Colorado Hospital Quality Incentive Payment (HQIP) Program...1 SPECIALTY HOSPITALS Friday, December...
Transcript of Colorado Hospital Quality Incentive Payment (HQIP) Program...1 SPECIALTY HOSPITALS Friday, December...
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SPECIALTY HOSPITALS
Friday, December 1, 20171:00 PM – 2:00 PM
Location: The Department of Health Care Policy & Financing, 303 East 17th
Avenue, Denver, CO 80203. 11th Floor Room A.
Conference Line: 1-877-820-7831 Passcode: 294442#
For more information contact: Elizabeth Quaife at [email protected]
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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 Pagehttps://www.colorado.gov/pacific/hcpf/hospital-engagement-meetings
Future Meetings
1/12/2018 2/2/2018
3/2/2018 4/6/2018
5/4/2018 6/1/2018
Please join us starting Friday, January 12th from 1pm – 2pm at
303 East 17th Avenue, Denver in Conference Room 7A, by
phone and/or webinar.
Site Visits
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No new requests for site visits have been received:
These are important to us as it presents:
1. 1 on 1 opportunities
2. Better understanding of services provided by Hospitals
3. Ability for both Hospital and State to ask questions
4. Better informed decisions by the State
5. Hear Hospital concerns uninterrupted
6. Free form conversation and brainstorming
Please contact me at [email protected] to set
up a visit.
Knowledge Gained from Site Visits(from Department)
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• Desire to Increase availability for Medicaid Patients
• Extent of treatment and care involved
• Patient diversity
• Criteria for admittance
• Concern for what happens after patient’s leave
• Different quality reporting measures already in place
• Understanding difference between Rehabilitation and Long
Term Acute Care
• Encouragement/ Assistance to Employees on gaining
additional Certifications
• Assist Employees to stay up to date in their field
Knowledge Gained from Site Visits(from Hospital)
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• Hospitals are passionate
• Concern for Contracted Physicians
• Desire to Increase availability for Medicaid Patients
• Goals vary
• Concern for what happens after patient’s leave
• Thoughts on Budget Neutral Option
• Concerns/Input on what they would like to see Long Term Rates
Include
Per Diem Rate For Budget Neutral
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• Mutual agreement by Providers and Department
• Moving forward with Budget Neutral Implementation process
Implementation of Budget Neutral
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• Run final query of 7/1/2016 – 6/30/2017
• Coordinate with other Sections of Health Care
Policy & Finance:
➢Budget
➢Access to Care
➢Policy
➢Systems
➢Special Financing
• Public Notice
• State Plan Amendment Submission
• Medical Services Board?
• Build New Provider Profiles
• Implementation Goal: July 1, 2018
Additional Information
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• Provider Type Change: Re-enrollment will likely be required to
change Provider Type and allow to add to Profile the per diem
needed for billing.
• Medicare Crossovers: Currently, there is crosswalk between
Medicare and Medicaid since both utilize a form of DRGs. With the
per diem, Crossovers will be paid at Coinsurance + Deductible
Additional Case Examples
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APR-DRG SOI WEIGHT ALOS TMPT LOS
130 1 3.3629 10.87 22 3
130 3 5.324 16.62 45 15
130 4 6.7266 21.62 62 90
Long Term Acute Care (LTAC)
Case Examples (cont.)
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Rehabilitation
APR-DRG SOI WEIGHT ALOS TMPT LOS
860 1 0.8574 8.74 20 3
860 3 2.141 15.36 39 15
860 4 2.4919 17.44 44 90
Case Examples (cont.)
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APR-DRG SOI WEIGHT ALOS TMPT LOS
40 2 1.2446 4.48 13 3
40 3 1.6653 6.46 20 15
40 4 3.8818 12.92 41 90
Brain and Spine Specialist
ICD-10 Concerns
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Received from a Provider: Presented by
Louisiana **NOT COLORADO MEDICAID**
ICD 10 (cont.)
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Reviewed approximately 500 cases from 7/1/2016 – 6/30/2017
➢ All grouped correctly
Health First Colorado Numbers (7/1/2016 – 6/30/2017) :
➢ Total Rehabilitation Cases: 932
➢ APR-DRG 860 = 868 (93.1%)
➢ APR-DRG 862 = 27 (2.9%)
➢ APR-DRG Other = 37 (4.0%)
Consulted with 3M in regards to concerns:
“It should be noted that there no discrepancy with the APR DRG grouper with
regard to DRG 860 and 862. With the specificity of ICD 10, DRG 860 and 862
distribution has been impacted, hence the difference between case
distribution as noted below. Further, specific coding guidelines for the
respective DRGs has also been updated to further enhance specificity.
Please note that, the change identified below is a direct reflection of ICD 10
and updated coding guidelines.” Per 3M’s Clinical and Economic Research
Team
Long Term Research Opportunities
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• LTAC & Rehab attached to a Parent Hospital: Since these are
attached to Parent Hospitals, they will not be included in the
Budget Neutral option at this time.
Long Term – we will be researching the possibility of carving out
these hospitals from the Parent Hospital and possibly adding to
Specialty group. Additional research will be required.
• Changes to Physician payments: During onsite visits, Hospitals
have expressed concerns for Specialty Contracted Physicians
whom are critical to care of patients but are not affected by current
Budget Neutral proposal.
Long Term - would like to research the possibility of adjusting
reimbursement to caption the services being provided to Specialty
Hospitals
Long Term Research Opportunities(Continued)
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• Quality Measures:
a) HCAHPS
b) Functional Independent Measures
c) Private Insurance Measures
d) Other Hospital Measures
Goal is to utilize similar reporting measures Hospitals are
already using and semi-customizing for Medicaid
reporting
Information Request
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New Budget Neutral Per Diem: How do you believe this will impact
the intake of Medicaid patients? Increase? Decrease? No change?
Could this impact utilization of STACs?
Interim Billing: Tracking Interim Claims and noticing inconsistencies
in payments. Outlier days missing, possible double payments for 112
and 113/114 (system not voiding original payment). If seeing any of
these or additional concerns please send ICNs to me as well to
continue investigating.
Crossover Payments (Lesser Of): On several escalations, have seen
double deduction of Medicare Payment removed. If you have seen
any examples of these, please send ICNs to me as well to continue
investigating.
Email – [email protected]
Questions and Discussion
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