1
HOSPITAL MEETINGFriday, July 7, 2017
8:00 AM – 12:00 PM
Location: The Department of Health Care Policy & Financing, 303 East 17th Avenue, Denver, CO 80203. 11th Floor Rooms A&B.
For more information contact: Diana Lambe at 303.866.5526 or [email protected]. & Elizabeth Quaife at 303.866.2083 or [email protected]
2
Overview of Meeting
• General Hospital Meeting 8:00-10:00• Break 10 min.
• General Hospital Meeting cont’d 10:10-noon
Colorado Department of Health Care Policy and Financing
3
HOSPITAL ENGAGEMENT MEETING TOPICS 7/7/2017 8am-12pm • General Hospital Meeting
- Hospital Transformation (Added Topic)- New Specialty Hospital Rates Methodology Update- IPP-LARCs implementation timeline- Update on GME Q2-2015 Payments- Cost Settlement Updates- EAPG Rate Update- Innovative Medications (Added Topic)
• Rate Related System Issues Update - ICD-10 10/1/2016 update on new Diagnosis Codes- Transfer Claims Update (affects only Rehabs & LTACs)- Baby Diagnosis on Mom's Claims- Mass Adjustment Update for 3 Low Volume Payment Hospitals
- Ongoing Issues Impacting EAPGs - EAPG Mass Adjustment Scheduling
Sheet1
HOSPITAL ENGAGEMENT MEETING TOPICS5/5/17TIMEOwner / Specific Materials needed to facilitate discussionMarch-17May-17July-17September-17November-17
General Hospital MeetingX8:00-12:00 noon
-Fiscal Year 2017-18 Inpatient Base RatesXDiana /
-Overview on how Inpatient Base Rates are builtXDiana /
-APR-DRG prospective weight changes due to removal of IPP-LARCs
-Update rates every other year methodology discussionXDiana /
-DRG base rate communicationXDiana /
-New Specialty Hospital Rates Methodology UpdateElizabeth
-Rate Related System Issues Update
-ICD-10 10/1/2016 update on new Diagnosis Codes - UPDATEX
-Transfer Claims Update (affects only Rehabs & LTACs)
-Baby Diagnosis on Mom's Claims Diana /
-Radiology Procedure Codes
-Outpatient Hospital PaymentsXAndrew /
-Cost Settlement UpdatesAndrew /
-Rate UpdateAndrew /
-Ongoing Issues Impacting EAPGsAndrew /
-Mass Adjustment SchedulingAndrew /
-Hospital Organizational Structureif time allows
-Hospital owned primary care practicesif time allowsAna/
-Stand alone emergency departmentsif time allowsAna/
-Salaried vs. non-salaried physicians within hospitalsif time allowsAna/
-Payment Reform Projects
-Community based projects
-Hospital Report Card
-Hospital site visits
-Yearly Hospital Meeting (Inpatient Base Rates)X
-Cost Shift Avoidance Discussion Shane / Kevin
HOSPITAL ENGAGEMENT MEETING TOPICS 7/7/2017 8am-12pm
· General Hospital Meeting
- Hospital Transformation (Added Topic)
- New Specialty Hospital Rates Methodology Update
- IPP-LARCs implementation timeline
- Update on GME Q2-2015 Payments
- Cost Settlement Updates
- EAPG Rate Update
- Innovative Medications (Added Topic)
· Rate Related System Issues Update
- ICD-10 10/1/2016 update on new Diagnosis Codes
- Transfer Claims Update (affects only Rehabs & LTACs)
- Baby Diagnosis on Mom's Claims
- Mass Adjustment Update for 3 Low Volume Payment Hospitals
- Ongoing Issues Impacting EAPGs
- EAPG Mass Adjustment Scheduling
links to registration
MAY 5, 2017 MEETING TIMES AND LINK TO REGISTER
General Hospital Meeting 8:00 - 12:00 noonhttps://cohcpf.adobeconnect.com/e237cw187s6/event/event_info.html
https://cohcpf.adobeconnect.com/e237cw187s6/event/event_info.html
Sheet3
Budget N Year:
Administrator: Administrator:Budget Neutrality baseline year. Should always be FY 02-03 until "Budget Neutrality" goes away.FY 02-03Formula pulls value inFormula pulls value inFormula pulls value inFormula pulls value inFormula pulls value inAdj Dischrgs for prior yr * Volume Inflator (R138)Formula pulls value indon't delete=$H66*$I66*J66*'Budget Actions'!$D$4Formula pulls value in=H66*I66*L66Formula pulls value in where appropriate from PPS & Non-PPS tables=N66*$R$128all currently 100% COL Rpulls in peer grp avg for CAH or low discharge hospitalsMedicaid Rate + Add OnsMedicaid Rate + Add-Ons * Est dischgs * CMIDifference between prior yr and current yr est paymentspercent change in payments current yr/prior yrformulaformulaformulaformulaformulaformulaformulaformula
PCG Report:
Administrator: Administrator:The year FY of the CFMC report that is used for discharges, CMI, and ALOS.FY 14-15 EstimatedQ2+AB2+AC2+AD2EstimatedBUDGET: $0.00
Prior Year:
Administrator: Administrator:Year that is prior to the year that
rates are being calculated for.FY 15-16TBD: 3A=New
TEFRA1=PediatricsCheck this formulaFY 16-17Estimated
OITDSS: estimated amt using last year's rate
this is NOT budget neutral # - budget neutral is in col Kcmi
adjusted rate
OITDSS: dl - don't know what this means. This column should be Medicare Final Rate LESS DSH + LVA (if applicable)we pay % of medicare rate to match budget neutralityadj by specialty %FY 16-17FY 16-17FY 16-17FINAL% OF MEDICARE:0.00%
Current Year:
Administrator: Administrator:FY that rates are being set
for.
OITDSS: estimated amt using last year's rate
this is NOT budget neutral # - budget neutral is in col
K
OITDSS: dl - don't know what this means. This column should be Medicare Final Rate LESS DSH + LVA (if applicable)FY 16-172=Not SpecialNon-CMI Adjusted DischargesPayments withFY 16-171-Oct-15FY 16-17MedicaidMedicaidPaymentsFY 16-17EstimatedMedicaid Cost Add-Ons / Cost per DischargeAmt over budget neutrality$0.00
1 = CAH3=RehabPeer GroupEstimatedFY 02-03Payments withMedicare
Initial Rate = Final Medicare DRG Rate - DSH + LVA (where
appropriate)
Chris: Jessica:1 = CAH2 = not3 = TEFRAMedicaidRates withRate with Rate withWithout Difference inMedicaid RateFY 16-17FinalFinal10% add on10% add on10% add on
Provider2 = Not4=Spinal RehabRural = 1CAH = 1FY 14-15FY 16-17FY 14-15FY 02-03Rates Incl PriorFY 15-16FY 15-16RateSpecialty CAH and lowMedicaidUpcoming YearEstimatedPercentw/Budget PaymentsFY 15-16FY 16-17Year over Year0.10.10.1FINAL RATES for RATE LETTERS
NumberProviders3 = TEFRA5=LTACUrban = 2Non-CAH =
2DischargesDischargesCase MixRates
: This will always be 02-03 Rates because that is our baseline year. Changing this would require State Plan Amendment.
Chris: Jessica:1 = CAH2 = not3 = TEFRABudget Actions
jlwagn: Check the cell reference for this formula in the Budget
Actions tab. Rates
Administrator: Administrator:Final MK Rates from previous
FYRates(% of Medicare)Percentages
Jessica Wagner: Jessica Wagner:1= pediatric2 = no special3 = rehab4 = spinal cord5 = urban safety net
Dischage avg.
Domenica Blum: Formulas are different for the rehabsAdd-OnsBudget ActionsPaymentsChangeActionsw/Budget ActionsInpatient Base RateInpatient Base Rate% ChangeNurseryNICUGMERATE w/out GME (purple) - goes in rate letterREASONS FOR RATE INCREASE/DECREASE% Diff in Rate from Prior Year
RURAL HOSPITALS
w/LVP GAF Fix
XXXXXSample
HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
OITDSS: this estimates how many discharges will occur in next
fiscal year for each hospital
Administrator: Administrator:Final MK Rates from previous
FYERROR:#N/AERROR:#N/AERROR:#N/A
OITDSS: calculating the estimated dollar amount that should be
spent this year by hospital to come up with a budget neutral
amount
Jessica Wagner: Jessica Wagner:1= pediatric2 = no special3 = rehab4 = spinal cord5 = urban safety net
Domenica Blum: Formulas are different for the rehabsERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
4
GROUND RULES FOR WEBINAR
• WE WILL BE RECORDING THIS WEBINAR
• 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
• Please speak clearly when asking a question and give your name and hospital
5
Welcome & Introductions
• Thank you for participating today!
• We are counting on your participation to make these meetings successful
6
• 3/3/2017
• 5/5/2017
• 7/7/2017
• 9/1/2017
• 11/3/2017
Dates for Future Hospital Engagement Meetings in 2017
The agenda for upcoming meetings will be available on our external website in
advance of each meeting. https://www.colorado.gov/hcpf/inpatient-
hospital-payment
Registration links for each session during the day will also be available prior to the
meeting.
Just click on the links to register for each session and you will receive the link to
connect to the webinar.
https://www.colorado.gov/hcpf/inpatient-hospital-payment
Colorado Hospital Transformation Program
Colorado’s Delivery System Reform Incentive Payment (DSRIP) Program Incentive Payment (DSRIP) program
Matt HaynesSpecial Finance Projects Manager
7
Matt HaynesSpecial Finance Projects Manager
2017
On the Road to Better HealthHow the Department of Health Care Policy and Financing is Driving Improved Health Care Delivery and Payment Systems in Colorado
Payment Reform Models
Taxpayers Clients
H
FQHCs
PCPs
1
2WHY? Because almost one of four
Coloradans is covered by Health First Colorado, HCPF has the ability to
move the market.
3WHO? HCPF
partners with key stakeholders.
4
HOW? HCPF works with stakeholders to build a value-based system.
5DESTINATION?
System Transformation.
Quadruple Aim• Lowered Costs• Improved Quality• Improved Health• Provider Satisfaction
LTSS
Specialists
RAEs
Desired Outcome1 2 3 4
Who Gets Payments for Services
9FY15-16 data 6
SB 17-267 - Enterprise• Establishes the Provider Fee program as a state
enterprise• Directive to pursue Delivery System Reform
Incentive Payments Planning Phase Goals Focus Areas
10
Next Steps• Stakeholder Re-engagement Program and Community Engagement Process
Development Measures and Metrics Application Process and Documents Project Scoring and Valuation Program Evaluation
11
The Sweet Spot
12
Hospital Priorities and Initiatives
HCPF Major Initiatives and Priorities
Community Identified Needs and
Sweet Spot
Questions and Discussion
13
Contact Information
14
Matt HaynesSpecial Finance Projects Manager
mailto:[email protected]
15
• Specialty Hospital Analyst: Elizabeth Quaife
• Reviewing Budget Neutral Options to be effective in 2018
• Comparing different options for long-term solution
• Any feedback or questions please contact Elizabeth Quaifeat 303.866.2083 or [email protected]
New Specialty Hospital RatesMethodology Update
16
APR-DRG Weight Changes due to Removal of IPP-LARC
• Utilization of Immediate Post-Partum Long-Acting ReversibleContraceptives (IPP-LARCs / IUDs and Implants) prior to hospitaldischarge is efficacious in preventing unintentional follow-uppregnancies.
• IPP-LARCs are currently paid as part of the global OB payment,through the APR-DRG system.
• A method to “carve-out” IPP-LARCs from the APR-DRG system hasbeen developed and will be submitted to CMS for approval.
• The Department is planning on instituting this change in payment onJuly 1, 2017 provided that approval is received from CMS.
17
IPP-LARCs ImplementationEstimated Timeline
CMS approval for FY2017-18 rates is
received
7/1/2017
Mass Adjustment of all claims back to 7/1/2017 to reflect FY2017-18 CMS
approved rates and Adjusted Birth DRG weights as proposed.
~October 2017 ?
Mass Adjustment of Claims with correct coding will receive payment for IPP-LARCs at this time
CMS approval for IPP-LARCs State Plan change is
received
Please Note: The State has no control over when CMS approves State Plan changes.
18
APR-DRG Weight Changes due to Removal of IPP-LARC (7/1/2017)
DRG-SOIAffected Birth
DRGsFY2015-16
Weight w/ LARCs
Weight w/LARCs removed
Difference in Weights
540-1 3,277 0.5893 0.5853 0.0040540-2 less than 30 0.9434 0.9394 0.0040540-3 less than 30 1.3456 1.3416 0.0040540-4 141 3.1956 3.1916 0.0040542-1 1,238 0.3787 0.3747 0.0040542-2 less than 30 0.5629 0.5589 0.0040542-3 less than 30 1.0438 1.0398 0.0040542-4 9,286 4.8252 4.8212 0.0040560-1 719 0.4795 0.4755 0.0040560-2 6,850 0.5601 0.5561 0.0040560-3 99 0.7559 0.7519 0.0040560-4 1,718 2.2333 2.2293 0.0040
23,393
19
• Proposed method for extra “carve-out” payment of Immediate Post Partum LARCs (Long Acting Reversible Contraceptives)
Maternity Immediate Post-Partum Long-Acting Reversible Contraceptives
DIAGNOSIS CODES JCODE MODIFIER NDC
Z30.430 J7298 FP 5041942101Z30.49 J7307 FP 00052027401
DIAGNOSIS CODES JCODE MODIFIER NDC
Z30.430 J7298 5041942101
Please note, The Department is only recommending what needs to appear on a claim in order to receive credit for inserting an IPP-LARCs
LARCS SUPPLEMENT
PAID
REQUIREMENTS FOR INPATIENT HOSPITAL IPP-LARCS CLAIMS
LARCS SUPPLEMENT
NOT PAIDANY CLAIMS SUBMITTED WITHOUT THE FP MODIFIER OR ANY OTHER REQURIED CODES WILL NOT RECEIVE PAYMENT FOR THE LARCS SUPPLEMENT
20
• After adjusting the APR-DRG weights for 540, 542 & 560, new CMIs were created for each hospital and entered into the base rate setting calculations.
• Hospitals base rates increased by an average of $0.23 ($0.18 - $0.46) which translates to a reduction in the overall budget for FY2017-18 of $574,865.
• In FY2015-16, DRGs 540, 542 & 560 accounted for 23,393 discharges out of a total of 95,262 total discharges or nearly 25% of all discharges.
APR-DRG Weight Changes due to Removal of IPP-LARC
21
LARCs insertions will be paid between $656 - $893Average = $774
APR-DRG Weight Changes due to Removal of IPP-LARC
NEW
LARC DEVICE NAME HCPCS/CPT CODE NDCCurrent Nov-2016
FFS Rate
Skyla IUD- Levonorgestrel IUS 13.5mg - 3 years
J7301 50419042201 $715.85
Mirena IUD- Levonorgestrel IUS 52mg -
5 years
J7298 changed as of 1/1/16 / J7302 discontinued code
50419042101 $892.99
Nexplanon - etonogestrel 68mg Implant - 3 years
J730752027401/52027201 - for
Implanon (being phased out as July 2016)
$777.37
Paragard - (CuT38A)- 10 years
J7300 51285020401 $742.70
Liletta IUD- Levonorgestrel IUS 52mg -
3 years
J7297 new code as of 1/1/16
Two-handed inserter: 5254403554/52544003554 One-
handed inserter: 00023585801/0023585801
$656.25
Kyleena - NEW IUD - Levonorgestrel IUS
19.5mg - 5years
Q9984 - NEW code as of 7/1/17
50419-424-01 50419-424-08 50419-424-71
Per invoice/Suggested
Manuf Retail $858.33
Sheet1
HOSPITAL ENGAGEMENT MEETING TOPICS5/5/17TIMEOwner / Specific Materials needed to facilitate discussionMarch-17May-17July-17September-17November-17
General Hospital MeetingX8:00-12:00 noon
-Fiscal Year 2017-18 Inpatient Base RatesXDiana /
-Overview on how Inpatient Base Rates are builtXDiana /
-APR-DRG prospective weight changes due to removal of IPP-LARCs
-Update rates every other year methodology discussionXDiana /
-DRG base rate communicationXDiana /
-New Specialty Hospital Rates Methodology Update
-Rate Related System Issues Update
-ICD-10 10/1/2016 update on new Diagnosis Codes - UPDATEXDiana /
-Transfer Claims Update (affects only Rehabs & LTACs)
-Baby Diagnosis on Mom's Claims
-Radiology Procedure Codes
-EAPG UPDATEXAndrew /
-Hospital Organizational Structureif time allows
-Hospital owned primary care practicesif time allowsAna/
-Stand alone emergency departmentsif time allowsAna/
-Salaried vs. non-salaried physicians within hospitalsif time allowsAna/
-Payment Reform Projects
-Community based projects
-Hospital Report Card
-Hospital site visits
-Yearly Hospital Meeting (Inpatient Base Rates)X
-Cost Shift Avoidance Discussion Shane / Kevin
HOSPITAL ENGAGEMENT MEETING TOPICS 7/7/2017 8am-12pm Hospital Engagement Meeting Time Line:
· General Hospital Meeting TopicPerson(s) Responsible
- New Specialty Hospital Rates Methodology UpdateHospital TransformationMatt Haynes
- IPP-LARCs implementation timelineSpecialty HospitalElizabeth Quaife
- Update on GME Q2-2015 PaymentsIPP LarcsDiana Lambe/Melanie Reece
- Cost Settlement UpdatesUpdate GMEDiana Lambe
- EAPG Rate UpdateBaby Diagnosis on Mom'sRaine Henry
- Innovative MedicationsInnovative MedicationsKevin Martin
Mass AdjustmentDiana Lambe/Clint Eatman
· Rate Related System Issues Update Cost Settlement UpdatesAndrew Abalos
- ICD-10 10/1/2016 update on new Diagnosis CodesEAPGsAndrew Abalos/Clint Eatman
- Transfer Claims Update (affects only Rehabs & LTACs)
- Baby Diagnosis on Mom's Claims
- Mass Adjustment Update for 3 Low Volume Payment Hospitals
- Ongoing Issues Impacting EAPGs
- EAPG Mass Adjustment SchedulingLARC DEVICE NAMEHCPCS/CPT CODENDCCurrent Nov-2016 FFS Rate
Skyla IUD- Levonorgestrel IUS 13.5mg - 3 yearsJ730150419042201$715.85
Mirena IUD- Levonorgestrel IUS 52mg - 5 yearsJ7298 changed as of 1/1/16 / J7302 discontinued code50419042101$892.99
Nexplanon - etonogestrel 68mg Implant - 3 yearsJ730752027401/52027201 - for Implanon (being phased out as July 2016)$777.37
Paragard - (CuT38A)- 10 yearsJ730051285020401$742.70
Liletta IUD- Levonorgestrel IUS 52mg - 3 yearsJ7297 new code as of 1/1/16 Two-handed inserter: 5254403554/52544003554 One-handed inserter: 00023585801/0023585801$656.25
Kyleena - NEW IUD - Levonorgestrel IUS 19.5mg - 5yearsQ9984 - NEW code as of 7/1/1750419-424-01 50419-424-08 50419-424-71Per invoice/Suggested Manuf Retail $858.33
links to registration
MAY 5, 2017 MEETING TIMES AND LINK TO REGISTER
General Hospital Meeting 8:00 - 12:00 noonhttps://cohcpf.adobeconnect.com/e237cw187s6/event/event_info.html
https://cohcpf.adobeconnect.com/e237cw187s6/event/event_info.html
Sheet3
Budget N Year:
Administrator: Administrator:Budget Neutrality baseline year. Should always be FY 02-03 until "Budget Neutrality" goes away.FY 02-03Formula pulls value inFormula pulls value inFormula pulls value inFormula pulls value inFormula pulls value inAdj Dischrgs for prior yr * Volume Inflator (R138)Formula pulls value indon't delete=$H66*$I66*J66*'Budget Actions'!$D$4Formula pulls value in=H66*I66*L66Formula pulls value in where appropriate from PPS & Non-PPS tables=N66*$R$128all currently 100% COL Rpulls in peer grp avg for CAH or low discharge hospitalsMedicaid Rate + Add OnsMedicaid Rate + Add-Ons * Est dischgs * CMIDifference between prior yr and current yr est paymentspercent change in payments current yr/prior yrformulaformulaformulaformulaformulaformulaformulaformula
PCG Report:
Administrator: Administrator:The year FY of the CFMC report that is used for discharges, CMI, and ALOS.FY 14-15 EstimatedQ2+AB2+AC2+AD2EstimatedBUDGET: $0.00
Prior Year:
Administrator: Administrator:Year that is prior to the year that
rates are being calculated for.FY 15-16TBD: 3A=New
TEFRA1=PediatricsCheck this formulaFY 16-17Estimated
OITDSS: estimated amt using last year's rate
this is NOT budget neutral # - budget neutral is in col Kcmi
adjusted rate
OITDSS: dl - don't know what this means. This column should be Medicare Final Rate LESS DSH + LVA (if applicable)we pay % of medicare rate to match budget neutralityadj by specialty %FY 16-17FY 16-17FY 16-17FINAL% OF MEDICARE:0.00%
Current Year:
Administrator: Administrator:FY that rates are being set
for.
OITDSS: estimated amt using last year's rate
this is NOT budget neutral # - budget neutral is in col
K
OITDSS: dl - don't know what this means. This column should be Medicare Final Rate LESS DSH + LVA (if applicable)FY 16-172=Not SpecialNon-CMI Adjusted DischargesPayments withFY 16-171-Oct-15FY 16-17MedicaidMedicaidPaymentsFY 16-17EstimatedMedicaid Cost Add-Ons / Cost per DischargeAmt over budget neutrality$0.00
1 = CAH3=RehabPeer GroupEstimatedFY 02-03Payments withMedicare
Initial Rate = Final Medicare DRG Rate - DSH + LVA (where
appropriate)
Chris: Jessica:1 = CAH2 = not3 = TEFRAMedicaidRates withRate with Rate withWithout Difference inMedicaid RateFY 16-17FinalFinal10% add on10% add on10% add on
Provider2 = Not4=Spinal RehabRural = 1CAH = 1FY 14-15FY 16-17FY 14-15FY 02-03Rates Incl PriorFY 15-16FY 15-16RateSpecialty CAH and lowMedicaidUpcoming YearEstimatedPercentw/Budget PaymentsFY 15-16FY 16-17Year over Year0.10.10.1FINAL RATES for RATE LETTERS
NumberProviders3 = TEFRA5=LTACUrban = 2Non-CAH =
2DischargesDischargesCase MixRates
: This will always be 02-03 Rates because that is our baseline year. Changing this would require State Plan Amendment.
Chris: Jessica:1 = CAH2 = not3 = TEFRABudget Actions
jlwagn: Check the cell reference for this formula in the Budget
Actions tab. Rates
Administrator: Administrator:Final MK Rates from previous
FYRates(% of Medicare)Percentages
Jessica Wagner: Jessica Wagner:1= pediatric2 = no special3 = rehab4 = spinal cord5 = urban safety net
Dischage avg.
Domenica Blum: Formulas are different for the rehabsAdd-OnsBudget ActionsPaymentsChangeActionsw/Budget ActionsInpatient Base RateInpatient Base Rate% ChangeNurseryNICUGMERATE w/out GME (purple) - goes in rate letterREASONS FOR RATE INCREASE/DECREASE% Diff in Rate from Prior Year
RURAL HOSPITALS
w/LVP GAF Fix
XXXXXSample
HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
OITDSS: this estimates how many discharges will occur in next
fiscal year for each hospital
Administrator: Administrator:Final MK Rates from previous
FYERROR:#N/AERROR:#N/AERROR:#N/A
OITDSS: calculating the estimated dollar amount that should be
spent this year by hospital to come up with a budget neutral
amount
Jessica Wagner: Jessica Wagner:1= pediatric2 = no special3 = rehab4 = spinal cord5 = urban safety net
Domenica Blum: Formulas are different for the rehabsERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
XXXXXSample HospitalERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/AERROR:#N/A
22
• IPP-LARCs insertions will be paid an average of $774
• Using the LARCs average above, and based on the 712 claims we were able to identify in 2015, the Department would pay $551,088 for IPP-LARCs insertions.
APR-DRG Weight Changes due to Removal of IPP-LARC
23
• Proper billing procedures for Newborn on Mother’s Claim can befound in the Inpatient/Outpatient Billing Manual.
• If the Mother is in the hospital, the mother and baby's charges(procedure and diagnosis codes) are billed on one claim as one stay.Services should be billed on the mother’s claim until the time themother is discharged.
• If procedures for the newborn were performed during the mother’sstay, they should only appear on the mother’s claim. They shouldnot appear on the newborn’s claim after the mother wasdischarged. If they do appear on the newborn’s claim, the claim willdeny.
• Mother’s claims with a newborn diagnosis or procedure that has anage or gender restriction are currently encountering errors. TheDepartment is working on a solution to this problem.
Newborn on Mother’s Claim
Innovative Medications• The prevalence of innovative drugs is increasing Spinraza Brineura
• These drugs often treat a small population at a high price
• Since current hospital payment methodologies are based on costs it takes several years to incorporate these costs into the payments
24
Innovative Medications
• We have been researching various options but this is a very resource intensive process
• Addressing individual drugs is not a sustainable option
• The larger issue that needs to be addressed is how to update payment methodologies with data that is more recent than ~3 years in the past
25
GME Q2-2015 Payments• Payments to Hospitals awaiting their GME Q2-2015
payments were made prior to the fiscal year end close on 6/30/2017.
• GME Hospitals should receive the payments very soon if they haven’t already received them.
• Letters sent to hospitals detailing the payments were sent in December 2016. If you need another copy of the letter please contact [email protected] or 303.866.5526. Thank you for your patience.
26
mailto:[email protected]
OVERVIEW OF MASS ADJUSTMENTS9,501 Claims
8,484 ICD10 New Diagnosis/New
Surgical Procedure Codes Claims
10/1/2016 - 2/28/2017
• 3,948 Paid Claims• 4,536 Denied Claims
722 claims CMS RuralDemonstration Hospitals –LVP restored, paid dates
>= 7/1/2016 &
28
• The old MMIS system was not able to recognize the new ICD10 Diagnosisand Surgical Procedure Codes that were instituted on 10/1/2016. The NewMMIS was able to correctly process these claims as of 3/1/2017.
ICD10 – NEW DIAGNOSIS/SURG PROC CODES
HOSPITAL SYSTEM HOSPITAL NAME COUNT(CLM_TCN)Denver Health Medical Center, Hospital 1070
UC HEALTH University of Colorado Hospital 895UC HEALTH Memorial Hospital 767SCL Health Exempla Saint Joseph Hospital, Inc. 456
Centura Health Centura Health-Penrose-St. Francis Health Services 368Parkview Medical Center 343
SCL Health Exempla Lutheran Medical Center 338HealthOne HealthOne The Medical Center of Aurora 276UC HEALTH Poudre Valley Hospital 250
Banner Banner Health-North Colorado Medical Center 237HealthOne HealthOne Swedish Medical Center 220
Centura Health Centura Health-St. Anthony North Hospital 196HealthOne HealthOne North Suburban Medical Center 192HealthOne HealthOne Presbyterian/St. Luke's Medical Center 164
Centura Health Centura Health-St. Anthony Central Hospital 163Centura Health Centura Health-Avista Adventist Hospital 158
The Children's Hospital 152HealthOne HealthOne Rose Medical Center 150SCL Health Exempla Good Samaritan 149UC HEALTH Medical Center of the Rockies 144SCL Health St. Mary's Hospital and Medical Center, Inc. 142
Centura Health Centura Health-St. Mary Corwin Medical Center 138Centura Health Centura Health-Longmont United Hospital 118Centura Health Centura Health-Parker Adventist Hospital 116
HealthOne HealthOne Sky Ridge Medical Center 112
8,484 ICD-10 NEW DIAGNOSIS CLAIMS FROM OLD MMIS 10/1/2016 - 2/28/2017 TO BE MASS ADJUSTED
8,484 ICD10 New Diagnosis/Surgical Procedure Codes
Claims 10/1/2016 -2/28/2017
FINAL CT BY PROV
8,484 ICD-10 NEW DIAGNOSIS CLAIMS FROM OLD MMIS 10/1/2016 - 2/28/2017 TO BE MASS ADJUSTED
NPIHOSPITAL SYSTEMHOSPITAL NAMEBILL_PROV_NPI_IDBILL_PROV_LOC_IDCOUNT(CLM_TCN)
1689624686Denver Health Medical Center, Hospital16896246861036401070
1477531580UC HEALTHUniversity of Colorado Hospital1477531580128069895
1144397134UC HEALTHMemorial Hospital1144397134115047767
1417946021SCL HealthExempla Saint Joseph Hospital, Inc.1417946021110781456
1932112125Centura HealthCentura Health-Penrose-St. Francis Health Services1932112125128946368
1104881507Parkview Medical Center1104881507126187343
1669461281SCL HealthExempla Lutheran Medical Center1669461281108667338
1659327013HealthOneHealthOne The Medical Center of Aurora1659327013127686276
1760492714UC HEALTHPoudre Valley Hospital1760492714126188250
1720004450BannerBanner Health-North Colorado Medical Center1720004450128068237
1396790200HealthOneHealthOne Swedish Medical Center1396790200127947220
1619985942Centura HealthCentura Health-St. Anthony North Hospital1619985942130453196
1821042979HealthOneHealthOne North Suburban Medical Center1821042979130177192
1720038946HealthOneHealthOne Presbyterian/St. Luke's Medical Center1720038946135124164
1164430567Centura HealthCentura Health-St. Anthony Central Hospital1164430567128949163
1891709192Centura HealthCentura Health-Avista Adventist Hospital1891709192128943158
1336245828The Children's Hospital1336245828139078152
1023062098HealthOneHealthOne Rose Medical Center1023062098142429150
1407845035SCL HealthExempla Good Samaritan1407845035108666149
1750392304UC HEALTHMedical Center of the Rockies1750392304128731144
1699716027SCL HealthSt. Mary's Hospital and Medical Center, Inc.1699716027113494142
1306857974Centura HealthCentura Health-St. Mary Corwin Medical Center1306857974128948138
1366465866Centura HealthCentura Health-Longmont United Hospital1366465866113496118
1386651297Centura HealthCentura Health-Parker Adventist Hospital1386651297128945116
1659325629HealthOneHealthOne Sky Ridge Medical Center1659325629120584112
1801800594Centura HealthCentura Health-Porter Adventist Hospital180180059412894477
1689688988Centura HealthCentura Health-Littleton Adventist Hospital168968898812913274
1083611644Centura HealthCentura Health-Mercy Regional Medical Center1083611644250767
1417980566BannerBanner Health-McKee Medical Center141798056612806562
1629071758SCL HealthPlatte Valley Medical Center162907175813447356
1235181744San Luis Valley Regional Medical Center123518174410341252
1821074196Boulder Community Health182107419612913148
1922012350Centura HealthCentura Health-St. Thomas More Hospital192201235012895148
1