Health Care Reimbursement Summit – State Policy Update Page 0

I consult for the following organization:

- PYA P.C.

- Post Acute Service Line Consulting Manager

- PYA is a professional services firm with specialized expertise in healthcare consulting and certified public accounting

Disclosure of Commercial Interests

Amy Dalton, NHAadalton@pyapc.com

March 19, 2019

ACHCA 2019 CONVOCATION & EXPO

Leveraging Data in the Healthcare Continuum

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Data in Healthcare What is Data? Set of values of quantitative variables that is collected, measured, analyzed, and 

reported

Characterized by 3 major criteria: high volume, high velocity, and includes a wide variety of types

Data mining and algorithms mine massive amounts of data and information to find new trends, relationships, and predict future outcomes

These traits make acquiring this data challenging, time consuming, and expensive to manage

Volume

The size of data

Velocity

Received in real time or continuous stream; quick availability

Variety

Data sources; EMRs, sensor traces, medical imaging, etc.

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Why Data? We’re moving from volume to value, right?

Payment Capitation – fixed amount of money per patient per unit of time in advance to the provider for delivery of care (ACOs are a forerunner of capitation)

It’s possible to improve quality and reduce costs simultaneously

More care isn’t necessarily better care

Access to valid and reliable data re: costs, quality, outcomes, referrals, and savings is a major sticking point

VBP and APM payment across the continuum

PDPM better prepares SNFs for APM and Bundled Payments

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Redefining the Continuum (System)

What defines “system” is what the patient experiences when they use your service

You don’t have to own all pieces of the continuum to work together

It doesn’t matter where the patient starts in the system, the key is the patient outcome:

Better reviews and ratings

Reduced readmissions and penalties

Referrals – physicians, hospitals, previous patients and family members

This is the initial push SNFs are receiving from CMS – PDPM to pay SNFs specifically for patient needs

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Alternative Payment Models

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Alternative Payment Models

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Alternative Payment Models

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Alternative Payment Models

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Risk Based Contracting - Continuum

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Raw Data ► Meaningful Actions

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Digital Health Adoption

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SNF Selection StudyResearchers recently studied how hospitalized patients make decisions about choosing a SNF, who helps them decide, what they think about the process, and what they consider as they make decisions.

Findings from interviews with 98 patients just admitted to SNF: Most people said they had to choose a SNF the day before or even the day of being discharged from the

hospital

66 study participants chose a SNF on their own; 19 people had a family member or friend make the decision; and the hospital staff chose the facility for 12 individuals

35 patients had previously stayed in the SNF they'd chosen and 54 people had never stayed in a skilled nursing facility before

They had very little time to choose a SNF

Hospital discharge planners gave them a list of facility names and addresses

Healthcare professionals involved in their care gave the patient little guidance about choices

1) American Geriatrics Society

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SNF Selection Study cont.Important factors in choosing a SNF: whether the resident or family and friends had been to the facility

whether the facility was close to home

only a few patients reported choosing facilities solely based on more staff, cleanliness, or amenities

1) American Geriatrics Society

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Cost Reporting

Facility

Midwest 

25th %tile

Midwest 

50th %tile

Midwest 

75th %tile

National 

25th %tile

National 

50th %tile

National 

75th %tile

Nursing 119.60$             61.66$        76.24$        95.94$        64.93$        82.15$        103.88$     

Employee Benefits 13.75                 12.89          18.24          26.00          11.94          18.53          27.39         

Admin & General 32.62                 30.96          40.71          52.19          34.70          46.23          60.74         

Plant Operation Maint and Repairs 18.38                 9.07             11.05          13.78          8.84             10.81          13.76         

Laundry & Linen 4.21                   1.78             2.60             3.55             1.93             2.77             3.72            

Housekeeping 10.43                 4.26             5.37             6.94             4.48             5.64             7.38            

Dietary 35.66                 14.94          17.60          21.71          14.97          17.56          21.74         

Social Service 3.71                   2.26             3.95             6.32             2.07             3.48             5.61            

Other General Service 25.91                 12.77          18.78          26.90          15.01          21.64          30.98         

Total 264.28$             150.59$      194.54$      253.33$      158.87$      208.81$      275.20$     

Total Routine Costs per Resident Day

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Cost Reporting

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Cost Reporting

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CMSDATA.GOVTopeka, KS Dashboard

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CMSDATA.GOVKansas – Top 15 Diagnoses

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CMSDATA.GOVKansas – Discharge Disposition Comparison

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CMSDATA.GOVACO Evaluation – Minnesota

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PACT Policy Hospital Impact

1) The Advisory Board (2018)

Old rule. New risk.

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Readmissions

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VBP Results

SNF VBP 

Ranking

SNF Star 

Rating Provider Name

Baseline Period: 

CY 2015 Risk‐

Standardized 

Readmission Rate

Performance 

Period: CY 2017 

Risk‐Standardized 

Readmission Rate

Achievement 

Score

Improvement 

Score

Performance 

Score

Incentive 

Payment 

Multiplier

1 5 TOPEKA PRESBYTERIAN MANOR 19.27% 16.18% 100                  90                     100                101.65%

1,197 5 LEXINGTON PARK NURSING & POST ACUTE CENTER 18.98% 17.20% 77                     64                     77                   101.44%

6,472 3 ALDERSGATE VILLAGE 16.25% 18.89% 39                     ‐                   39                   98.92%

9,703 4 BREWSTER HEALTH CENTER 16.21% 19.68% 21                     ‐                   21                   98.20%

9,763 1 TANGLEWOOD NURSING & REHABILITATION 16.86% 19.69% 21                     ‐                   21                   98.19%

9,967 1 LEGACY ON 10TH AVENUE 18.30% 19.75% 20                     ‐                   20                   98.17%

12,159 5 ROLLING HILLS HEALTH CENTER 22.40% 23.74% ‐                   ‐                   ‐                 98.02%

12,159 3 MCCRITE PLAZA HEALTH CENTER 20.70% 21.05% ‐                   ‐                   ‐                 98.02%

12,159 2 MANORCARE HEALTH SERVICES ‐ TOPEKA 18.03% 20.95% ‐                   ‐                   ‐                 98.02%

12,159 4 PLAZA WEST REGIONAL HEALTH CENTER 21.93% 23.97% ‐                   ‐                   ‐                 98.02%

Topeka, KS Facilities

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VBP Compared to Hospital Penalties

Provider Name VBP HAC HRRP PACT TOTAL

University of Kansas Health System 744,808$        ‐$                   150,110$        845,293$        1,740,211$       

Stormont Vail Regional Health Center 628,311$        1,056,066$        515,063$        845,293$        3,044,733$       

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Involvement in Population Health

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Findings and Caveats

Physician performance is a key to cost savings. Cost reduction revolves around referrals and clinical judgement

Claims data is not thought to be a complete picture of all costs

Healthcare data is old and not real time

Data can be wrong and unreliable

APM programs aren’t as standardized as we would all hope, specifically with data sharing and best practices

APMs need additional payors – Private, Medicaid, employer-based need to piggyback off Medicare efforts

They ways things are currently make it difficult to make an impact on a single persons health

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Means to an End

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Engagement

1. Self-assessment of performance Claims data analysis Documentation of adverse events Patient satisfaction surveys

2. Self-assessment of capabilities Available resources to provide transitional care Willingness of local providers Admission and discharge process

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Engagement, Cont.3. Market analysis (potential opportunity) Home Health (compare performance) PPS hospital (demonstrate savings and improvement)

4. Business plan Necessary resource investment to pursue opportunities

5. Partner recruitment Don’t expect anyone to come knocking on your door

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