1 Zimmet Healthcare Services Group, LLC Innovation in Reimbursement August 17 - 18, 2016 CCJR: Early Lessons from the Provider Community August 17 – 18, 2016 Atlantic City, NJ HHS Payment Reform • HHS Secretary Burwell: “Target to increase the number of payments that are linked to quality outcomes by 2018” – Goal #1: 30% of all Medicare provider payments to be in alternate payment models tied to quality by 2016; 50% by 2018 – Goal #2: Virtually all Medicare fee-for-service payments to be tied to quality and value; 85% in 2016 and 90% in 2018 Value-Based Purchasing • Goal for 30% value-based purchasing achieved 11 months early – Largely due to ACO and Bundled Payment expansion – Aim to continue increase to 50% by 2018 through CJR bundled project starting April 1, 2016, and New Episode Based Payment Models starting July 1, 2017
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CCJR: Early Lessons from the Provider Community...•5-star Nursing Home Compare rating now significantly impacts discharge decisions •Now Annual survey and Nurse staffing imperative
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Zimmet Healthcare Services Group, LLC
Innovation in Reimbursement
August 17 - 18, 2016
CCJR: Early Lessons from the Provider Community
August 17 – 18, 2016 Atlantic City, NJ
HHS Payment Reform
• HHS Secretary Burwell: “Target to increase the number of payments that are linked to quality outcomes by 2018”
– Goal #1: 30% of all Medicare provider payments to be in alternate payment models tied to quality by 2016; 50% by 2018
– Goal #2: Virtually all Medicare fee-for-service payments to be tied to quality and value; 85% in 2016 and 90% in 2018
Value-Based Purchasing
• Goal for 30% value-based purchasing achieved 11 months early
– Largely due to ACO and Bundled Payment expansion
– Aim to continue increase to 50% by 2018 through CJR bundled project starting April 1, 2016, and New Episode Based Payment Models starting July 1, 2017
• Collaborators for gainsharing arrangements could be with PAC providers including SNFs
• Must engage in care redesign strategies to be eligible for gainsharing; can have two-sided risk
• Hospital must retain at least 50% repayment risk with CMS, can’t share more than 25% with any one collaborator
Re-Hospitalizations
The 800-pound Pink Elephant in the room!
• SNF must have clinical programs and protocols in place to reduce readmissions (use of NP/PAs) and re-hospitalizations (post-discharge follow-up).
• Emphasis should be placed on clinical assessments and interventions prior to ER discharge, avoiding premature discharges, and communication between patients, caregivers and providers
• Use of Technology for “Care Transitions” to ensure post-discharge compliance
• New incentive for hospitals to provide follow-up services post discharge
• Waiver for both patient geographic and originating site requirements
• New G-codes to report home telehealth visits furnished to CJR beneficiaries
• These patients lend themselves to this form of monitoring as the clinical condition typically without cognitive impairment, age range 65 - 75 and without significant co-morbidities in most cases
SNF 3-Midnight Waiver
• Waiver for SNF 3-day hospital stay to a discharge SNF with at least a 3 star rating.
• Begins Year 2 of Program
• SNF will only get the more acute and complex cases
• 5-star Nursing Home Compare rating now significantly impacts discharge decisions
• Now Annual survey and Nurse staffing imperative to financial success
New Quality Measures
• Five of six will be phased into 5-star Quality Ratings system over a 9-month period
• Only the measure on anti-anxiety or hypnotic medication not used
• Benchmark data will be a year of information up to July 2015