Mandatory Elements of Healthcare Reform Walter Coleman 1
Agenda ACA Mandatory Elements of Reform Value Based Purchasing Readmission Reduction Program Hospital Acquired Conditions Best practices to analyze current and previous performance Opportunities for Revenue Maximization Questions 2
Revenue Industry Tipping Point Time How do local market conditions impact timing considerations? Can market-changing events create an urgent paradigm shift? What is my step-change business model risk? Do I have the financial tools to adequately analyze relevant states? 3
Hierarchy of Risk and Payment Models 4
Alignment of Strategy and Metrics Questions to Ask How many metrics am I tracking? How many metrics are duplicated? Do they have the same numerator and denominator? Source? Are they aligned with our results and strategic goals? What contracts are coming up for renewal that should have new metrics or should be at risk (mgd care, medical directorships, PMAs, etc.) What are we focused on? 5
Timeline of Reform 6
Mandatory Elements of Reform Value Based Purchasing VALUE BASED PURCHASING 7
Value Based Purchasing Outcomes = Income Mandatory Pay for Performance Program 3,500 hospitals are included in this program across the country Reimbursement Determine Two Ways: Achievement How we compare to National Top Decile (350 Hospitals) Improvement How we measure against ourselves Did we do better than a previously measured baseline period 8
Value Based Purchasing Percent of Medicare Reimbursement at Risk FY 2013 1.00% FY 2014 1.25% FY 2015 1.50% FY 2016 1.75% FY 2017 2.00% FY 2018 2.00% FY 2019 2.00% FY 20xx refers to the Federal Fiscal Year (Oct. 1 Sep. 30) when DRG payments will be affected 9
VBP FY 2017 New Measures Patient Experience No Change Same HCAHPS Measures Clinical Care Core Measures 6 Dropped; 1 New Mortality (formerly Outcomes) AMI, HF, PN Safety (Formerly Outcomes) 4 Existing; 2 New Efficiency No Change 10
VBP FY 2017 Patient Experience Communication with Nurses Communication with Doctors Responsiveness of Hospital Staff Pain Management Communication about Medicines Cleanliness and Quietness of Hospital Discharge Information Overall Rating of Hospital **For answers to count, patients must give hospitals a score of 4 or Always 11
VBP FY 2016 Core Measures AMI-7a SCIP-Inf-9 PN-6 SCIP-Inf-2 SCIP-Inf-3 SCIP-Card-2 SCIP-VTE-2 IMM-2 12
VBP FY 2017 Clinical Care: Process AMI-7a IMM-2 PC-01 PC-01 = Elective Delivery Prior to 39 Completed Weeks Gestation 13
VBP FY 2016 Outcomes Outcomes 30 Day Mortality AMI 30 Day Mortality HF 30 Day Mortality PN AHRQ PSI-90 CLABSI CAUTI SSI-Colon SSI-Abdominal Hyster. 14
VBP FY 2017 Clinical Care and Safety Clinical Care- Outcomes 30 Day Mortality AMI 30 Day Mortality HF 30 Day Mortality PN AHRQ PSI-90 CLABSI CAUTI SSI-Colon SSI-Abdominal Hyster. Safety MRSA C. Diff 15
Timeline of Reform 16
Outcomes 30 Day Mortality Currently in 3 Performance Periods FY 2016 ended June 30, 2014 FY 2019 began July 1, 2014 30 Day Mortality Measures Assess deaths: AMI, HF, and PN that occur within 30 days after admission; which, depending on the length of stay, may occur post-discharge. 17
Mortality Deaths w/in 30 Days and Outside of Facility Total # of Patients who Died w/in 30 Days # of Patients who Died w/in 30 Days Outside of Facility % of Patients who Died w/in 30 Days Outside of Facility Facility A 209 144 68.90% Facility B 222 128 57.66% Facility C 117 77 65.81% Facility D 119 65 54.62% Facility E 206 112 54.37% Facility F 117 67 57.26% Facility G 277 180 64.98% Facility H 147 71 48.30% Facility I 52 25 48.08% Facility J 44 25 56.82% Facility K 127 90 70.87% TOTAL 1,637 984 60.11% 18
CMS 30 Day Risk-Standardized Mortality Rate Calculation Facility Predicted Deaths Facility Expected Deaths = X Measure (AMI, HF, PN) National Crude Rate 19
VBP FY 2016 - Efficiency Medicare Spend Per Beneficiary (MSPB) Captures total Medicare Spending Per Beneficiary relative to a hospital stay, bundling hospital sources (Part A) with post acute care (Part B) Bundles the cost of care delivered to a beneficiary for an episode across the continuum of care: 3 Days Prior Hospital Inpatient Stay 30 Days post Discharge 20
PROPOSED MSPB Measures Additional Efficiency Measures proposed to be added Medical Kidney/Urinary Tract Infection Cellulitis Gastrointestinal hemorrhage Surgical Hip replacement/revision Knee replacement/revision Lumbar spine fusion/refusion Risk Adjusted similarly to MSPB Proposed to facilitate alignment with the Physician Value Based Payment Modifier program Includes Part A and B and 3 days prior to admission and 30 days post discharge SOURCE: May 1, 2014 Federal Register 21
VBP Shifting of Domain Weights FY 2014 FY 2015 FY 2016 FY 2017 Mortality Clinical Care Patient Experience Safety - Outcomes Efficiency (MSPB) 22 22
VBP FY13 Domain Weights Performance Period: July 1, 2011 March 31, 2012 Reimbursement Period: October 1, 2012 September 30, 2013 Core Measures = 70% 23
VBP FY14 Domain Weights Performance Period: April 1, 2012 December 31, 2012 Reimbursement Period: October 1, 2013 September 30, 2014 Outcomes = 25% Core Measures = 45% 24
VBP FY15 Domain Weights Performance Period: January 1, 2013 December 31, 2013 Reimbursement Period: October 1, 2014 September 30, 2015 HCAHPS = 30% Core Measures = 20% Outcomes = 30% MSPB = 20% One Measure!! 25
VBP FY16 Domain Weights Performance Period: January 1, 2014 December 31, 2014 Reimbursement Period: October 1, 2015 September 30, 2016 HCAHPS = 25% Core Measures = 10% MSPB = 25% Outcomes = 40% 26
VBP FY17 Domain Weights Performance Period: January 1, 2015 December 31, 2015 Reimbursement Period: October 1, 2016 September 30, 2017 Clinical Care - Process = 5% HCAHPS = 25% Clinical Care - Outcomes = 25% Safety = 20% MSPB = 25% 27 27
VBP FY'15 TOTAL PERFORMANCE Earned Back Unearned Available $$ % Earned System $4,925,357 $6,187,541 $11,112,898 44.32% $4,925,357 Breakeven Point: $5,301,360 $0 $11,112,898 Overall Performance System was penalized $376,003 in FY 15 VBP Program Must acknowledge the amount UNEARNED Of the programs dollars made available: System did not capitalize on $6,187,541 28
Core Measures Earned Back Unearned Measure Value % Earned Facility $381,643 $218,077 $599,720 63.64% Outcomes Earned Back Unearned Measure Value % Earned Facility $539,763 $359,837 $899,600 60.00% Breakeven Point: $232,525 $381,643 Breakeven Point: $348,788 $539,763 $0 $599,720 $0 $899,600 HCAHPS Earned Back Unearned Measure Value % Earned Facility $278,896 $620,704 $899,600 31.00% $278,896 Breakeven Point: $348,788 Efficiency Earned Back Unearned Measure Value % Earned Facility $59,974 $539,746 $599,720 10.00% Breakeven Point: $232,535 $59,974 $0 $899,600 $0 $599,720 29
Facility Bonus / (Penalty) Total Score State Average National Average National Δ Facility A $97,593 42.03 41.81933117 41.70169535 0.325577377 Core Measures HCAHPS Measure Score Amount Earned by Measure Amount Unearned by Measure % of Measure Earned AMI-8a 6 $ 32,712 $ 21,808 60.00% SCIP-Inf-1 9 $ 49,068 $ 5,452 90.00% SCIP-Inf-2 7 $ 38,164 $ 16,356 70.00% SCIP-Inf-3 5 $ 27,260 $ 27,260 50.00% SCIP-Inf-4 9 $ 49,068 $ 5,452 90.00% SCIP-Inf-9 5 $ 27,260 $ 27,260 50.00% HF-1 8 $ 43,616 $ 10,904 80.00% PN-3b 5 $ 27,260 $ 27,260 50.00% PN-6 8 $ 43,616 $ 10,904 80.00% SCIP-Card-2 3 $ 16,356 $ 38,164 30.00% SCIP-VTE-2 5 $ 27,260 $ 27,260 50.00% Core Measures TOTAL $ 381,643 $ 218,077 63.64% Comm. w/ Nurses 2 $ 17,994 $ 71,966 20.00% Comm. w/ Doctors 1 $ 8,998 $ 80,962 10.00% Resp. of Hosp. Staff 2 $ 17,994 $ 71,966 20.00% Pain Management 2 $ 17,994 $ 71,966 20.00% Comm. Re: Medicines 1 $ 8,998 $ 80,962 10.00% Clealiness & Quietness 2 $ 17,994 $ 71,966 20.00% Discharge Information 3 $ 26,990 $ 62,970 30.00% Overall Rating 1 $ 8,998 $ 80,962 10.00% Consistency Score 17 $ 152,933 $ 26,987 85.00% HCAHPS TOTAL $ 278,896 $ 620,704 31.00% Outcomes Efficiency AMI 10 $ 179,920 $ (0) 100.00% HF 3 $ 53,980 $ 125,940 30.00% PN 8 $ 143,934 $ 35,986 80.00% AHRQ PSI-90 9 $ 161,928 $ 17,992 90.00% CLABSI 0 $ 0 $ 179,920 0.00% Outcomes TOTAL $ 539,763 $ 359,837 60.00% MSPB 1 $ 59,974 $ 539,746 10.00% Efficiency TOTAL $ 59,974 $ 539,746 Facility TOTAL $ 1,260,277 $ 1,738,363 42.03% 30
Mandatory Elements of Reform Readmission Reduction Program READMISSION REDUCTION PROGRAM 31
Timeline of Reform 32
Readmission Reduction Program 9% of Current and Future Medicare Reimbursement at Risk 3% penalty of Medicare Reimbursement at risk each program year Measured Populations 30 days from DISCHARGE AMI, HF, PN, COPD, THA & TKA August 2014: CABG Added to FY 2017 Performance Periods: 3 Year Rolling Program FY 15: July 1, 2010 June 30, 2013 3% 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% Currently participating in 3 performance periods simultaneously 33
PAC Readmits DHG- Healthcare RRP Approach RRP Success 34
How are Readmissions Measured? Scoring Index based at 1.0 Calculate Excess Readmission Ratio Facility Predicted Value Facility Expected Value Excess Readmission Ratio > 1 = BAD Excess Readmission Ratio < 1 = GOOD 35
RRP Penalty Breakdown RRP Adj. Factor: 0.9787 DRG Reimb. $ 30,747,194 RRP Penalty $ 654,915 RRP Penalty Per Penalized Read. $ 9,396 AMI COPD HF PN THA / TKA RRP Penalty $ 85,953 $ 263,139 $ 96,016 $ 88,508 $ 121,300 % of Penalty 13.1% 40.2% 14.7% 13.5% 18.5% Pen. Patients 9.1 28.0 10.2 9.4 12.9 % of RRP Pats. 6.8% 35.3% 30.4% 22.2% 5.3% 36
Penalized RRP Patients Breakdown Measure Number of Eligible Discharges at Your Hospital Number of Readmissions at Your Hospital # of Penalized Patients Per Year Improvement Penalized Patients as % of Readmissions Penalized Patients as % of Total AMI 134 33 9.1 3.0 27.7% 6.8% COPD 699 172 28.0 9.3 16.3% 4.0% HF 567 148 10.2 3.4 6.9% 1.8% PN 530 108 9.4 3.1 8.7% 1.8% THA/TKA 238 26 12.9 4.3 49.7% 5.4% TOTAL 2,168 487 69.7 TOTAL 14.3% 3.2% Per YEAR 723 162 23.2 Per YEAR 4.8% 1.1% 37
Readmissions by Measure Last 3 Years 74 59 56 57 36 42 30 42 32 15 12 11 9 9 3 2010-2011 2011-2012 2012-2013 AMI COPD HF PN THA / TKA 38
FY 16 RRP 2010-2011 Performance Dropped AMI Readmissions 2010-2011 2011-2012 2012-2013 July 2 1 August 1 September 1 2 October 1 November 1 1 1 December 2 1 January 1 1 February 3 1 March 2 1 April 1 3 2 May 1 June 1 2 9 15 9 COPD Reamissions 2010-2011 2011-2012 2012-2013 July 5 4 3 August 4 4 2 September 2 8 3 October 3 4 2 November 9 5 7 December 6 6 7 January 9 7 8 February 6 7 7 March 4 1 3 April 6 3 7 May 3 3 4 June 2 4 4 59 56 57 HF Readmissions 2010-2011 2011-2012 2012-2013 July 8 2 2 August 5 4 1 September 5 3 2 October 7 2 3 November 8 2 1 December 6 4 5 January 2 5 5 February 8 3 3 March 8 3 4 April 9 6 3 May 6 5 1 June 2 3 2 74 42 32 PN Readmissions 2010-2011 2011-2012 2012-2013 July 0 4 3 August 1 1 4 September 7 4 2 October 4 4 5 November 3 3 3 December 0 3 2 January 5 2 4 February 3 3 4 March 3 1 7 April 1 0 1 May 2 3 4 June 7 2 3 36 30 42 THA / TKA Readmissions 2010-2011 2011-2012 2012-2013 July 2 3 0 August 2 1 1 September 2 1 0 October 1 0 0 November 0 0 0 December 1 1 0 January 1 0 0 February 1 2 1 March 1 0 1 April 0 0 0 May 1 1 0 June 0 2 0 12 11 3 39 39
FY 16 RRP 2010-2011 Performance Dropped AMI Readmissions 2010-2011 2011-2012 2012-2013 July 2 1 August 1 September 1 2 October 1 November 1 1 1 December 2 1 January 1 1 February 3 1 March 2 1 April 1 3 2 May 1 June 1 2 9 15 9 COPD Reamissions 2010-2011 2011-2012 2012-2013 July 5 4 3 August 4 4 2 September 2 8 3 October 3 4 2 November 9 5 7 December 6 6 7 January 9 7 8 February 6 7 7 March 4 1 3 April 6 3 7 May 3 3 4 June 2 4 4 59 56 57 HF Readmissions 2010-2011 2011-2012 2012-2013 July 8 2 2 August 5 4 1 September 5 3 2 October 7 2 3 November 8 2 1 December 6 4 5 January 2 5 5 February 8 3 3 March 8 3 4 April 9 6 3 May 6 5 1 June 2 3 2 74 42 32 PN Readmissions 2010-2011 2011-2012 2012-2013 July 0 4 3 August 1 1 4 September 7 4 2 October 4 4 5 November 3 3 3 December 0 3 2 January 5 2 4 February 3 3 4 March 3 1 7 April 1 0 1 May 2 3 4 June 7 2 3 36 30 42 THA / TKA Readmissions 2010-2011 2011-2012 2012-2013 July 2 3 0 August 2 1 1 September 2 1 0 October 1 0 0 November 0 0 0 December 1 1 0 January 1 0 0 February 1 2 1 March 1 0 1 April 0 0 0 May 1 1 0 June 0 2 0 12 11 3 40 40
Length of Inpatient Stay and Readmissions Trends AMI Readmission Rate Avg. LOS Readmission 6.52 Avg. LOS Non Read. 5.08 1.44 COPD Readmission Rate Avg. LOS Readmission 6.97 Avg. LOS Non Read. 5.64 1.33 HF Readmission Rate Avg. LOS Readmission 6.54 Avg. LOS Non Read. 5.67 0.87 PN Readmission Rate Avg. LOS Readmission 8.23 Avg. LOS Non Read. 7.06 1.17 THA/TKA Readmission Rate Avg. LOS Readmission 4.62 Avg. LOS Non Read. 3.58 1.04 41 41
COPD Readmissions by Discharge Destination % of Total Readmissions 0% 11% 0% 1% 5% 16% % of Penalized Readmissions 0% 0% 0% 11% 10% 11% 67% 68% Facility that Provides Custodial or Supportive Care Home Health Home or Self Care (Routine Discharge) Hospice - Home Long Term Care Hospital Psychiatric Hospital or Unit SNF Facility that Provides Custodial or Supportive Care Home Health Home or Self Care (Routine Discharge) Hospice - Home Long Term Care Hospital Psychiatric Hospital or Unit SNF 42
350 Skilled Nursing Facility (SNF) Analysis Note: *21 SNF s with only 1 Patient* 300 250 200 223 150 100 50 0 104 83 55 104 8 9 9 27 30 36 35 1 5 19 14 8 6 10 3 4 7 5 6 Facility A Facility B Facility C Facility D Facility E Facility F Facility G Facility H Facility I Facility J Facility K Facility L Readmitted Pateints Not Readmitted Patients 43
Mandatory Elements of Reform Hospital Acquired Conditions HOSPITAL ACQUIRED CONDITIONS 44
Timeline of Reform 45
Hospital Acquired Conditions (1% at Risk*) 12 Hospital Acquired Conditions Identified Divided in to 2 Domains If a hospital is in the BOTTOM QUARTILE (worst performing 25% in the country), it will be penalized a FULL 1% of Medicare Reimbursement Penalties will begin FY 15 (beginning October 1, 2014) *1% After DSH, Uncompensated Care, and IME 46
Hospital Acquired Conditions: FY 2015 First Domain: PSIs Performance Period: 7/1/11-6/30/13 Pressure Ulcer Rate Iatrogenic Pneumothorax Rate Second Domain: CDC Performance Period: CY 2012 & 2013 CLABSI CAUTI Central Venous Catheter-Related Bloodstream Infections Postoperative Hip Fracture Postoperative Pulmonary Embolism and Deep Vein Thrombosis Rate Postoperative Sepsis Postoperative Wound Dehiscence Accidental Puncture or Laceration 47
HAC Domain Weightings: FY 15 DOMAIN 1: 35% DOMAIN 2: 65% Postop. Sepsis 4.375% CLABSI 32.5% Pressure Ulcer 4.375% CAUTI 32.5% 48
Hospital Acquired Conditions: FY 2016 First Domain: PSIs 25% Second Domain: CDC 75% Pressure Ulcer Rate Iatrogenic Pneumothorax Rate Central Venous Catheter-Related Bloodstream Infections Postoperative Hip Fracture CLABSI CAUTI SSI Following Colon Surgery (FY 2016) SSI Following Abdominal Hysterectomy (FY 2016) Postoperative Pulmonary Embolism and Deep Vein Thrombosis Rate Postoperative Sepsis Postoperative Wound Dehiscence Accidental Puncture or Laceration 49
HAC Domain Weightings: FY 16 DOMAIN 1: 25% DOMAIN 2: 75% Postop. Sepsis 3.125% CLABSI 25% Pressure Ulcer 3.125% SSI 25% CAUTI 25% 50
Hospital Acquired Conditions: FY 2017 First Domain: PSIs 25% Second Domain: CDC 75% Pressure Ulcer Rate Iatrogenic Pneumothorax Rate Central Venous Catheter-Related Bloodstream Infections Postoperative Hip Fracture Postoperative Pulmonary Embolism and Deep Vein Thrombosis Rate CLABSI CAUTI SSI Following Colon Surgery (FY 2016) SSI Following Abdominal Hysterectomy (FY 2016) Methicillin-Resistant Staphylococcus Aureus (MRSA) Bacteremia (FY 2017) Postoperative Sepsis Clostridium Difficile (FY 2017) Postoperative Wound Dehiscence Accidental Puncture or Laceration 51
How the Scoring Worked Scenario: what it could have looked like to score under a 7.0 52
Penalties & Your DRG Payment SAMPL IPPS Reimbursement Letter PPS EFFECTIVE 10/1/2014 DRG Weight 1.00 Facility CMI 1.54 OPERATING INFORMATION Federal National Standardized Labor Rate 3,329.57 Wage Index 0.8994 Labor Rate x Wage Index 2,994.62 Federal National Standardized Non-Labor Rate 2,040.71 PPS Blended Rate 5,035.33 FY 2015 Hospital Readmissions Reduction (HRR) Adjustment Factor 0.9994 5,032.30 ($3.02) RRP Reduction FY 2015 Value-Based Purchasing (VBP) Adjustment Factor 0.994348 5,003.86 ($28.44) VBP Reduction ($31.46) Per DRG Reduction ($31.46) x 1.54 ($48.45) VBP & RRP Per DRG Red. CMI Adj Disproportionate Share Adjustment (Operating) (Empirically Justified Amount 25%) 0.0691 0.02 5,090.43 Disproportionate Share Adjustment (Operating) (Uncompensated Care Amount) 507.71 5,598.14 Fully Loaded Operating Rate adjusted for CMI 8,346.97 FY 2015 Hospital Acquired Condition (HAC) Adjustment Factor 0.99 8,263.50 ($83.47) HAC Per DRG CMI Adjusted ($131.92) Total Per DRG Reduction 53
Mandatory Elements of Reform: Opportunities OPPORTUNITIES 54
Clinical Care - Process = 5% HCAHPS = 25% Clinical Care - Outcomes = 25% Safety = 20% MSPB = 25% 55
Clinical Care - Outcomes = 25% MSPB = 25% 56
Opportunities Sample Analysis 1 2 3 Efficiency - Medicare Spend Per Beneficiary Outcomes - Mortality-PN Outcomes - AHRQ PSI-90 FY15 FY15 FY15 Performance 1.0127 Performance 87.09% Performance 0.5783 Baseline 1.0048-0.0078 Baseline 87.18% -0.09% Baseline 0.6457 0.0674 Threshold 0.9850-0.0277 Threshold 88.27% -1.18% Threshold 0.6162 0.0379 Benchmark 0.8270-0.1857 Benchmark 90.42% -3.33% Benchmark 0.4500-0.1283 Score 0 Score 0 Score 3 Improvement Dollar Value Score Improvement Dollar Value Score Improvement Dollar Value Score 0.05 $ 97,756 3 0.50% $ 14,663 1 0.05 $ 29,327 5 0.10 $ 244,390 6 1.50% $ 58,654 4 0.10 $ 102,644 10 0.15 $ 342,146 8 2.50% $ 102,644 7 0.15 $ 102,644 10 0.20 $ 488,780 10 3.50% $ 146,634 10 0.20 $ 102,644 10 0.25 $ 488,780 10 4.50% $ 146,634 10 0.25 $ 102,644 10 0.30 $ 488,780 10 5.50% $ 146,634 10 0.30 $ 102,644 10 0.35 $ 488,780 10 6.50% $ 146,634 10 0.35 $ 102,644 10 0.40 $ 488,780 10 7.50% $ 146,634 10 0.40 $ 102,644 10 0.45 $ 488,780 10 8.50% $ 146,634 10 0.45 $ 102,644 10 57
VBP CMS Proposed Future Measures FY 2018 Program (Performance Period: CY 2016) Patient Experience: Care Transition 58
VBP Other Possible Metrics to Follow Emergency Department Care Preventative Care Pneumonia Vaccine Children s Asthma Care Stroke Care Blood Clot Prevention Care Preventative Care 59
FY 19 New Measure Added THA/TKA for 30 month performance period. January 1, 2015-June 30, 2017 Baseline of July 1, 2010-June 30, 2013 Risk standardized measure for complications after Total Hips and Knees surgeries for up to 90 days post surgery One of eight complications: AMI, pneumonia, sepsis, SSI, PE, death, mechanical complication or periprosthetic joint infection/wound infection. Each has a defined time frame Each is a Yes or No Risk adjusted for patient age, sex and comorbidities 60
Readmissions Proposed Future Measures Percutaneous Coronary Intervention (PCI) Stroke 61
Mandatory Elements of Reform: Current Dollars at Risk CURRENT DOLLARS AT RISK 62
VBP FY 2017 Sample $$ at Risk $65,000,000 Medicare Reimbursement Facility VBP FY 2017 Domain Weight At Risk On the Table Medicare Spend Per Beneficiary 25% $ 325,000 $ 681,200 Safety 20% $ 260,000 $ 544,960 Patient Experience 25% $ 325,000 $ 681,200 Clinical Care - Outcomes 25% $ 325,000 $ 681,200 Clinical Care - Core Measures 5% $ 65,000 $ 136,240 TOTAL 100% $ 1,300,000 $ 2,724,800 63
VBP Sample Total Current $$ at Risk $65,000,000 Medicare Reimbursement Facility VBP Current Dollars At Risk (Active Performance Periods) Domain Weight At Risk On the Table FY 2016 Value Based Purchasing COMPLETE FY 2017 Medicare Spend Per Beneficiary 25% $ 325,000 $ 681,200 Safety 20% $ 260,000 $ 544,960 Patient Experience 25% $ 325,000 $ 681,200 Clinical Care - Outcomes 25% $ 325,000 $ 681,200 Clinical Care - Core Measures 5% $ 65,000 $ 136,240 FY 2018* Clinical Care - Outcomes 25% $ 325,000 $ 681,200 Safety - AHRQ 3.75% $ 48,750 $ 102,180 FY 2019* Clinical Care - Outcomes: Mortality 18.75% $ 243,750 $ 510,900 Clinical Care - Outcomes: THA/TKA 6.25% $ 81,250 $ 170,300 TOTAL $ 1,998,750 $ 4,189,380 *Performance Periods are finalized; however weightings are not and reflect current finalized adjustments 64
All Reform Sample Current $$ at Risk $65,000,000 Medicare Reimbursement Facility All Active Mandatory Reform Domain On the Table FY 2016 Value Based Purchasing COMPLETE Readmissions COMPLETE Hospital Acquired Conditions COMPLETE FY 2017 Value Based Purchasing $ 2,724,800 Readmissions $ 1,950,000 Hospital Acquired Conditions $ 650,000 FY 2018 Value Based Purchasing** $ 783,380 Readmissions $ 1,950,000 FY 2019 Value Based Purchasing* $ 681,200 Readmissions $ 1,950,000 TOTAL $ 10,689,380 *VBP Weightings are not finalized 65
Thank You! Contact Information: Walter Coleman Walter.Coleman@dhgllp.com (804) 474-1248 66