5.5.2017 hospital engagement meeting ppt final 2 [read-only] · 5/5/2017 · mirena iud‐...

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HOSPITAL MEETING

Friday, May 5, 20178:00 – noon

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].

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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

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HOSPITAL ENGAGEMENT MEETING TOPICS 5/5/2017

General Hospital Meeting ‐ New Specialty Hospital Rates Methodology Update‐ APR‐DRG prospective weight changes due to removal of IPP‐LARC‐ Overview on how Inpatient Base Rates are built‐ Fiscal Year 2017‐18 Inpatient Base Rates‐ DRG base rate communication‐ Update rates every other year methodology discussion

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

EAPG UPDATE ‐ Rate Methodology Discussion

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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

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Welcome & Introductions

• Thank you for participating today!

• We are counting on your participation to make these meetings successful

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• 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.

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• Marguerite Richardson has retired from the department.

• Progress Update

New Specialty Hospital RatesMethodology Update

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APR‐DRG prospective 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 a instituting this change in paymenton July 1, 2017 provided that approval is received from CMS.

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• Proposed method for extra “carve‐out” payment of Immediate Post Partum LARCs (Long Acting Reversible Contraceptives)

Maternity Immediate Post‐Partum Long‐Acting Reversible Contraceptives

DIAGNOSTIC CODES JCODE MODIFIER NDCZ30.430 J7298 FP 5041942101Z30.49 J7297 FP 5254403554

DIAGNOSTIC CODES JCODE MODIFIER NDCZ30.430 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

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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 3 0.9434 0.9394 0.0040540‐3 29 1.3456 1.3416 0.0040540‐4 141 3.1956 3.1916 0.0040542‐1 1,238 0.3787 0.3747 0.0040542‐2 23 0.5629 0.5589 0.0040542‐3 10 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

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• 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.


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LARCs insertions will be paid between $656‐$893Average = $774


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 52

mg ‐ 5 years

J7298 changed to 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 52

mg ‐ 3 years

J7297 new code 1/1/16 J3490 ‐ used initially Mics

Drug Code

Two‐handed inserter: 5254403554 / 52544003554

One‐handed inserter: 00023585801 / 0023585801

$656.25

Kyleena ‐ NEW IUD ‐ Levonorgestrel IUS 19.5mg ‐ 5 years

NEW Oct2016 ‐ no HCPCS yet, not on Fee Schedule

yet

Per invoice / Suggested Manuf Retail $858.33

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• 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 LARCs insertions.


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1. How much can we spend this year and remain budget neutral to FY2002‐03?A. FY15‐16 discharges are adjusted by the Volume Inflator designated

by The Department for FY16‐17 (1+4.32%) and FY17‐18 (1+4.97%) which is 9.5% this year.

B. Case Mix Index (CMI) without LARCs is calculated for each hospital’s FY15‐16 discharges (Total DRG Weights/Total Discharges).

C. FY2002‐03 DRG Base Rates (adjusted by prior Budget Actions) ‐ Note: this does not include the 1.4% increase that is proposed in the current Long Bill

How Inpatient Rates are Built

Budget Year & Type of Action TotalSFY 17‐18 (Before Budget Action) $791,616,882

Calculation = A*B*C

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2. Determine % of Medicare RateA. Input 10/1/2016 Medicare Base Rates – DSH + Medicaid Add‐Ons for all

PPS Hospitals

B. Average peer group rates are calculated and attributed to all Critical Access Hospitals (CAH), low discharge hospitals and new hospitals as necessary.

C. FY2016‐17 Non‐PPS Hospital Rates are entered with budget increase since we currently have no methodology to update these rates

D. Run Goal Seek to find % of Medicare Rate that allows us to remain Budget Neutral to FY2002‐03 Budget which is $791,616,882.


Percent of Initial Medicare Rate SFY 17‐18At the Budget Neutral Amount 83.27%

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3. Apply Budget Action to PPS Hospitals to arrive at final percent of initial Medicare Rate

A. Apply Budget Action of 1.4% to Budget Neutral Amount

B. Distribute resulting amount to all PPS Hospitals to arrive at total budget for FY2017‐18 of $802,699,519


Percent of Initial Medicare Rate SFY 17‐18With Legislative Increase of 1.4% 84.69%

Budget Year & Type of Action TotalBudget Action (1.4% increase) $11,082,636

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Hospital Rates Effective 7/1/2017The SFY 17‐18 Long Bill included a 1.4% rate increase effective this July 1. This 1.4% increase was added to the budget neutrality amount for SFY 17‐18. The methodology for calculating the inpatient rates remains the same as previous years.

Inpatient: Percent of Initial Medicare Rate: 84.69%

State Plan Amendment Approval – Sometime in September/October

Percent of Initial Medicare Rate SFY 16‐17 SFY 17‐18At the Budget Neutral Amount 85.50% 83.27%With Legislative Increase of 1.4% NA 84.69%

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• There are about 88 DRG hospitals enrolled with Medicaid and the Budget Neutrality amount for SFY 2017‐18 is ~$792 million.

• The decrease in budget is largely due to a significantly lowered growth rate expected for discharges in FY2017‐18. Discharges were expected to grow by 19.4% last year while this year’s expected growth is only 9.5%.

• For Medicaid rates effective July 1, 2017, the starting point is the Medicare rate effective October 1, 2016.

Hospital Rates Effective 7/1/2017

Budget Year & Type of Action TotalSFY 16‐17 (No Budget Action) $804,216,520 SFY 17‐18 (Before Budget Action) $791,616,882SFY 17‐18 Budget Action (1.4% increase) $11,082,636 Total SFY 17‐18 w/Budget Action $802,699,519

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• Overall, the average rate change reflects a 1.4% increase, which accounts for both the 1.4% rate increase and the change in Medicare base rates between FFY 17 and FFY 18.


• The final rates will not be loaded into the system until the Department receives approval from CMS. After which a mass adjustment will be done to reprocess affected claims.

• In the meantime, the current hospital rates will be kept in place.

Peer Group Avg 2016‐17 Avg 2017‐18 % ChangeRural $6,714.34 $7,054.07 5.06%Urban $5,237.79 $5,129.51 ‐2.07%

Specialty $7,539.35 $7,644.91 1.40%

Decreases and increases are mostly due to fluctuations in the Initial Medicare base rate from last year. The few Rural hospitals that contribute to the peer group average experienced an increase,

while urban hospitals overall experienced a decrease.

Specialty hospitals received a 1.4% increase across the

board.

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• A word about transmission of rates:

• The rates we have shared today are in DRAFT form and we want your help in reviewing them and letting us know if you have questions or concerns.

• Hospitals can request the calculation of their inpatient rate by contacting Diana Lambe at [email protected] or 303.866.5526.

• The Department is planning on posting rates on the Inpatient website as of June 1, 2017

• Notification of the posting of the new rates and location to find them will be available in the June Provider Bulletin. For Informal Reconsiderations or Appeals, there will be a date present on the announcement from which the 30‐day period will be calculated.


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Hospital Rates Effective 7/1/2017FY17‐18 Averages Rural UrbanIn‐State $7,054.07 $5,129.51Out of State (90%) $6,348.66 $4,616.56

HOSPITAL SYSTEM DBARates Effective

7/1/2017 pending CMS Approval

Animas Surgical Hospital $5,078.22Arkansas Valley Regional Medical Center $7,090.95Aspen Valley Hospital $7,123.88

Banner Banner Health‐Ft. Collins $5,129.51Banner Banner Health‐East Morgan County Hospital $7,054.07Banner Banner Health‐McKee Medical Center $5,152.40Banner Banner Health‐North Colorado Medical Center $5,491.49Banner Banner Health‐Sterling Regional MedCenter $7,774.52

Boulder Community Health $5,141.88Centura Health Centura Health‐Avista Adventist Hospital $5,244.23Centura Health Centura Health‐Castle Rock Adventist $5,164.99Centura Health Centura Health‐Littleton Adventist Hospital $5,307.83Centura Health Centura Health‐Longmont United Hospital $5,106.89Centura Health Centura Health‐Parker Adventist Hospital $5,245.86Centura Health Centura Health‐Penrose‐St. Francis Health Services $5,221.85Centura Health Centura Health‐Porter Adventist Hospital $5,132.29Centura Health Centura Health‐St. Anthony Central Hospital $5,133.92Centura Health Centura Health‐St. Anthony North Hospital $6,010.59Centura Health Centura Health‐St. Anthony Summit $6,600.63Centura Health Centura Health‐St. Mary Corwin Medical Center $5,403.77Centura Health Centura Health‐St. Thomas More Hospital $6,603.60Centura Health Centura Health‐Mercy Regional Medical Center $6,694.40

Colorado Acute Long Term Hospital $7,004.69

FY 2017‐18 HOSPITAL BASE RATES

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Hospital Rates Effective 7/1/2017FY17‐18 Averages Rural UrbanIn‐State $7,054.07 $5,129.51Out of State (90%) $6,348.66 $4,616.56

HOSPITAL SYSTEM DBARates Effective


Colorado Plains Medical Center $6,562.19Community Hospital $4,856.97Conejos County Hospital District $7,054.07Craig Hospital $14,490.63Delta County Memorial Hospital $5,624.32Denver Health Medical Center, Hospital $7,121.62Estes Park Medical Center $5,159.60

SCL Health Exempla Good Samaritan $5,220.21SCL Health Exempla Lutheran Medical Center $5,164.26SCL Health Exempla Saint Joseph Hospital, Inc. $5,921.84SCL Health St. Mary's Hospital and Medical Center, Inc. $5,931.28SCL Health Platte Valley Medical Center $5,888.01

Family Health West $5,129.51Grand River Medical Center $7,054.07Gunnison Valley Hospital $7,121.39Haxtun Hospital District $7,054.07

HealthOne HealthOne North Suburban Medical Center $5,144.05HealthOne HealthOne Presbyterian/St. Luke's Medical Center $5,716.52HealthOne HealthOne Sky Ridge Medical Center $5,206.39HealthOne HealthOne Rose Medical Center $5,540.64HealthOne HealthOne Spalding Rehabilitation Hospital $4,735.68HealthOne HealthOne Swedish Medical Center $5,314.37HealthOne HealthOne The Medical Center of Aurora $5,222.49HealthSouth HealthSouth Rehabilitation Hospital of Colorado Spr $5,853.09HealthSouth HealthSouth Littleton Rehabilitation $7,718.78

FY 2017‐18 HOSPITAL BASE RATES

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Hospital Rates Effective 7/1/2017DBA

Rates Effective 7/1/2017 pending CMS Approval

Heart of the Rockies Regional Medical Center $7,151.06Keefe Memorial Hospital $7,054.07Kindred Hospital, Denver $5,795.71Kindred Hospital Aurora/SCCI $16,022.23Kit Carson County Memorial Hospital $7,245.14Kremmling Memorial Hospital $7,054.07Lincoln Community Hospital and Nursing Home $7,054.07Centura Longmont United Hospital $5,106.89Medical Center of the Rockies $5,148.85Melissa Memorial Hospital $7,054.07Memorial Hospital $5,110.19Montrose Memorial Hospital $5,562.71Mount San Rafael Hospital $7,054.07National Jewish Medical and Research Center $5,331.01Northern Colorado Rehabilitation Hospital $5,795.71Northern Colorado Long Term Acute Hospital $5,813.86Pagosa Mountain Hospital $7,054.07Parkview Medical Center $5,330.99Pikes Peak Regional Hospital $5,129.51Pioneers Hospital $7,054.07Poudre Valley Hospital $5,610.51Prowers Medical Center $7,087.40Rangely District Hospital $7,054.07Rio Grande Hospital $7,054.07San Luis Valley Regional Medical Center $5,886.21

DBARates Effective


Sedgwick County Memorial Hospital $7,138.88Kindred Hospital ‐ Colorado Springs $5,872.58Kindred Hospital ‐ Denver South $5,872.58Southeast Colorado Hospital & LTC $7,054.07Southwest Memorial Hospital $7,103.57Spanish Peaks Regional Health Center $7,054.07St. Vincent General Hospital District $7,054.07The Children's Hospital $8,590.88The Memorial Hospital‐Craig $7,080.92University of Colorado Hospital $6,611.41Vail Valley Medical Center $12,347.82Valley View Hospital $7,167.79Vibra Hospital $5,817.36Weisbrod Memorial County Hospital $7,054.07Wray Community District Hospital $7,135.05Yampa Valley Medical Center $9,971.83Yuma District Hospital $7,054.07

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• The Department is proposing to update rates every other year and just make slight updates to rates in the off year and only to hospitals that experience a meaningful change in Medicare Base Rate and/or Medicaid Rate.

• This will not only allow the Department to devote time to creating a new base rate methodology, but minimize the work done to update rates when overall, the changes to base rates from year to year are nominal unless there is a change in:

• Medicare Base Rate: • Change in hospital classifications (like CAH)• Wage index reclassifications• Changes in HSP/LVP• ??

• Medicaid: • Nursery, NICU or GME Add‐Ons• Changes related to receiving Peer Group Average: (New Hospital,

CHOW ((w/new Medicare Provider ID) Low discharge hospital, CAH)• ??

Rate Updates – Every Other Year Methodology Discussion

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Mass Adjustment of All Claims: The Department anticipates CMSapproval in the 4th quarter of calendar year 2017. At that time, allinpatient hospital claims with discharge dates 7/1/2017 or later will bere‐priced using the new rates and the revised APR‐DRG weights.

APR‐DRG Weight Recalibration Discharge Dates>=7/1/2017

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• Claims with “serve to” dates on or after 10/1/2016 and adjudication datesprior to 3/1/2017 which contain new diagnosis codes or changes inSeverity of Illness (SOI) as a result of the new ICD‐10 update should havealready been mass‐adjusted and paid correctly. Please let Diana Lambe [email protected] or 303.866.5526 if you haven’t seen thesechanges.

• Outstanding issue: Any claims that have a “serve from” date before10/1/2016 and “serve to” date after 10/1/2016 is likely to have beenprocessed incorrectly. The system was pulling in the APR‐DRG processingschedule from the “serve from” date and not recognizing the new ICD‐10diagnosis codes. We will be mass adjusting these claims as soon as we getword the system is fixed.

ICD‐10 10/1/2016 Update on new Diagnosis Codes

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• It was brought to our attention that transfers for LTACs and Rehabs werereceiving a cutback payment (payment on DRG Per Diem if less than ALOS)when these hospitals should receive full reimbursement and outlier days ifapplicable.

• Resolution: Our systems people tell us that this issue has been fixed andthat all claims should have been mass‐adjusted. Please let me know [email protected] or 303.866.5526 if you see any transfer claimsare improperly paid.

Transfer Claims Update

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• Claims with a Newborn Diagnosis code that is age specific (like P36.8“Other bacterial sepsis of newborn” and other age‐restricted diagnosiscodes) on Mother’s claim are being denied whether they have the UKModifier or not.

Newborn Diagnosis on Mom’s Claim

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• Mass adjustment of inpatient claims for three rural providers whose LowVolume Payments were restored for FY Rates effective 7/1/2016.

• Re‐issued Q2‐2015 GME payments were recouped in February 2017, butpayment was never re‐issued. We will be researching this issue next weekand determining how to fix in the new system.

• Are there other issues that we should know about?

Outstanding Issues

EAPG Proposed Post‐Corridor Rate Setting Methodology

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Post‐Corridor EAPG Base Rate Methodology

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The starting point for Hospital‐specificOutpatient Base Rate Calculations,modeled on CMS’ “Conversion Factor”

May fluctuate depending on legislativerate changes or other budgetaryactions

Representative of payment for theaverage state‐wide collection ofoutpatient services (i.e., EAPG RelativeWeight of 1.0) without add‐ons.

Should recognize administrative andoverhead‐facility expenses at marketvalue

EAPG Rate – State‐wide Standardized Rate

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Modeled after CMS’ All PatientsClassification Rate Methodology

Recognizes the variances in state‐wide wages, scaled to CO wages

Recognizes that only a portion of costfor delivering outpatient hospitalservices are attributable to areawages

Information publicly available onCMS’ website. For wage indices notavailable, state‐wide wage index used

Would need to periodicallyincorporate CMS’ wage index updates

EAPG Rate – Labor Portion, Wage Index

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Adjustment would only apply to Ruralor Critical Access Hospitals asdesignated by Colorado Department ofPublic Health and Environment(CDPHE)

Recognizes that, statistically, RelativeWeights are more likely to beinfluenced by high‐volume hospitals

Due to differences in purchasing powerand economies of scale, costs for Ruraland Critical Access Hospitals tend to behigher for the same servicesperformed

EAPG Rate ‐ Rural or CAH Adjustment

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Recognizes the difference in costrequired to treat specializedpopulation in Colorado

Logic can be incorporated into 3Msoftware to be utilized on a claim‐by‐claim basis, may not be required as afactor in base rate

EAPG Rate – Pediatrics Add‐on

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Adjustment only applies to GMEHospitals

Modeled after state ofWashington’s GME Add‐onEquation

Recognizes greater cost forperforming services with GMEcomponent than without

EAPG Rate ‐ GME Add‐on

EAPG Proposed Rate Methodology Spreadsheet

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How often will the rate be updated?How to effectively determinestandardized rate without usingcharge/cost report data?Implementation schedule ofpotential quality measures?How will quality metrics beconsidered in this model?

Does the 60/40 split for the laborportion represent an accurate split ofresources for service delivery?How to effectively quantify theincreases in costs associated withRurals/CAHs and pediatric members?Any other considerations for GMEadd‐ons?

EAPG Rate – Questions

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Federal Base Rate as Possible Starting Point for Medicaid Base Rate?

Hospital Name HOSPITAL 1 HOSPITAL 2 HOSPITAL 3 HOSPITAL 4

MEDICARE FEDERAL BASE RATE

OPERATING Labor Related Amount 3,805.30 3,760.40 3,389.78 3,349.79 Wage Index 1.0006 1.0006 0.9615 0.9615 Adjusted Labor Amount 3,807.58 3,762.66 3,259.27 3,220.82 Non‐Labor Amount 1,662.09 1,642.48 2,077.61 2,053.09OPERATING TOTAL 5,469.67 5,405.14 5,336.88 5,273.91

CAPITAL Standard Federal Rate 438.75 438.75 438.75 438.75 GAF 1.0004 1.0004 0.9735 0.9735CAPITAL TOTAL 438.93 438.93 427.12 427.12

MEDICARE FEDERAL BASE RATE $5,908.60 $5,844.06 $5,764.01 $5,701.04

MEDICAID SPECIFIC ADD‐ONS

Nursery $27.00 $6.00 $10.00 $0.00NICU $0.00 $40.00 $0.00 $0.00GME $40.00 $8.00 $0.00 $0.00?? $500.00 $0.00 $0.00 $400.00?? $0.00 $900.00 $0.00 $0.00?? $0.00 $0.00 $0.00 $2,000.00?? $0.00 $0.00 $1,500.00

MEDICAID ADD‐ON SUBTOTAL $567.00 $954.00 $1,510.00 $2,400.00

MEDICAID BASE RATE $6,475.60 $6,798.06 $7,274.01 $8,101.04

Thank you for all of your suggestions on this point. We will pick this back up during the July meeting and incorporate your input.

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Hospital Designations: Urban/Rural or Something Else?

Hospital Peer Groups: A grouping of hospitals for the purpose of cost comparison and determination of efficiency and economy. The peer groups are defined as follows:

a. Pediatric Specialty Hospitals: all hospitals providing care exclusively to pediatric populations.

b. Rehabilitation and Specialty‐Acute Hospitals: all hospitals providing rehabilitation or specialty‐acute care (hospitals with average lengths of stay greater than 25 days).

c. Rural Hospitals: Colorado Hospitals not located within a federally designated Metropolitan Statistical Area (MSA).

d. Urban Hospitals: all Colorado hospitals in MSA's including those in the Denver MSA. Also included would be the Rural Referral Centers in Colorado, as defined by HCFA. (SSAS, 1886 (d) (5) (c) (I); Reg. 412.90 (c) and 412.96).

Facilities which do not fall into the peer groups described in a. or b. will default to the peer groups described in c. and d. based on geographic location.

Source: Colorado State Plan Attachment 4.19A

Thank you for all of your suggestions on this point. We will pick this back up during the July meeting and incorporate your input.

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Thank You!Ana LucaciHospital Policy [email protected]

Raine HenryHospital Policy [email protected]

Melanie ReeceFamily Planning Policy [email protected]

Richard DelaneyPhysician Services Policy [email protected]

Shane MoffordPayment Reform Section [email protected]

Kevin MartinFee for Service Rates [email protected]

Diana LambeHospital Rates [email protected]

Andrew AbalosHospital Rates [email protected]

5.5.2017 hospital engagement meeting ppt final 2 [read-only] · 5/5/2017 · mirena iud‐...

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