SPECIALTY HOSPITAL ENGAGEMENT MEETING Friday, March 2, 2018 1:00 PM – 2:00 PM Location: The Department of Health Care Policy & Financing, 303 East 17 th Avenue, Denver, CO 80203. 7 th Floor Room A. Conference Line: 1-877-820-7831 Passcode: 294442# For more information contact: Elizabeth Quaife at elizabeth.quaife@state.co.us 1
Welcome & Introductions • Thank you for participating today! • We are counting on your participation to make these meetings successful • We are a small group so we highly encourage logging onto the Conference Line for discussion. Conference Line: 1-877-820-7831 Passcode: 294442# 2
GROUND RULES FOR WEBINAR • WE WILL BE RECORDING THIS WEBINAR • Please speak clearly when asking a question/comment and give your name and hospital • 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 • Be cautious of side conversations and language (we can hear you and it is being recording) 3
Specialty Hospital Meetings Future Meetings: Will be announced via Provider Bulletin, Hospital Engagement Meetings, Hospital Engagement Website and Email Notification. Next Meeting: April 6, 2018 For more information, please visit our Hospital Engagement Meeting Page https://www.colorado.gov/pacific/hcpf/hospital-engagement-meetings 4
Timeline Update Review Meet with other File State Plan Methodology Sections of Amendment and Calculate Department for (SPA) new Per Diem Feedback Budget Neutral Per Diem start goal July 1, 2019 Delay Related to: • System Updates • Calculations missing elements • Per Diems failed Budget Neutral Test 5
Budget Neutral Calculation Changes Initial Per Diem Proposed Step Down Per Diem Rate (based on FY 17): Q1 $ Q2 $ Q3 $ Q4 $ LTAC 0-21 $2,084.02 22-42 $1,979.82 43-77 $1,880.83 78 $1,786.79 REHAB 0-21 $1,082.20 22-42 $1,028.09 43-77 $976.69 78 $927.85 CRAIG 0-21 $3,070.13 22-42 $2,916.62 43-77 $2,770.79 78 $2,632.25 • Over budget by $1,084,959.82 Secondary Per Diem Proposed Step Down Per Diem Rate (based on FY 17): Q1 $ Q2 $ Q3 $ Q4 - starts $ LTAC 0-14 $1,989.29 15-35 $1,889.83 36-63 $1,795.33 64 $1,705.57 REHAB 0-14 $1,032.70 15-21 $981.07 22-35 $932.01 36 $885.41 CRAIG 0-28 $2,930.58 29-63 $2,784.05 64-84 $2,644.85 85 $2,512.61 • Over budget by $346,251.62 6
Budget Neutral Calculation Changes Changes to 2017 Claims with Mass Adjustments Test Total Cases Total Days APR-DRG Total ($) Original Test 2017 1091 16,046 $25,575,963.81 Mass Adj Test 2017 1156 17,462 $26,334,851.92 Difference: 65 1416 $758,888.11 Additional cases & days created from corrections and mass adjustments in the system Previous calculations should not have been affected drastically by new cases. This led to the review of: • Calculation accuracy • Stepdown Bracket methodology • Per diem calculation • Accuracy in data entry and referring calculations 7
Budget Neutral Formula Current Formula: 𝑈𝑝𝑢𝑏𝑚 𝑒𝑝𝑚𝑚𝑏𝑠𝑡 𝑇𝐶1 + (1 − 𝑦)𝑇𝐶2 + (1 − 𝑦) 2 𝑇𝐶3 + (1 − 𝑦) 3 𝑇𝐶4 Total Dollars = Total dollars reimbursed to specific Classification • LTAC Total Reimbursed Dollars • Rehab Total Reimbursed Dollars • Brain/Spine Total Reimbursed Dollars SB = Stepdown Bracket x = Percentage of stepdown (decimal form ex. 5% is 0.95) 8
Consistent Per Diem Elements Three (3) classifications Stepdown Brackets • Long Term Acute Care (LTAC) • Rehabilitations • Spine/Brain Budget Neutral in regards to Reimbursement paid out by HealthFirst Colorado Medicare Crossover Reimbursement: Coinsurance + Deductible 9
Per Diem Elements Under Review 1. Breakdown of stepdown brackets • Bracket days • Revisit individual step downs 2. Consistent or variable stepdown percentages between brackets 3. Verifications Requests of Long Term Stays 4. Interim Billing Rules 10
Questions and Discussion 11
Elizabeth Quaife Specialty Hospital Rates Analyst Elizabeth.Quaife@state.co.us 12
Recommend
More recommend
