dual chapter conference – hfma cental ohio / southwestern ohio dayton, oh – september 25, 2014...

DUAL CHAPTER CONFERENCE – HFMA CENTAL OHIO / SOUTHWESTERN OHIODAYTON, OH – SEPTEMBER 25, 2014

{Bundled Payments.}

DUAL CHAPTER AUTUMN INSITUTE – DAYTON, OH – SEPTEMBER 25, 2014

{BUNDLED PAYMENTS.}

OUR DISCUSSION TODAY

Agenda

2

• Define Bundles• Creating a Successful Bundle• The Commercial Movement• Impact on Revenues and Operations• Questions

3

Define Bundles


{BUNDLED PAYMENTS.}

Define Bundles

4

PACKAGED SERVICES

Pre-Admit Inpatient Recovery Follow-Up

Pre-Window

Excludes charges through surgeon

evaluation Excludes Hospice, Outpatient Rx, ESRD

Includes specific pre-

surgical workup

expenses

Includes all physician hospital

charges

Includes physician, hospital charges for complications and re-admissions and PT, HHC,

SNF, IP Rehab

3 Days 30 - ??? Days

Post-Window


{BUNDLED PAYMENTS.}

Define Bundles

5

CMS BPCI – MODEL 1

PARTICIPANTS15 representing 15 providers

CLINICAL CONDITION EPISODESMost Medicare FFS discharges

BUNDLE COVERAGEHospitals, physicians

PAYMENT ARRANGEMENTRetrospective

EPISODE TRIGGERAcute hospital stay

EPISODE DURATIONAcute hospital LOS


{BUNDLED PAYMENTS.}

Define Bundles

6


PARTICIPANTS656 representing 2,150 providers

CLINICAL CONDITION EPISODES48

BUNDLE COVERAGEHospitals, physicians, post-acute, re-admissions, lab, DME, Part B Rx



EPISODE DURATION30 or 90 days after discharge


{BUNDLED PAYMENTS.}

Define Bundles

7


PARTICIPANTS287 representing 4,617providers


BUNDLE COVERAGEPhysician, SNF, IRF, LTAC, HHA, re-admissions, lab, DME, Part B Rx


EPISODE TRIGGERAcute hospital stay, and begins at initiation of post-acute services

EPISODE DURATION30, 60 or 90 days after initiation of episode


{BUNDLED PAYMENTS.}

Define Bundles

8


PARTICIPANTS17 representing 18 providers


BUNDLE COVERAGEHospitals, physicians

PAYMENT ARRANGEMENTProspective


EPISODE DURATIONAcute hospital LOS


{BUNDLED PAYMENTS.}

Define Bundles

9

• What constitutes an Episode Family Similar services by DRG, across an acuity Necessary ‘n’

• What occurrences (claims) should not be included within an Episode Duration

Irrelevant readmissions Principle diagnosis code exclusions

INCLUSIONS / EXCLUSIONS

10

Creating a Successful Bundle


{BUNDLED PAYMENTS.}


11

CHOOSING WISELY

Sufficient Volume

Clinical Leadership

Existing Variability

Valid Plan for Protocols

Controllable Costs

Required Partners

Target

$ Price


{BUNDLED PAYMENTS.}


12

EXISTING VARIABILITY

1525

1

1609

5

1693

9

1778

3

1862

7

1947

1

2031

5

2115

9

2200

3

2284

7

2369

1

2453

5

2537

9

2622

3

2706

7

2791

1

2875

5

2959

9

3044

3

3128

7

3213

1

3297

5

3381

9

3466

3

3550

70

50

100

150

200

250

300

Episode Distribution

Cost

Freq

uenc

y


{BUNDLED PAYMENTS.}


13

EXISTING VARIABILITY

1525

1

1609

5

1693

9

1778

3

1862

7

1947

1

2031

5

2115

9

2200

3

2284

7

2369

1

2453

5

2537

9

2622

3

2706

7

2791

1

2875

5

2959

9

3044

3

3128

7

3213

1

3297

5

3381

9

3466

3

3550

70

50

100

150

200

250

300

Episode Distribution

Cost

Freq

uenc

y

Length of Reconciliation Period

Risk Assessment

Qualification of the Bundle Family of Episodes


{BUNDLED PAYMENTS.}


14

VALID PLAN FOR PROTOCOLS

Source: HCI3 – Prometheus Model


{BUNDLED PAYMENTS.}


15


Source: HCI3 – Prometheus Model


{BUNDLED PAYMENTS.}


16


• Care re-design

Care Coordination – elimination of redundant testing, readmission prevention, improved follow-up care

Clinical Practice Improvement – Reduction of preventable errors, clinical best practice guidelines in concordance with evidence based medicine

Supply Chain – reduce variation in supply costs

Patient Centered Interventions – improve engagement of patients in their care


{BUNDLED PAYMENTS.}


17


• Care re-design examples

Proven Care – Geisinger Health System CABG

Integrated Healthcare Association – Orthopedic Procedures

Iowa Health System St. Luke’s – Heart Failure

Prometheus – Total Knee Replacement Toolkit


{BUNDLED PAYMENTS.}


18

CONTROLLABLE COSTS

Valid Plan for

Protocols

Controllable Costs

Target

$ PriceHistoric

Claims Paid less 3%

Operating Costs less

than Target Price


{BUNDLED PAYMENTS.}


19

CONTROLLABLE COSTS

Valid Plan for

Protocols

Controllable Costs

Target

$ Price Duplication

Unnecessary Least Acute

Process Change Labor Supply

Standardization

20

The Commercial Movement


{BUNDLED PAYMENTS.}


21

EMPLOYER AND COMMERCIAL


{BUNDLED PAYMENTS.}


22

EMPLOYER

250,000343,0002,200,000160,000


{BUNDLED PAYMENTS.}


23

COMMERCIAL

TESTED BUNDLES

ADHD

Colon-oscopy

Developmental Disability

Tonsillectomy

Upper Resp. Infection

Bariatric Surgery

Source: Bailit Healthcare Purchasing

24

Impact on Revenue & Operations


{BUNDLED PAYMENTS.}


25

CLINICAL

+

-

Discount on FFS

Source: Adapted from The Advisory Board


{BUNDLED PAYMENTS.}


26

CLINICAL

+

-

Discount on FFS

Start-UpCosts



{BUNDLED PAYMENTS.}


27

CLINICAL

+

-

Discount on FFS

Start-UpCosts

Process Improvement



{BUNDLED PAYMENTS.}


28

CLINICAL

+

-

Discount on FFS

Start-UpCosts

Process Improvement

Device Management



{BUNDLED PAYMENTS.}


29

CLINICAL

+

-

Discount on FFS

Start-UpCosts

Process Improvement

Device Management


Physician Gainsharing


{BUNDLED PAYMENTS.}


30

CLINICAL

+

-

Discount on FFS

Start-UpCosts

Process Improvement

Device Management



Change in Utilization

Practices on % Of Charge Agreements


{BUNDLED PAYMENTS.}


31

CLINICAL

+

-

Discount on FFS

Start-UpCosts

Process Improvement

Device Management



Change in Utilization

Practices on % Of Charge Agreements

Volumes

32

Questions

DUAL CHAPTER CONFERENCE – HFMA CENTAL OHIO / SOUTHWESTERN OHIODAYTON, OH – SEPTEMBER 25, 2014

Tony ColarossiFHFMAPartnerHealthcare Consulting

{Bundled Payments.}

dual chapter conference – hfma cental ohio / southwestern ohio dayton, oh – september 25, 2014...

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