vbp, qrp, rop, oig=omg! - achca.memberclicks.net · vbp, qrp, rop, oig=omg! lisa thomson chief...

3/1/2019

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This document is for general informational purposes only.

It does not represent legal advice nor relied upon as supporting documentation or advice with CMS or other regulatory entities.

© Pathway Health Services, Inc. – All Rights Reserved – Copy with Permission Only - 2019

Consulting | Talent | Training | Resources

VBP, QRP, RoP, OIG=OMG!

Lisa ThomsonChief Strategy and Marketing Officer

www.pathwayhealth.com








Disclosure of Commercial Interests

I have commercial interests in the following organization(s): Pathway Health Services

List the Name of Your Employer: -Lisa Thomson -Pathway Health Services

Pathway Health is a professional management and consulting organization serving clients in the long-term and post-acute care industry.








Objectives

• Define key health care initiatives affecting skilled nursing facilities

• Identify key leadership “need to know” specifics to assist in

prioritizing actions needed for success

• Identify key action steps for action plan formulation in

coordination with operational strategic vision

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Industry

Landscape

Rapid Pace . Change . Priorities.




VBP, QRP, RoP, OIG

Internal/External

Post-Acute Care Landscape 01

02 03

04

Regulatory

2019 and Beyond

Reimbursement and

Outcomes 2019 and Beyond

External

Oversight

Trends and Expectations

Quality

Measurement

Challenges and

Expectations

Challenges and Opportunities © Pathway Health Services, Inc. – All Rights Reserved – Copy with Permission Only - 2019





Regulatory RoP

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ROP/COP

• Skilled Nursing

• Home Care

• Inpatient Rehabilitation

Facilities

• Acute Care (IPPS)

• Practitioner

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Skilled Nursing

Affordable Care Act*

IMPACT Act*

Protecting Access to

Medicare Act (PAMA)*

Value-Based Purchasing

(VBP)*

Quality Reporting Program (QRP)*

Requirements of Participation

National Quality Strategy*

Medicaid Reform*

* Now Financial Implications








Emergency Preparedness

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Ph

ase

1 Resident Rights

Facility Responsibilities

Abuse

Advance Directives

Admission, Transfer Discharge

Grievance

Resident Assessment

Care Planning – Person Centered

Physician Services

Nursing Services - Staffing

Pharmacy Services

Dental

Lab, diagnostics

Food and Nutrition

Specialized rehabilitation

QAPI Committee

Infection Control – Program

Physical Environment

Ph

ase

2 Resident Rights - Contacts

Abuse - Reporting Crimes

Transfer/Discharge Documentation

Base Line Care Plan

Nursing staffing and FA

Facility Resource Assessment

Competencies and Skills

Behavioral Health Services

Pharmacy – Chart review

Dental – Dentures

Food and Nutrition – Link to FA, RD, DSM

Ethnic, Cultural and Religious preferences

Antibiotic Stewardship

QAPI Pan

Smoking P

has

e 3

Care Plan – cultural competent and TI

Cultural Competence

Trauma Informed Care

Sufficient and Competent Staff – FA

Governing Body

QAPI – full implementation

Infection Preventionist

Compliance and Ethics

Physical Environment – Call Light

Training Requirements

Facility Training Program

Phase 3

11/28/19

Phase 2

11/28/17

Phase l 11/28/16








F659: Comprehensive Care Plans that are culturally-competent and trauma-informed

F699: Trauma-informed Care

F741: Sufficient and Competent Staff, FWRA, PTSD and/or trauma

F837: Governing Body-QAPI

F865: QAPI implementation

F866: QAPI Program Feedback, Data Systems and Monitoring

F867: QAPI Program Systematic Analysis and Systemic Action

F868: Infection Preventionist involvement in the QAA

F882: Requirements for the Infection Preventionist

F895: Compliance and Ethics Program

F919: Resident Call System

F926, F940, F941, F942, F944, F945, F947, F949: Training Requirements





Value Based Purchasing SNF VBP and More!

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© Pathway Health Services, Inc. – All Rights Reserved – Copy with Permission Only - 20193/1/2019




Focus on Readmissions

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VBP Timeline Started with PAMA 2014

Protecting Access to Medicare Act

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VBP: SNFRMSkilled Nursing Facility Readmission Measure (SNFRM) NQF #2510: All-Cause Risk-Standardized Readmission Measure








Medicare FFS Payment Risks2% automatic “Cut” Started 10/1/2018• 60% of the amount withheld

(the 2%) will be given back as quality incentive payments to those facilities that have better SNFRM

• Performance ScoresAchievement or Improvement








Top Ten

Discharge

Diagnoses to

PAC

SNF PPR ??

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Total hip/knee joint replacement

Septicemia or severe sepsis

Heart failure and shock

StrokeSimple pneumonia

and pleurisy

Renal failure

Kidney and urinary tract infection

Chronic obstructive pulmonary disease

Hip and femur procedure except

major joint

Cellulitis

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© Pathway Health Services, Inc. – All Rights Reserved – Copy with Permission Only - 20193/1/2019 Skilled Nursing – VBP, APMs, and Commercial Products and More








Challenges

ALOSContracting

RatesOutliers

ReadmissionsVBP for Med Adv

NEW Five Star





Quality Reporting ProgramSNF QRP

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SNF Quality Measures

SNF

QM

s

Information

CASPER

Nursing Home Compare

5 Star

Survey

Reimbursement

QRP

VBP








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CMS Moves from Payor to

Buyer

Providers must submit all data necessary to

calculate SNF QRP measures on at least 80%

of the MDS assessments submitted to be in

compliance with FY 2019 SNF QRP

requirements.

SNFs that do not submit the required QRP

data are subject to a 2% reduction in Medicare

payments for the year.

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Financial Impact

2% - SNFVBP

+

2% - SNFQRP

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OIGExternal Oversight















VBP

QRP

RoP

OIG

OMG!

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LeadershipStrategies for Success




Knowledge and Understanding

Assess Readiness for Change – Clinical &

Operations

Organization DataPrioritize & Plan

Educate

Team CollaborationMonitor

QAPI

Prepare Plan Implement








Prepare

Knowledge and

Understanding –

RoP Phase 3

Other Programs -

handout

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Prepare

Readiness

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https://www.hrsa.gov/sites/default/files/quality/toolbox/508pdfs/readinessassessment.pdf








Plan - Data

SNF VBP Review and Correct

Confidential

Feedback

SNF QRP Review and Correct

Confidential

Feedback

CASPER QM Reports

3/1/2019

MDS Process

Medicare & UB-04 Process

Data

Knowledge








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Check Validation Reports after each submission for error warning codes:

389739073908








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Confidential Feedback

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Plan

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https://www.youtube.com/watch?v=H1KNTTEpDXw&feature=youtu.be

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https://www.youtube.com/watch?v=H1KNTTEpDXw&feature=youtu.be

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Plan – Prioritize

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Implement – Team

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Implement – Monitor

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“The goal is not to be perfect by

the end. The goal is to be better

tomorrow.

-Simon SinekAuthor and Leadership Motivational

Speaker







© Pathway Health Services, Inc. – All Rights Reserved – Copy with Permission Only - 20193/1/2019 Thank You!





VBP, QRP, RoP, OIG=OMG!

Lisa ThomsonChief Strategy and Marketing Officer

www.pathwayhealth.com

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“This presentation provided is copyrighted information of Pathway Health. Please note

the presentation date on the title page in relation to the need to verify any new updates

and resources that were listed in this presentation. This presentation is intended to be

informational. The information does not constitute either legal or professional

consultation. This presentation is not to be sold or reused without written authorization of

Pathway Health.”

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