reduce Preventable Readmissions
Predicting
risk of readmission for Ambulatory Sensitive Conditions to target resources
Model incorporates LACE, BOOST and proprietary elements to identify High Risk Patients upon admission
Facilitating
care coordination and discharge planning to reduce readmissions
Analytics leverage BOOST and Project RED to significantly impact “Transitions in Care”
Alerting
the Emergency Department of recent discharges to prevent readmission
.03
%
-
2.65
%
Range of hospital penalty
NJ hospitals penalized by Medicare
98
%
#
1
N.J. leads nation for
number of hospitals penalized for high readmissionsSlide5
Capabilities Needed to Reduce
Hospital Acquired Conditions
Collecting and preparing data
for infectious disease measures and hospital penalty calculations
Predicting HACs
with variables that are important predictors for hospital acquired conditions such as pressure ulcers
Calculating potential HAC/HAI penaltiesSlide6
Capabilities Needed to
Improve Value-based Purchasing Scores
Predicting patients that qualify for VBP measures
in real-time so interventions can be made to improve care and scores
Providing alerts
on gaps in documentation and care to enable targeted interventions
Forecasting reimbursements
with a VBP calculator so strategies can be implemented in advance to improve scores
Providing scorecards to track VBP measures against CMS targets and benchmarksSlide7
Overall Quality/Performance Improvement Challenges
IT Challenges
Multiple
IT application systems
Multiple
, disparate data sources, feeds, code sets
Migrating
to HIS vendor's data warehouse
Working around unstructured (text) data
Lack of data governanceProcess and Change Management Challenges
Lack
of industry best practicesLimited care coordination personnel
Poor patient engagementLack of commitment from care partners – community and providers
Inadequate discharge processes
Slow adoption of QI technologySlide8
Overall Keys to Success in Readmissions, HAC ands VBP Programs
Operational StrategySlide9
IT Should be Integrated with Expert Managed Services
A successful strategy includes better care continuum integration across three key areas
ACCESS TO CARE
Transfer
process
Referral
sourcesDirect admission access (ED)
PATIENT CARE DELIVERY
Quality clinical outcomesIntensive
care unit utilizationPhysician involvementLow cost alternatives to admission (
CDU or telehealth)
POST DISCHARGE MGMT
Discharge follow up processManaged care program appropriatenessSub-acute follow up process
Identify patients for high risk of return Slide10
Hospital Measure Programs
Custom Measures
Labs
Ambulatory
HCAHPS
ADT
Meds
Custom
EMR
HIE
Claims
EDW
Analytics & Visualization
Readmissions
HAC/HAI Surveillance
Risk Stratification and Population Health
Operational impact
LOS
ED Throughput
Utilization and Cost Analytics
Inpatient Analytics
Population Health Analytics
Measures FrameworkPredictive EngineElectronic InterfaceData collection from all available sourcesAnalytics and ReportingPredictive AnalyticsMeasures Calculation/ReportingReal-time AnalyticsSlide11
Thank You
Presenter Contact Information
Raj Lakhanpal, MD
CEO, SpectraMedix
609.336.7733
Ext
301 (Office)
609.865.3244 (
Cell)
Raj.Lakhanpal@SpectraMedix.comIvan Cheng
Senior Manager,
North Highland
215.207.0772 (Office)404.889.0347 (Cell)
Ivan.Cheng@northhighland.com