Healthcare 360Evaluating Your Operations

From Every Angle

Presented by:

Veronica M. BencivengaDirector

HMM Consulting, a Division of HMM, CPA’s LLPOffice: (631) 265-6289

Mobile: (631) 880-2882vbencivenga@horanmm.com

www.horanmm.com

Intercounty Health Facilities Association

December 1, 2016

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AGENDA Speaking “DATA” Evaluating Your Technology Plan External Evaluation - Current Data Initiatives Industry Developments and Trends

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Speaking “DATA”

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• Medicaid Managed Care

• Value Based Purchasing

• Quality Pools (NHQI)

• Bundling• Shared Savings• DSRIP• Payment

Reform

• Patient Centered Care Coordination

• Clinical Decision Support

• Early Detection of Decline

• Transitions in Care• Care Delivery

• CMS Five-Star • Nursing Home

Quality Measures

• Payment Analytics (Pepper)

• Rehospitalizations

• Performance Monitoring

Data Landscape Today

Your data tells people about you. Managing your data story is critical.

• Five Star Rating• Quality Measures• Length of Stay• Staffing/Turnover• Rehospitalization Rates• Patient Satisfaction• Cost Control

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Managing Your Data Story

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Veronica’s Data Story

This is ME!• 10 - Years at HMM• 23 – Years of experience in

nursing home industry

• 132 - Client engagements

• 117 - Speaking engagements

• 20 – Average hours spent preparing each speaking engagement

• 293 - Connections on LinkedIn (Narrow Network )

This is ME!• 18 - Years happily married

• 3 - Children (Michael-13, Jack-12, Natalie-10)

• 23 – Level on Pokemon Go (Team Valor-Red)

• 260 – Hours volunteered in 2015 for school, church or community activities

• 90,000 – Photos stored on my home server

• 2 – Digital SLR cameras

4Hours

of Sleep

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Clinical and Financial are the

SAME DATAQuality = Payment

Not getting paid for the service, getting paid for the outcome

Clinical and Financial are ONE

The new language of healthcare• Metrics• Numerator• Denominator• Data elements• Cut points• Quintile• Statistics• Root cause

analysis 8

Quality by the Numbers

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Quality by the Numbers

Hospital Readmissions

Finance speaks DATA, hence can help with learning to speak QUALITY• Multi purpose data• Conditional data • Overlapping data• Data from many angles • Different timeframes • CMS Quality Measures

• SNF Value Based Purchasing (VBP)

• SNF Quality Reporting Program (SNF QRP)

You won’t get the right answer if you don’t ask the right question.• Inclusions and Exclusions• Parameters

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Understanding the Reports

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Clinical and Financial are the

SAME DATAQuality = Payment

Not getting paid for the service, getting paid for the outcome

Clinical and Financial are ONE

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Information at risk when clinical and financial software not bi-directionally integrated or using a single database

• Which system's data will you rely on? • Which do you give to the OMIG, RAC, other auditors? • How do you avoid data DRIFT

Information at Risk

Demographic Name, DOB, Social, Medical Record #Financial

Payers - different payers have different requirements Authorizations – All staff need access to this

Census

Usually admission interface only, discharges have to be done independently in both systems

Contacts Emergency and ordering, notes by social workers, etc.Level of Care Clinical determination, changes with condition of patientMDS Missing, corrections, in-activationsDiagnosis

Increasing importance on accuracy and maintenance for payment bundles and staffing (PBJ)

Analytics/Stats

Which system's data will you rely on? Discrepancies will need to be investigated

Data at Risk

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How do we get there?• Evaluate all information streams• Identify barriers• Capture data at the source

whenever possible• Leverage technology

Real-time Data

Examples:• Census• Insurance verification, Eligibility• Costing of a potential patient• Actual staffing

Let it FLO

W!

You can’t keep doing things the same old way• Make purposeful changes• Educate

– Leadership– Staff– Families– Business Partners, Vendors

• Manage Expectations

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How do you change and entire organization?

Old New

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Evaluating YourTechnology Plan

• Every company is a technology company – Fortune 500 CEO Survey - Rapid pace of technological

change is the single biggest challenge facing their companies

– Endless streams of data and growing intelligent algorithms have the potential to transform almost every aspect of nearly every business

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It’s All Connected

• TODAY Every company is a technology company capturing and sharing data– Pizzerias, law enforcement, clothing companies,

MAPMyRUN, religious organizations… and yes SNF’s)

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It’s All Connected

• Success will be defined by your ability to capture, manage interpret and share data

• Software and hardware are your foundation• Do you have a Technology Plan?• Have you really looked at your capital budget with today’s

objectives in mind?• Are you specifically budgeting for:

– Hardware upgrades and replacement– Web enabled medical devices that transfer data to EMR– Advancing adoption of your EMR through advanced training, new

features

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Evaluating your Technology Plan

• Do you understand your EMR vendor’s product road map?

• Do your software vendors have the resources to not only keep up with the changes, but anticipate what’s coming next?

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Evaluating your Technology Plan

EMR is a series of investments whose benefits accumulate over time

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EMR Adoption – Use More, Get More ROI

• You CAN’T do it all at once

• Make a plan to expand EMR use including:– Impact on workflows– Training time and

training resources– Hardware

Schedule an “Optimization Session”• Review software configuration• Identify re-training opportunities• Identify features you are paying for but not

using

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EMR Adoption – Use More, Get More ROI

TIP: For VBP and Receivables management, most SNF’s need to reconfigure their:• Census workflow• Payor set-ups• Levels of care

• Integrated 4.0 Interact tools• Dashboards and Notifications

– Manage by Exception• Analytics

– Report on any combination of measures• All, Survey, Nursing Home Compare, Five-Star

– Results for the QM Numerator, Denominator and Percentage

– Compare to State and National Averages

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Value Added EMR Features – Decision Support

Dashboards allow you to monitor clinical and financial metrics in real time.

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A picture is worth a 1,000 words

Decision Support – Dashboards

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Alerts and Warnings draw attention to potential issues that are time sensitive

BRINGS THE DATA TO YOU• Values out of acceptable parameters

• No bowel movement in 3 days• Temp out of range

• Unusual patterns • Duplicate medications• Decreased inputs and outputs

Decision Support – Managing by Exception

• Availability• Mobility • Displays

• Larger, portable or multiple• Connected Devices

– Nurse Rosie Connect• Telemonitoring

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Hardware and Devices – The Right Fit

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External Evaluation-Current Data

Initiatives

Federal

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State

Payment Quality

Current Quality and Payment Initiatives

• Medicare Advantage• Bundled Payment (Episodes)

• Bundled Payments for Care Improvement (BPCI)

• Comprehensive Care for Joint Replacement (CJR)

• Mandatory Effective April 1, 2016

• SNF Value Based Purchasing • 30-Day All-Cause Readmission

Measure (SNFRM)• NEW: Effective 10/1/2016

12/31/2016 for Fiscal Year 2018

• Five-Star Quality Rating System• Nursing Home Compare

• 5 new measures added July 2016

• Staffing Data Submission PBJ • NEW: Effective 7/1/2016

• SNF Quality Reporting Program (SNF QRP)

• NEW: Effective 10/1/2016 12/31/2016 for Fiscal Year 2018

• Mandatory Medicaid Managed Care for new LTC patients

• Roll out began 2/12015

• Delivery System Reform Incentive Payment (DSRIP)

• VBP Road Map

• Nursing Home Quality Initiative (NHQI)

• Effective 2013 with ongoing methodology changes

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• Improving Medicare Post Acute Transformation Act 2014• Purpose is to compare outcomes across all four post acute care

settings and create longitudinal data• Skilled Nursing Facilities• Home Health Agencies• Inpatient Rehabilitation Facilities• Long Term Care Hospitals

• Implements collection of standardized data using assessments currently required (SNF=MDS, HHA=Oasis, etc.)

• Requires development and implementation of “cross setting” Quality Measures based on standardized data

• Data Collection 10/1/2016-12/31/2016 will be used for rate setting FY 2018

IMPACT Act of 2014

For the first time since PPS started in 1998

your Medicare rates will be different from your neighbor!

Behavior Management• Clinically nuanced insurance coverage

– 2017-2022 CMS will test Value-Based Insurance Design (VBID) in Medicare Advantage and measure whether structuring patient cost sharing and other health plan design elements encourages enrollees to use health care services in a way that improved their health and reduces costs.

• Health score (like a credit score)

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What’s Next?

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Industry Developments

and Trends

I believe this is a result of a disconnect between program mandates such as…mandating payment rates while failing to provide sufficient revenue, constant regulatory changes that add additional administrative burdens and otherwise failing to recognize operational challenges these changes impose

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Sign of Things to Come

““

"There are problems with the state not reimbursing plans to adequately reflect when a plan has a large number of very high cost or high utilizing patients," Gottfried said. "And GuildNet is caught in that squeeze as a lot of plans and providers are."

~ Alan Morse, CEO of GuildNet

SNF’s struggle to quantify the managed care cashflow crisis due to:

• Differences in recordkeeping• Where/how managed care days are combined, level of detail

• Differences in staff skill levels• Differing contract terms for same plan on a provider

by provider basis

Quantifying the “Managed Care Problem”

Questions?

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Thank You

Veronica M. BencivengaOffice (631) 265-6289Mobile (631) 880-2882VBencivenga@horanmm.comwww.horanmm.com

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HMM ConsultingA division of HMM, CPAs LLP

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CMS Quality Measures - 33• 30 Main measures

• 11 Short Stay• 19 Long Stay

• 3 additional “Surveyor Quality Measures”

Surveyor Measures - 17• Available to State surveyors and SNF’s through

CASPER• Subset-17 of the 33 measures

Nursing Home Compare - 18• Publically Available• Compares SNF to State and National averages• Subset-18 of the 30 main measures

• 5 Short Stay• 13 Long Stay

CMS Five-Star Rating - 11• 3 components

• Quality Measures – Subset 11 of the 18 in Nursing Home Compare

• 3 Short Stay• 8 Long Stay

• Health Inspection• Staffing

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#3 – SNF QRP• 30 Day all-cause re-hospitalizations

• New effective 10/1/2016• IMPACT Act 2014• Claims Based

Hospital Readmissions

#1 - Hospital• Hospital Readmissions Reduction

Program• Reported through SPARCS (indirect)

#2 – Five Star• Percent of short stay residents who were

re-hospitalized after a nursing home admission

• New Quality Measure effective 7/27/2016

• Claims Based

#4 – SNF VBP• 30 Day all-cause re-hospitalizations

• Protecting Access to Medicare Act of 2014 (PAMA)

• Claims Based• Year 1 – SNF Readmisson Measure

(SNFRM)• Year 2 – SNF Potentially

Preventable Readmission Measure (SNFPPR)