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HMM, CPAs LLP 1
Healthcare 360Evaluating Your Operations
From Every Angle
Presented by:
Veronica M. BencivengaDirector
HMM Consulting, a Division of HMM, CPA’s LLPOffice: (631) 265-6289Mobile: (631) 880-2882
vbencivenga@horanmm.comwww.horanmm.com
Intercounty Health Facilities Association
December 1, 2016
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AGENDA
þ Speaking “DATA”þ Evaluating Your Technology Planþ External Evaluation - Current Data Initiatives
þ Industry Developments and Trends
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Speaking “DATA”
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• Medicaid Managed Care• Value Based Purchasing• Quality Pools (NHQI)• Bundling• Shared Savings• DSRIPPayment Reform
• Patient Centered Care Coordination• Clinical Decision Support• Early Detection of Decline• Transitions in Care
Care Delivery
• CMS Five-Star • Nursing Home Quality Measures• Payment Analytics (Pepper)
• Rehospitalizations
Performance Monitoring
Data Landscape Today
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Your data tells people about you. Managing your data story is critical.
• Five Star Rating• Quality Measures• Length of Stay• Staffing/Turnover• Rehospitalization Rates• Patient Satisfaction• Cost Control
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Managing Your Data Story
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Veronica’s Data Story
This is ME!• 10 - Years at HMM• 23 – Years of experience in
nursing home industry
• 132 - Client engagements• 117 - Speaking engagements• 20 – Average hours spent
preparing each speaking engagement
• 293 - Connections on LinkedIn (Narrow Network J)
This is ME!• 18 - Years happily married• 3 - Children (Michael-13,
Jack-12, Natalie-10)
• 23 – Level on Pokemon Go (Team Valor-Red)
• 260 – Hours volunteered in 2015 for school, church or community activities
• 90,000 – Photos stored on my home server
• 2 – Digital SLR cameras
4Hours of
Sleep
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Clinical and Financial are the
SAME DATAQuality = Payment
Not getting paid for the service, getting paid for the outcome
Clinical and Financial are ONE
The new language of healthcare• Metrics• Numerator• Denominator• Data elements• Cut points• Quintile• Statistics• Root cause analysis 8
Quality by the Numbers
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Quality by the Numbers
Hospital Readmissions
Finance speaks DATA, hence can help with learning to speak QUALITY• Multi purpose data• Conditional data • Overlapping data• Data from many angles • Different timeframes • CMS Quality Measures
• SNF Value Based Purchasing (VBP)
• SNF Quality Reporting Program (SNF QRP)
You won’t get the right answer if you don’t ask the right question.• Inclusions and Exclusions• Parameters
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Understanding the Reports
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Clinical and Financial are the
SAME DATAQuality = Payment
Not getting paid for the service, getting paid for the outcome
Clinical and Financial are ONE
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Information at risk when clinical and financial software not bi-directionally integrated or using a single database
• Which system's data will you rely on? • Which do you give to the OMIG, RAC, other auditors? • How do you avoid data DRIFT
Information at Risk
Demographic Name, DOB, Social, Medical Record #
Financial Payers -‐ different payers have different requirements Authorizations – All staff need access to this
Census Usually admission interface only, discharges have to be done independently in both systems
Contacts Emergency and ordering, notes by social workers, etc.
Level of Care Clinical determination, changes with condition of patient
MDS Missing, corrections, in-‐activations
Diagnosis Increasing importance on accuracy and maintenance for payment bundlesand staffing (PBJ)
Analytics/Stats Which system's data will you rely on? Discrepancies will need to be investigated
Data at Risk
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How do we get there?• Evaluate all information streams• Identify barriers• Capture data at the source whenever possible
• Leverage technology
Real-time Data
Examples:• Census• Insurance verification, Eligibility• Costing of a potential patient• Actual staffing
You can’t keep doing things the same old way• Make purposeful changes• Educate– Leadership– Staff– Families– Business Partners, Vendors
• Manage Expectations
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How do you change and entire organization?
Old New
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Evaluating YourTechnology Plan
• Every company is a technology company – Fortune 500 CEO Survey - Rapid pace of technological change is the single biggest challenge facing their companies
– Endless streams of data and growing intelligentalgorithms have the potential to transform almost every aspect of nearly every business
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It’s All Connected
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• TODAY Every company is a technology company capturing and sharing data– Pizzerias, law enforcement, clothing companies, MAPMyRUN, religious organizations… and yes SNF’s)
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It’s All Connected
• Success will be defined by your ability to capture, manage interpret and share data
• Software and hardware are your foundation• Do you have a Technology Plan?• Have you really looked at your capital budget with today’s objectives in mind?
• Are you specifically budgeting for: – Hardware upgrades and replacement– Web enabled medical devices that transfer data to EMR– Advancing adoption of your EMR through advanced training, new features
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Evaluating your Technology Plan
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• Do you understand your EMR vendor’s product road map?
• Do your software vendors have the resources to not only keep up with the changes, but anticipate what’s coming next?
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Evaluating your Technology Plan
EMR is a series of investments whose benefits accumulate over time
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EMR Adoption – Use More, Get More ROI
• You CAN’T do it all at once
• Make a plan to expand EMR use including:– Impact on workflows– Training time and training resources
– Hardware
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Schedule an “Optimization Session”• Review software configuration• Identify re-training opportunities• Identify features you are paying for but not using
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EMR Adoption – Use More, Get More ROI
TIP: For VBP and Receivables management, most SNF’s need to reconfigure their:• Census workflow• Payor set-ups• Levels of care
• Integrated 4.0 Interact tools• Dashboards and Notifications – Manage by Exception
• Analytics– Report on any combination of measures• All, Survey, Nursing Home Compare, Five-Star
– Results for the QM Numerator, Denominator and Percentage
– Compare to State and National Averages
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Value Added EMR Features – Decision Support
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Dashboards allow you to monitor clinical and financial metrics in real time.
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A picture is worth a 1,000 words
Decision Support – Dashboards
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Alerts and Warnings draw attention to potential issues that are time sensitive
BRINGS THE DATA TO YOU• Values out of acceptable parameters
• No bowel movement in 3 days• Temp out of range
• Unusual patterns • Duplicate medications• Decreased inputs and outputs
Decision Support – Managing by Exception
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• Availability• Mobility • Displays• Larger, portable or multiple
• Connected Devices – Nurse Rosie Connect
• Telemonitoring
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Hardware and Devices – The Right Fit
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External Evaluation-Current Data
Initiatives
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Federal
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State
Payment Quality
Current Quality and Payment Initiatives
• Medicare Advantage• Bundled Payment (Episodes)
• Bundled Payments for Care Improvement (BPCI)
• Comprehensive Care for Joint Replacement (CJR)
• Mandatory Effective April 1, 2016
• SNF Value Based Purchasing • 30-Day All-Cause Readmission
Measure (SNFRM)• NEW: Effective 10/1/2016
12/31/2016 for Fiscal Year 2018
• Five-Star Quality Rating System• Nursing Home Compare
• 5 new measures added July 2016
• Staffing Data Submission PBJ • NEW: Effective 7/1/2016
• SNF Quality Reporting Program (SNF QRP)
• NEW: Effective 10/1/2016 12/31/2016 for Fiscal Year 2018
• Mandatory Medicaid Managed Care for new LTC patients
• Roll out began 2/12015
• Delivery System Reform Incentive Payment (DSRIP)• VBP Road Map
• Nursing Home Quality Initiative (NHQI)
• Effective 2013 with ongoing methodology changes
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• Improving Medicare Post Acute Transformation Act 2014• Purpose is to compare outcomes across all four post acute care settings and create longitudinal data• Skilled Nursing Facilities• Home Health Agencies• Inpatient Rehabilitation Facilities• Long Term Care Hospitals
• Implements collection of standardized data using assessments currently required (SNF=MDS, HHA=Oasis, etc.)
• Requires development and implementation of “cross setting” Quality Measures based on standardized data
• Data Collection 10/1/2016-12/31/2016 will be used for rate setting FY 2018
IMPACT Act of 2014
For the first time since PPS started in 1998
your Medicare rates will be different from your neighbor!
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Behavior Management• Clinically nuanced insurance coverage
– 2017-2022 CMS will test Value-Based Insurance Design (VBID) in Medicare Advantage and measure whether structuring patient cost sharing and other health plan design elements encourages enrollees to use health care services in a way that improved their health and reduces costs.
• Health score (like a credit score)
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What’s Next?
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IndustryDevelopmentsand Trends
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I believe this is a result of a disconnect between program mandates such as…mandating payment rates while failing to provide sufficient revenue, constant regulatory changes that add additional administrative burdens and otherwise failing to recognize operational challenges these changes impose
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Sign of Things to Come
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"There are problems with the state not reimbursing plans to adequately reflect when a plan has a large number of very high cost or high utilizing patients," Gottfried said. "And GuildNet is caught in that squeeze as a lot of plans and providers are."
~ Alan Morse, CEO of GuildNet
SNF’s struggle to quantify the managed care cashflow crisis due to:
• Differences in recordkeeping• Where/how managed care days are combined, level of detail
• Differences in staff skill levels• Differing contract terms for same plan on a provider by provider basis
Quantifying the “Managed Care Problem”
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Questions?
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Thank You
Veronica M. BencivengaOffice (631) 265-6289Mobile (631) 880-2882VBencivenga@horanmm.comwww.horanmm.com
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HMM ConsultingA division of HMM, CPAs LLP
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CMS Quality Measures - 33• 30 Main measures
• 11 Short Stay• 19 Long Stay
• 3 additional “Surveyor Quality Measures”
Surveyor Measures - 17• Available to State surveyors and SNF’s through
CASPER• Subset-17 of the 33 measures
Nursing Home Compare - 18• Publically Available• Compares SNF to State and National averages• Subset-18 of the 30 main measures
• 5 Short Stay• 13 Long Stay
CMS Five-Star Rating - 11• 3 components
• Quality Measures – Subset 11 of the 18 in Nursing Home Compare• 3 Short Stay• 8 Long Stay
• Health Inspection• Staffing
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#3 – SNF QRP• 30 Day all-cause re-hospitalizations
• New effective 10/1/2016• IMPACT Act 2014• Claims Based
Hospital Readmissions
#1 - Hospital• Hospital Readmissions Reduction Program
• Reported through SPARCS (indirect)
#2 – Five Star• Percent of short stay residents who were re-hospitalized after a nursing home admission• New Quality Measure effective 7/27/2016
• Claims Based
#4 – SNF VBP• 30 Day all-cause re-hospitalizations
• Protecting Access to Medicare Act of 2014 (PAMA)
• Claims Based• Year 1 – SNF Readmisson Measure (SNFRM)
• Year 2 – SNF Potentially Preventable Readmission Measure (SNFPPR)
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