midas+ xerox hospital readmission penalty forecaster
Post on 15-Dec-2015
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Midas+ XeroxHospital Readmission Penalty Forecaster
Hospital Readmission Reduction ProgramPenalties Forecasted to Impact More
Hospitals in Future
• Acute Myocardia Infarction
• Pneumonia
• Heart Failure
• Total Hip and Knee
• COPD
• CABG
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FY 201464% US hospitals had penalties and 18 had a full 2% reduction of their base operating
DRG
FY 2015FY 2016
CMS estimates only 39 hospitals will be subject
to maximum 3% reduction in
FY 2015 FY 2017
Midas+ Xerox estimates 80% of all
hospitals will be penalized in FY 2017
Excessive Readmission Ratios Values > 1.0 = Financial Penalties
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Your Hospital ERROther Hospitals
Hospital Readmission Reduction ProgramPenalties Forecasted to Impact More
Hospitals in Future
• Acute Myocardia Infarction
• Pneumonia
• Heart Failure
• Total Hip and Knee
• COPD
• CABG
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Excess Readmission Ratio’s > 1
in ANY one of the clinical cohorts
results in financial penalties
Excess Readmission Ratio = Predicted /Expected
A Primer on Predicted and Expected
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PredictedFY 2016
Excess Readmission Ratio = Predicted /Expected
=
Your patient’s riskfactors for FY 2016Part A & B Claims
(July 1, 2010 – June 30, 2014)
xRisk
Coefficients(July 1, 2011 – June 30, 2014)
+
Your hospitalprovider Intercept
(July 1, 2011 - June 30, 2014)
ExpectedFY 2016
= +
Average hospitalprovider interceptfor all Section(d)Hospitals in US
(July 1, 2011 – June 30, 2014)
Your patient’s riskfactors for FY 2016Part A & B Claims
(July 1, 2010 – June 30, 2014)
xRisk
Coefficients(July 1, 2011-June 30, 2014)
FY 2017 Financial Penalties Will Be Determined by June 30, 2015
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Risk Factors Risk Coefficients
Hospital Specific Reports
Adjusted Payments
Begin
July 2011 to June 2015 October 1, 2016
July 2012 to June 2015
August2016
We have less than a year to impact these values!
Midas+ Advanced Analytics
Five years of Medicare data linked with your patients in Midas+ to replicate CMS risk models proactively
Adjusted readmission rates to account for non-same hospital readmissions
See predicted and expected readmission rates for your hospital nearly two years before CMS provides you with your hospital specific reports
Prioritize which clinical cohorts have the greatest risk for financial penalty and the greatest opportunity for improvement
Patient level risk coefficients to drive quality improvement across your organization
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Midas+ Predictive Analytics Creates a Proactive Response Strategy……
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Risk Factors Risk Coefficients
Midas+ Clients see their results
CMS Hospital Specific Reports
Adjusted Payments
Begin
July 2012 to June 2015
July 2011 to June 2015
October 2016TODAY!
August 2016
Midas+ Hospitals canprioritize and intervene
high risk populations to impact financial penalties two years
before they apply!
Risk Factors and Risk Coefficientscalculated from Medicare Part A & B Claims
July 1, 2011 – Dec 31, 2013+
Midas+ Data Jan 1, 2014 to date+
Midas+ Predictive Analytics
Understanding Your Tipping Point
• Which populations are at greatest risk?
• How many readmissions are too many?
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Identify Hospitals and Populations at Highest Risk for Readmission Penalties 2 Years Earlier!
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Clinical Cohort
Index Admissions
FY 2017
Adjusted Readmits
FY 2017
Excess Readmits
FY 2017Penalties per Topic
FY 2017Acute MI 157 36 8.88 $106,279.83CHF 178 58 20.33 $125,748.03COPD 183 46 12.47 $79,498.86Pneumonia 140 32 9.90 $58,503.09Total Joint 129 8 3.79 $40,006.30CABG 82 9 (2.21) $0
55.38 $410,036.10
Call Us Today to ScheduleYour Hospital Readmission
Reduction Engagement 800.737.8835 or
www.midasplus.com
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