SPECIALTY HOSPITAL ENGAGEMENT MEETING Friday, April 6, 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: May 4, 2018 **NEW TIME: 3:00pm-4:00pm** For more information, please visit our Hospital Engagement Meeting Page https://www.colorado.gov/pacific/hcpf/hospital-engagement-meetings 4
Budget Neutral Formula Budget Neutral Formula: 𝑈𝑝𝑢𝑏𝑚 𝑒𝑝𝑚𝑚𝑏𝑠𝑡 𝐶1 + (1 − 𝑦)𝐶2 + (1 − 𝑦) 2 𝐶3 + (1 − 𝑦) 3 𝐶4 Total Dollars = Total dollars reimbursed to specific Classification • LTAC Total Reimbursed Dollars • Rehab Total Reimbursed Dollars • Brain/Spine Total Reimbursed Dollars B = Stepdown Bracket x = Percentage of stepdown (decimal form ex. 5% is 0.05) **Note: Budget Neutral to Health First Colorado Reimbursed dollars for FY 2017 (7/1/2016-06/30/2017) not Provider billed amount. 5
Scatterplot for ‘Billed Amount’ Created Scatterplots utilizing ‘Billed Amount’ from Providers • Three (3) scatterplots created: one (1) for each classification 6
Scatterplot for ‘Billed Amount’ (cont.) 7
Scatterplot for ‘Billed Amount’(cont.) 8
Scatterplot of Average per Day (cont.) Created Scatterplots utilizing ‘Cost per Day’ from Provider’s ‘Billed Amount’ • Three (3) scatterplots created: one (1) for each classification • Equation 𝐷𝑚𝑏𝑗𝑛 𝐶𝑗𝑚𝑚𝑓𝑒 𝐵𝑛𝑝𝑣𝑜𝑢 𝐷𝑚𝑏𝑗𝑛 𝑒𝑏𝑧(𝑡) 9
Scatterplot of Average per Day (cont.) 10
Scatterplot of Average per Day (cont.) 11
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Per Diem vs. APR-DRG Examples *Abbreviation Key* B: Bracket ALOS: Average Length of Stay Amt: Amount TMPT: Trimpoint SOI: Severity of Illness LOS: Length of Stay 13
Per Diem vs. APR-DRG Examples 14
Per Diem vs. APR-DRG Examples 15
Per Diem currently under review Components: • Three Classifications: LTAC, Rehabilitation & Spine/Brain Specialist • Four Brackets • Custom Brackets for each Classification • 5% general stepdown 16
Type of Bill Type of bill (TOB) will still be 11X will still be used for billing Reimbursement Profile will be assigned upon new will dictate payment rate not the Type of Bill Interim will still utilize TOB: 112, 113, 114 17
Interim Billing Options ** Psychiatric Hospitals are currently on a per diem and will be included in this part of the rule 18
Provider Type Providers will be required to enroll in a new Provider Type: • The new type will be announced as we get closer to 07/01/2019 • Profile will link Provider to correct classification and correct Per Diem for reimbursement • Working with Policy to request Provider Enrollment Fee waiver 19
Timeline & Deadlines Budget Neutral Per Diem will start July 1, 2019 Timeline: April 20, 2018 – All feedback and input from Providers on per diem due May 4, 2018 – Per diem to move forward for implementation, start State Plan Amendment (SPA) June 15, 2018 – Submit system changes • Allows for testing • Adequate implementation time • Prevent mass adjustments November 1, 2018* – Have SPA submitted May 1, 2019* – All legislation including SPA approved. Announce new Provider type for Providers to enroll for July 1, 2019 *Completed at the latest, hoping to have completed prior to date provided 20
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Onsite Visits **Renewed interest shown by Providers** Purpose: • Meet and Greet • Strengthen relations between State and Specialty Hospitals • Tour Facility • Better understand Client’s visit/journey • Services provided and staff required to provide care • Provide Department with knowledge needed for long term reimbursement options. • Obtain feedback from Providers o Reimbursement ideas o Missing factors/elements in APR-DRG or Per Diem o How can we support our client’s success after leaving the facility o Quality measures align with current goals of both the Department and Providers 22
Onsite Visits Site Visits was a critical influence on decisions made for current Budget Neutral Per Diem and would like to keep the hospitals involved as we begin to look into long term reimbursement options. Goal: Would like to meet with most of the LTACs and Rehabilitations To volunteer for an Onsite Visit please contact Elizabeth Quaife at Elizabeth.quaife@state.co.us 23
Staffing Changes Andrew Larson our CC/CCEC Analyst and Liaison has resigned as of March 16, 2018. Due to staffing changes I will be taking over CC/CCEC Analyst duties. The additional tasks will not affect the timeline for implementation of the Budget Neutral Per Diem as it is currently top priority. 24
Questions and Discussion 25
Elizabeth Quaife Specialty Hospital Rates Analyst Elizabeth.Quaife@state.co.us 26
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