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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