HFMA Colorado chapter newsletter, July 2016. While the Comprehensive Care for Joint Replacement (CJR) program is positioned as a “test,” given the infrastructure being put in place by CMS to run the program, CJR is likely just the start of a larger effort by CMS to implement additional mandatory bundled payment programs. Therefore, it’s very important that hospital financial stakeholders become familiar with CJR even if their hospital isn’t currently a participant.
Published January, 2017 - First Illinois Speaks
Author: Maria C. Miranda, FACHE, Director, Emerging Payment Models
Introduction: While the Comprehensive Care for Joint Replacement (CJR) program is positioned as a “test,” given the infrastructure being put in place by the Centers for Medicare and Medicaid Services (CMS) to run the program, CJR is likely just the start of a larger effort by CMS to implement additional mandatory bundled payment programs. Therefore, it’s very important that hospital financial stakeholders become familiar with CJR even if their hospital isn’t currently a participant.
Comparing Regulatory Enforcement of Hospitals and Long-Term Care FacilitiesPolsinelli PC
Hospitals and long-term care share the same regulatory framework: a State license, federal certification to participate in Medicare and Medicaid, and surveys to evaluate compliance and sanction noncompliance. But hospitals and long-term care surveys seem more different than alike. Through deemed status, hospital accreditation plays a larger role than State/CMS surveys. Only a Condition of Participation level deficiency will threaten a hospital's Medicare/Medicaid certification. On the other hand, long-term care is exclusively regulated by State/CMS surveyors, encounters more frequent surveys, and is subject to a range of intermediate sanctions that impose fines and deny Medicare/Medicaid payments during an ongoing survey cycle.
ON OUR AGENDA:
-Compare the hospital and long-term care regulatory process
-Explain the hospital regulatory framework of deemed status, Condition of Participation and Standard level deficiencies, and noncompliance sanctions.
-Explain the long-term care regulatory framework of State/CMS surveys, the concept of a survey cycle, and intermediate sanctions throughout the cycle.
-Explain the State-license only regulation for assisted living facilities
Advisor Live: Proposed Episode Payment Models for AMI, CABG, and Hip and Femu...Premier Inc.
On July 25, 2016, the Centers for Medicare & Medicaid Services (CMS) released a proposed rule to establish three new bundled payment policies for acute myocardial infarction (AMI), coronary artery bypass graft (CABG) and surgical hip and femur fracture treatment (SHFFT). Collectively, the models are referred to as Episode Payment Models (EPMs). The new payment models will be mandatory for hospitals in particular geographic regions.
CMS proposes to test the EPM models for a five-year performance period, beginning July 1, 2017, and ending Dec. 31, 2021. The proposed rule also includes changes to the Comprehensive Care for Joint Replacement Model and proposes to establish an incentive payment to hospitals for coordinating cardiac rehabilitation and intensive cardiac rehabilitation services. CMS is accepting comments on the proposed rule until Oct. 3, 2016.
This webinar provides an overview of the proposed rule, including:
- Background and rationale for new payment models,
- Inclusion and exclusion criteria,
- Payment methodology,
- Quality performance in the payment methodology, and
- Legal waivers.
Published January, 2017 - First Illinois Speaks
Author: Maria C. Miranda, FACHE, Director, Emerging Payment Models
Introduction: While the Comprehensive Care for Joint Replacement (CJR) program is positioned as a “test,” given the infrastructure being put in place by the Centers for Medicare and Medicaid Services (CMS) to run the program, CJR is likely just the start of a larger effort by CMS to implement additional mandatory bundled payment programs. Therefore, it’s very important that hospital financial stakeholders become familiar with CJR even if their hospital isn’t currently a participant.
Comparing Regulatory Enforcement of Hospitals and Long-Term Care FacilitiesPolsinelli PC
Hospitals and long-term care share the same regulatory framework: a State license, federal certification to participate in Medicare and Medicaid, and surveys to evaluate compliance and sanction noncompliance. But hospitals and long-term care surveys seem more different than alike. Through deemed status, hospital accreditation plays a larger role than State/CMS surveys. Only a Condition of Participation level deficiency will threaten a hospital's Medicare/Medicaid certification. On the other hand, long-term care is exclusively regulated by State/CMS surveyors, encounters more frequent surveys, and is subject to a range of intermediate sanctions that impose fines and deny Medicare/Medicaid payments during an ongoing survey cycle.
ON OUR AGENDA:
-Compare the hospital and long-term care regulatory process
-Explain the hospital regulatory framework of deemed status, Condition of Participation and Standard level deficiencies, and noncompliance sanctions.
-Explain the long-term care regulatory framework of State/CMS surveys, the concept of a survey cycle, and intermediate sanctions throughout the cycle.
-Explain the State-license only regulation for assisted living facilities
Advisor Live: Proposed Episode Payment Models for AMI, CABG, and Hip and Femu...Premier Inc.
On July 25, 2016, the Centers for Medicare & Medicaid Services (CMS) released a proposed rule to establish three new bundled payment policies for acute myocardial infarction (AMI), coronary artery bypass graft (CABG) and surgical hip and femur fracture treatment (SHFFT). Collectively, the models are referred to as Episode Payment Models (EPMs). The new payment models will be mandatory for hospitals in particular geographic regions.
CMS proposes to test the EPM models for a five-year performance period, beginning July 1, 2017, and ending Dec. 31, 2021. The proposed rule also includes changes to the Comprehensive Care for Joint Replacement Model and proposes to establish an incentive payment to hospitals for coordinating cardiac rehabilitation and intensive cardiac rehabilitation services. CMS is accepting comments on the proposed rule until Oct. 3, 2016.
This webinar provides an overview of the proposed rule, including:
- Background and rationale for new payment models,
- Inclusion and exclusion criteria,
- Payment methodology,
- Quality performance in the payment methodology, and
- Legal waivers.
The CMS Innovation Center held a Comprehensive Care for Joint Replacement Model webinar on proposed rule changes to the model on September 7, 2016.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
Guide to CMS Comprehensive Care for Joint Replacement modelQ-Centrix
On April 1, the CMS Comprehensive Care for Joint Replacement (CCJR) model went into effect for nearly 800 hospitals in 67 markets nationwide. Essentially, CMS converted its voluntary payment model—Bundled Payment for Care Improvement (BPCI)—into a regulatory mandate that will hold hospitals accountable for spending by all healthcare providers for 90 days following the initial episode of care.
The Bumpy Road Ahead New Challenges Facing PracticesCureMD
Insurance mergers, shift to alternative payment models, Meaningful Use stage 2, preventing data breaches, pressure to consolidate – welcome to 2016.
Your patience is not the only thing at stake when these changes kick in. Your hard earned money will become harder to collect and worse to retain. While we cannot wish these changes away, we can help you fight them.
Key Trends in ASC Valuations: Benchmark and use common valuation methodologiesCBIZ, Inc.
The increase in transaction activity in the health care industry has resulted in increased regulatory scrutiny. Having an accurate valuation is critical for avoiding costly mistakes and maintaining compliance. Learn about these topics and key trends in ASC valuations in this article by Tami Bolder who leads the Valuation & Litigation Advisory practice for CBIZ MHM, LLC.
NYU Langone Medical Center’s TJA BPCI Experience: Lessons in How to Maximize ...Wellbe
The Bundled Payments for Care Improvement (BPCI) Initiative began generating data in January of 2013. Dr. Iorio will outline the challenges and benefits of implementing BPCI for Total Joint Arthroplasty at an urban, tertiary, academic medical center with a hybrid compensation model. Early results from the implementation of a Medicare BPCI Model 2 primary TJA program demonstrate cost-savings with an improvement in quality of care metrics and continued cost savings through year 3 of our experience. Changes in patient optimization, care coordination, clinical care pathways, and evidence-based protocols are the key to improving the quality metrics and cost effectiveness within the implementation of the Bundled Payment for Care Initiative, thus bringing increased value to our TJA patients.
Maximizing Value in a Bundled Environment – Keys to Success:
• Evidence based, cost effectiveness analysis
• Standardized protocol adoption
• Transparent data
• Perioperative Patient Optimization
• Care management
• Physician-hospital alignment with Gain sharing
• Enhanced pain relief and rehabilitation protocols
• Blood management and rational VTED prophylaxis
About the Speaker:
Richard Iorio, MD, is the William and Susan Jaffe Professor of Orthopaedic Surgery at New York University Langone Medical Center Hospital for Joint Diseases and Chief of Adult Reconstruction at NYU Langone HJD. He co-founded Labrador Healthcare Consulting Services, Responsive Risk Solutions, and the Value Based Healthcare Consortium in 2015. He is a member of the Board of Directors for LIMA, the Lifetime Initiative for the Management of Arthritis. Dr. Iorio is a national expert in physician and hospital quality and safety and a leader in the implementation of alternate payment paradigms in orthopaedic surgery.
Advisor Live: Medicare Final Rules on OPPS and MPFSPremier Inc.
The Centers for Medicare & Medicaid Services (CMS) published the outpatient prospective payment system (OPPS) interim final rule and the Medicare physician fee schedule (PFS) final rule on November 1 and 2, 2016. The finalized changes will be effective December 31, 2016. Comments on the OPPS interim final rule are due January 1, 2017.
The CMS Innovation Center held a Comprehensive Care for Joint Replacement Model webinar on proposed rule changes to the model on September 7, 2016.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
Guide to CMS Comprehensive Care for Joint Replacement modelQ-Centrix
On April 1, the CMS Comprehensive Care for Joint Replacement (CCJR) model went into effect for nearly 800 hospitals in 67 markets nationwide. Essentially, CMS converted its voluntary payment model—Bundled Payment for Care Improvement (BPCI)—into a regulatory mandate that will hold hospitals accountable for spending by all healthcare providers for 90 days following the initial episode of care.
The Bumpy Road Ahead New Challenges Facing PracticesCureMD
Insurance mergers, shift to alternative payment models, Meaningful Use stage 2, preventing data breaches, pressure to consolidate – welcome to 2016.
Your patience is not the only thing at stake when these changes kick in. Your hard earned money will become harder to collect and worse to retain. While we cannot wish these changes away, we can help you fight them.
Key Trends in ASC Valuations: Benchmark and use common valuation methodologiesCBIZ, Inc.
The increase in transaction activity in the health care industry has resulted in increased regulatory scrutiny. Having an accurate valuation is critical for avoiding costly mistakes and maintaining compliance. Learn about these topics and key trends in ASC valuations in this article by Tami Bolder who leads the Valuation & Litigation Advisory practice for CBIZ MHM, LLC.
NYU Langone Medical Center’s TJA BPCI Experience: Lessons in How to Maximize ...Wellbe
The Bundled Payments for Care Improvement (BPCI) Initiative began generating data in January of 2013. Dr. Iorio will outline the challenges and benefits of implementing BPCI for Total Joint Arthroplasty at an urban, tertiary, academic medical center with a hybrid compensation model. Early results from the implementation of a Medicare BPCI Model 2 primary TJA program demonstrate cost-savings with an improvement in quality of care metrics and continued cost savings through year 3 of our experience. Changes in patient optimization, care coordination, clinical care pathways, and evidence-based protocols are the key to improving the quality metrics and cost effectiveness within the implementation of the Bundled Payment for Care Initiative, thus bringing increased value to our TJA patients.
Maximizing Value in a Bundled Environment – Keys to Success:
• Evidence based, cost effectiveness analysis
• Standardized protocol adoption
• Transparent data
• Perioperative Patient Optimization
• Care management
• Physician-hospital alignment with Gain sharing
• Enhanced pain relief and rehabilitation protocols
• Blood management and rational VTED prophylaxis
About the Speaker:
Richard Iorio, MD, is the William and Susan Jaffe Professor of Orthopaedic Surgery at New York University Langone Medical Center Hospital for Joint Diseases and Chief of Adult Reconstruction at NYU Langone HJD. He co-founded Labrador Healthcare Consulting Services, Responsive Risk Solutions, and the Value Based Healthcare Consortium in 2015. He is a member of the Board of Directors for LIMA, the Lifetime Initiative for the Management of Arthritis. Dr. Iorio is a national expert in physician and hospital quality and safety and a leader in the implementation of alternate payment paradigms in orthopaedic surgery.
Advisor Live: Medicare Final Rules on OPPS and MPFSPremier Inc.
The Centers for Medicare & Medicaid Services (CMS) published the outpatient prospective payment system (OPPS) interim final rule and the Medicare physician fee schedule (PFS) final rule on November 1 and 2, 2016. The finalized changes will be effective December 31, 2016. Comments on the OPPS interim final rule are due January 1, 2017.
Advisor Live: Hospital Outpatient Prospective Payment System and Physician Fe...Premier Inc.
The Centers for Medicare & Medicaid Services (CMS) published the proposed payment rules on the outpatient prospective payment system (OPPS) and the Medicare physician fee schedule (PFS) on July 14 and 15, 2016. If finalized, the changes generally would be effective Jan. 1, 2017.
This webinar provides an overview of the final rules, with more specific coverage of outpatient PPS and Telehealth services.
Will quality payment program impacting medicare reimbursementsmithjgrace
Medical billing and coding prerequisites are not easy to manage, especially if you are conducting the work through in-house staff. The changing dynamics of the overall medicinal industry demands precision in medical billing and coding without costly errors.
Outsourcing the tedious work via a third-party approach is an excellent consideration that lets physicians and hospitals to concentrate more on the patients and let specialists perform the billing and coding work.
The Center for Medicare & Medicaid Innovation (CMS Innovation Center) hosted a webinar to discuss various aspects of the Advancing Care Coordination through Episode Payment Models (EPMs); Cardiac Incentive Payment Model; and changes to the Comprehensive Care for Joint Replacement Model final rule on Wednesday, February 22, 2017, from 12:00 p.m. – 1:00 p.m. EST. The final rule was displayed at the Federal Register on December 20, 2016 and is effective on February 18, 2017.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
In follow-up to the March 10, 2015 announcement of the Next Generation Accountable Care Organization (ACO) Model of payment and care delivery, the Center for Medicare and Medicaid Innovation (CMS Innovation Center) hosted the first in a series of open door forums focusing on various aspects of the Model.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
Creating a Unified Data Strategy for Risk-Adjusted PaymentsCognizant
Taking a holistic approach to addressing tighter Medicare data requirements and new risk models will help payers optimize data accuracy for risk-adjusted payments as well as improved operations, patient health and regulatory compliance.
2019 outpatient prospective payment system final rule key pointsBESLER
The 2019 Hospital Outpatient Prospective Payment System (OPPS) Final Rule has been issued and changes are on the way that can affect your organization’s Medicare reimbursement.
As part of our commitment to help protect and enhance your Medicare revenue, we’ve developed this expert analysis of the FY 2019 OPPS Final Rule to quickly give you insight into the most important changes.
BESLER remains your trusted advisor and we look forward to helping you identify areas of revenue opportunity for your facility.
In follow-up to the March 10, 2015 announcement of the Next Generation Accountable Care Organization (ACO) Model of payment and care delivery, the Center for Medicare and Medicaid Innovation (CMS Innovation Center) hosted a repeat of the first open door forum in a series focusing on various aspects of the Model.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
MACRA: Restructuring Medicare ReimbursementPaul B. Tripp
Everyone must rethink their approach to the delivery of care. It is no longer a viable option to maintain the fee-for- service (FFS) mindset. New measures from CMS will push healthcare to the next level of reform where the patient is increasingly at the center of care and care payment.
The 2021 Hospital Inpatient Prospective Payment System (IPPS) Final Rule has been issued and changes are on the way that can affect your organization’s Medicare reimbursement. As part of our commitment to help protect and enhance your Medicare revenue, we’ve developed this expert analysis of the FY 2021 IPPS Final Rule to quickly give you insight into the most important changes. BESLER remains your trusted advisor and we look forward to helping you identify areas of revenue opportunity for your facility.
The 2020 Hospital Outpatient Prospective Payment System (OPPS) Final Rule has been issued and changes are on the way that can affect your organization’s Medicare reimbursement.
As part of our commitment to help protect and enhance your Medicare revenue, we’ve developed this expert analysis of the FY 2020 OPPS Final Rule to quickly give you insight into the most important changes.
BESLER remains your trusted advisor and we look forward to helping you identify areas of revenue opportunity for your facility.
Annually, CMS proposes changes to the Inpatient Prospective Payment System (IPPS) rules that can impact how IPPS facilities are reimbursed from Medicare – either positively or negatively.
Proposed updates are posted in April and issued as a final rule in October of each year. Because IPPS hospitals are paid based on Medicare Severity Diagnosis Related Groups (MS-DRG), additions, deletions, or alterations to MS DRGs can affect how hospitals should submit claims to Medicare.
2020 Inpatient Prospective Payment System (IPPS) Final Rule Summary - BESLERBESLER
The 2020 Hospital Inpatient Prospective Payment System (IPPS) Final Rule has been issued and changes are on the way that can affect your organization’s Medicare reimbursement.
As part of our commitment to help protect and enhance your Medicare revenue, we’ve developed this expert analysis of the FY 2020 IPPS Final Rule to quickly give you insight into the most important changes.
Research Report - Insights into Revenue Cycle ManagementBESLER
The findings in this report are based on online research conducted in October 2018 among 102 respondents employed in leadership roles within finance, revenue cycle, reimbursement and HIM in U.S. hospitals and acute-care facilities.
With hospitals and acute-care facilities under increasing pressure to optimize the revenue cycle, BESLER and HIMSS Media conducted a new study to identify the biggest industry challenges and potential opportunities for improvement. The study included over 100 respondents employed in leadership roles within finance, revenue cycle, reimbursement, and health information management (HIM) in U.S. hospitals and acute-care facilities.
2019 inpatient prospective payment system final rule key pointsBESLER
The 2019 Hospital Inpatient Prospective Payment System (IPPS) Final Rule has been issued and changes are on the way that can affect your organization’s Medicare reimbursement.
As part of our commitment to help protect and enhance your Medicare revenue, we’ve developed this expert analysis of the FY 2019 IPPS Final Rule to quickly give you insight into the most important changes.
BESLER Transfer DRG Revenue Recovery Service HFMA Peer Review key findings - 02BESLER
Healthcare Financial Management Association’s (HFMA) Peer Review designation spotlights healthcare products and services that objectively earn top ratings during a thorough evaluation process. Part of the evaluation process prior to designation is surveying the product’s current clients and prospects on a variety of topics that measure quality and effectiveness.
BESLER Transfer DRG Revenue Recovery Service HFMA Peer Review key findingsBESLER
Healthcare Financial Management Association’s (HFMA) Peer Review designation spotlights healthcare products and services that objectively earn top ratings during a thorough evaluation process. Part of the evaluation process prior to designation is surveying the product’s current clients and prospects on a variety of topics that measure quality and effectiveness.
Creating A New Mindset - Fully Embracing Revenue IntegrityBESLER
Revenue Integrity is an exciting addition to the existing healthcare revenue cycle process. Revenue Integrity brings together a holistic focus on our responsibility to ensure appropriate billing and compliance in all financial aspects of healthcare.
Revenue Integrity has ushered in an elevated level of awareness to healthcare financial organizations along with improved healthcare delivery.
Although, Revenue Integrity is still fairly new, it has proven to be a catalyst for change both in the financial and clinical functions of hospitals and doctors’ offices.
We Turn and Face the Changes - The S-10 Emerges as a Proxy for PaymentBESLER
The Federal Fiscal Year 2017 Hospital Inpatient Prospective Payment System (IPPS) final rule issued a postponement for using data from Worksheet S-10 of the Medicare cost report to determine Medicare Disproportionate Share Uncompensated Care payments.The Centers for Medicare and Medicaid Services originally intended to incorporate WS S-10 in the methodology beginning next October (FFY 2018). However, due to copious and thoughtful observations from commenters, CMS has again put WS S-10 on hold while a number of issues surrounding fairness, consistency and accuracy are deliberated. The hospital community will be engaged in future rulemaking and CMS anticipates WS S-10 will be used for UC payments no later than FFY 2021 (using WS S-10 from cost reports beginning in FFY 2017).So join us as we take a look at the S-10’s key issues and what could have been if the S-10 was employed to determine UC payments sooner rather than later.
Electronic health record (EHR) implementations can be operationally invasive and can have significant financial implications. Organizations may see a reduction in net revenue, an increase in accounts receivable days and a slowdown in cash collections. With several NJ providers in the process of moving to an Epic HIS and EHR environment, preserving net revenue, maintaining consistent cash and ensuring accurate financial reporting should be among the provider’s primary conversion goals. We have worked with several providers throughout the country who have undergone a recent Epic conversion and thought it would be beneficial to share conversion lessons learned from these providers. A consistent phrase in the Epic conversion world is ”Big Bang,” indicating that every module that’s been purchased is implemented at the same time. The conversion timeline is an eighteen month journey and has been described as a conversion like no other. More and more providers are moving towards the “Single Billing Office” (SBO) solution, meaning hospital, physician and potentially other entities such as home health appear on a single statement. This alone is a significant change for hospital providers.
Healthcare Retrospect Part 3: Achieving The Triple AimBESLER
In part three of this three part series, John Dalton, Advisor Emeritus at BESLER Consulting, discusses the effects of the PPACA and the path towards achieving the triple aim.
Healthcare Retrospect Part 2: Skyrocketing Costs and the Emergence of Rate S...BESLER
In part two of this three part series, John Dalton, Advisor Emeritus at BESLER Consulting, provides a look at the state of healthcare in America from the 1960s through the 1990s.
Healthcare Retrospect Part 1: All Americans Were UninsuredBESLER
In part one of this three part series, John Dalton, Advisor Emeritus at BESLER Consulting, provides a look at the state of healthcare in America from the 1930s through the 1960s.
Uncertain future of medicare pass throughs and add-onsBESLER
Very few items are still settled on your cost report. With so many changes resulting from the ACA and other potential initiatives being discussed every day, your organization should be acutely aware of the total amount of Medicare Revenue that is at risk. There is talk of eliminating, greatly reducing or completely altering payment methodologies that hospitals have become so reliant on for so long. Revenue potentially at risk includes Medicare Bad Debt, Nursing Allied Health, Graduate Medical Education, Wage Index adjustments, and Transplant.
The benefits of revenue cycle and compliance collaborationBESLER
This presentation highlights the importance of the working relationship between hospital Revenue Cycle and Compliance teams. This complimentary partnership can become seamless by utilizing the data analytics obtained from 835 and 837 data sets, Return to Provider (RTP), CERTs, Readmissions, ZPICs, HACs, RACs and Transfer DRGs. The combination of this data can assist in quickly identifying and resolving issues prior to provider submission, reducing days in AR and improving cash in the door.
One of the most developed cities of India, the city of Chennai is the capital of Tamilnadu and many people from different parts of India come here to earn their bread and butter. Being a metropolitan, the city is filled with towering building and beaches but the sad part as with almost every Indian city
Empowering ACOs: Leveraging Quality Management Tools for MIPS and BeyondHealth Catalyst
Join us as we delve into the crucial realm of quality reporting for MSSP (Medicare Shared Savings Program) Accountable Care Organizations (ACOs).
In this session, we will explore how a robust quality management solution can empower your organization to meet regulatory requirements and improve processes for MIPS reporting and internal quality programs. Learn how our MeasureAble application enables compliance and fosters continuous improvement.
CRISPR-Cas9, a revolutionary gene-editing tool, holds immense potential to reshape medicine, agriculture, and our understanding of life. But like any powerful tool, it comes with ethical considerations.
Unveiling CRISPR: This naturally occurring bacterial defense system (crRNA & Cas9 protein) fights viruses. Scientists repurposed it for precise gene editing (correction, deletion, insertion) by targeting specific DNA sequences.
The Promise: CRISPR offers exciting possibilities:
Gene Therapy: Correcting genetic diseases like cystic fibrosis.
Agriculture: Engineering crops resistant to pests and harsh environments.
Research: Studying gene function to unlock new knowledge.
The Peril: Ethical concerns demand attention:
Off-target Effects: Unintended DNA edits can have unforeseen consequences.
Eugenics: Misusing CRISPR for designer babies raises social and ethical questions.
Equity: High costs could limit access to this potentially life-saving technology.
The Path Forward: Responsible development is crucial:
International Collaboration: Clear guidelines are needed for research and human trials.
Public Education: Open discussions ensure informed decisions about CRISPR.
Prioritize Safety and Ethics: Safety and ethical principles must be paramount.
CRISPR offers a powerful tool for a better future, but responsible development and addressing ethical concerns are essential. By prioritizing safety, fostering open dialogue, and ensuring equitable access, we can harness CRISPR's power for the benefit of all. (2998 characters)
Telehealth Psychology Building Trust with Clients.pptxThe Harvest Clinic
Telehealth psychology is a digital approach that offers psychological services and mental health care to clients remotely, using technologies like video conferencing, phone calls, text messaging, and mobile apps for communication.
The dimensions of healthcare quality refer to various attributes or aspects that define the standard of healthcare services. These dimensions are used to evaluate, measure, and improve the quality of care provided to patients. A comprehensive understanding of these dimensions ensures that healthcare systems can address various aspects of patient care effectively and holistically. Dimensions of Healthcare Quality and Performance of care include the following; Appropriateness, Availability, Competence, Continuity, Effectiveness, Efficiency, Efficacy, Prevention, Respect and Care, Safety as well as Timeliness.
1. FIRST QUARTER | JULY 2016
PEAKS & plainsHFMA COLORADO CHAPTER
INSIDE THIS ISSUE
PRESIDENT’S MESSAGE
CHERYL CURRY p. 2
MEMBER SPOTLIGHT
KIM DAVIS p. 5
GREAT FALL RETREATp. 7
PROVIDER
SPOTLIGHT
SCL HEALTH | ST. JOSEPH
HOSPITAL p. 12
WIN PRIZES IN OUR
CHAPTER CONTESTS!
like us on facebook or
submit a cover photo p.4
The Essential Elements of
Comprehensive Care for Joint
Replacement (CJR) p. 7
MARY MIRABELLI ROLLS OUT
THE NEW 2016/2017 THEME p.3
KEYS TO COLLECTING
IN THE AGE OF PATIENT
CONSUMERISM
p. 16
CHA UPDATE
p. 20
10THOUGHTS ABOUT
LEADERSHIP p. 23
COMMITTEE CORNER
p. 24
4
2. PAGE | 8
INTRODUCTION
While the Comprehensive Care for Joint Replacement (CJR)
program is positioned as a “test,” given the infrastructure
being put in place by CMS to run the program, CJR is
likely just the start of a larger effort by CMS to implement
additional mandatory bundled payment programs. Therefore,
it’s very important that hospital financial stakeholders become
familiar with CJR even if their hospital isn’t currently a
participant.
PROGRAM SUMMARY
The Comprehensive Care for Joint Replacement (CJR)
bundled payment model is effective April 1, 2016 and is
set to continue through five performance periods ending on
December 31, 2020. CMS is implementing this model via its
authority under section 1115A of the Social Security Act as
modified by Section 3021 of the Affordable Care Act, which
established the Center for Medicare and Medicaid Innovation
(CMMI). CMMI was created to test new payment and
service delivery models with the goals of reducing CMS
program expenditures while maintaining or improving
outcomes.
CJR will test a new bundled payment model for inpatient
lower extremity (i.e. hip and knee) joint replacements.
Unlike voluntary programs such as BPCI, with few exceptions
participation in CJR is mandatory for hospitals in 67 selected
MSAs.
CJR EPISODES
A CJR episode starts with admission of an eligible beneficiary
for an LEJR procedure ultimately discharged under one of
the following two MS-DRGs:
■■ MS-DRG 469: Major Joint Replacement or Reattachment
of Lower Extremity with MCC
■■ MS-DRG 470: Major Joint Replacement or Reattach-
ment of Lower Extremity without MCC
CMS refers to these two MS-DRGs as “anchor MS-DRGs.”
The episode also includes all related Medicare Part A and Part
B care for 90 days after discharge. This includes additional
hospital stays, care received at SNFs and other post-acute
providers, physician visits, physical therapy, etc. unless the
provided service is on a CMS exclusion list.
The day of discharge counts as the first day of the 90 day
post-discharge period.
CMS will exclude subsequent unrelated hospital stays from
the episode based on MS-DRG. Similarly, CMS will identify
unrelated outpatient care based on ICD-9 / ICD-10 code.
CMS will update the lists for both exclusion types on an
annual basis, at a minimum, during the CJR program. The
exclusions will apply to the calculation of both target prices
and episode spending.
WhetheryouareaCJRparticipantorplanningforit,understandingyourexposure
and strategic position is key to success in this new era of mandatory bundled
payment models.
BESLER’s CJR Analysis & Risk Assessment service examines the drivers that
impact bundled payment success for you and identifies key performance
indicators and risk factors including:
· Target price analysis, discharge trends, provider utilization and readmissions
· Analysis of quality measures including HCAHPS and complication rates
· Post-acute care summary and identification of potential collaborators
· Quarterly data analysis and year-end reconciliation
(877) 4BESLER | www.besler.com | @BeslerDotCom
Enhancing and protecting Medicare revenue for hospitals
Visit besler.com/CJR to download a Special Report that explains how
CJR works and what your responsibilities are in this new environment.
Are you ready for CJR?
THE
ESSENTIAL
ELEMENTS OF
CJR
By Jim Hoffman, COO, BESLER
Consulting
3. plainsPEAKS FIRST QUARTER 2016-2017 | JULY
&
TARGET PRICES
CMS uses three years of historical data to set target prices.
The historical data will be updated every other year during
the program. Both hospital-specific and regional data is used.
Regional pricing is included in the calculations to provide
gainsharing opportunities for hospitals that are already
well-performing.
CMS will provide hospitals with a number of target prices
for each performance year, segmented by MS-DRG, presence
of hip fracture and submission of optional quality data. In
addition, since CMS will normalize prices based on various
IPPS and OPPS program changes (which go into effect on
10/1 and 1/1 of each calendar year, respectively), CMS will
further distinguish target prices for episodes initiated between
January 1 and September 30 vs. episodes initiated between
October 1 and December 31.
CMS applies a discount factor to the target prices, which
is Medicare’s portion of the reduced expenditures from the
CJR episodes.
EPISODE SPENDING
CMS calculates the spending for an episode by summing
payments for qualified hospitalizations under MS-DRG 469
and 470 and all subsequent related Part A and Part B care
for 90 days post-discharge.
QUALITY MEASURES
CMS is implementing a composite quality score to determine
eligibility for reconciliation payments and to potentially
reduce the discount factor applied to episode spending when
determining the amount of repayment or reconciliation
payment.
The composite quality score is based on three weighted
measures:
■■ Hospital-level risk-standardized complication rate follow-
ing elective primary total hip arthroplasty (THA) and / or
total knee arthroplasty (TKA)
■■ Hospital Consumer Assessment of Healthcare Providers
and Systems (HCAHPS) Survey
■■ THA/TKA voluntary patient-reported outcome and lim-
ited risk variable data submission
RECONCILING PAYMENTS
After each CJR performance year, CMS will perform
a retrospective reconciliation of CJR episode spending
compared to the target prices by calculating the Net Payment
Reconciliation Amount (NPRA). The NPRA is the sum of
the amounts above and below the target price for each CJR
episode in the performance period.
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ELEMENTS OF CJR (continued)
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If the final NPRA is below zero, that amount is paid to the
hospital as a “reconciliation payment” as long as the hospital
meets a minimum composite quality score. If the NPRA is
above zero, that amount is owed to CMS by the hospital as
a “repayment amount.”
Hospitals will not be responsible for any repayment
amount due for the first performance year, but may earn
reconciliation payments for all performance years.
DATA SHARING
CMS will provide detailed and summary claim and payment
data related to CJR episodes to participant hospitals so that
they may better understand their target price calculations and
operational performance and identify areas for improvement.
FINANCIAL AGREEMENTS WITH OTHER
PROVIDERS
Since CMS considers care coordination critical for successful
LEJR outcomes, they are allowing CJR hospitals to establish
risk-sharing and gain-sharing relationships (“sharing
arrangements” described in “collaborator agreements”) with
other providers (“CJR collaborators”).
When risk-sharing payments are made to a hospital by a CJR
collaborator, CMS refers to the payment as an “alignment
payment.” A hospital that shares a reconciliation payment
with a CJR collaborator makes a insharing payment.”
ELEMENTS OF CJR (continued)
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&
WAIVERS
In order to make the implementation
and operation of the CJR program more
efficient and potentially more effective,
CMS is introducing a number of program
waivers related to home health visits,
telehealth and the SNF 3-Day Rule.
CONCLUSION
Providers should be working now to
proactively identify areas of risk under
CJR and put a program in place that
measures their ongoing performance.
A special report is available at besler.com/
cjr that further explains how CJR works
and expands on the responsibilities of
participating providers.
ABOUT THE AUTHOR
Jim Hoffman serves as COO at BESLER
Consulting, where his responsibilities
include sales, marketing, finance, IT and
service operations.
He brings over 25 years of technology
and operations experience to BESLER,
having previously held executive positions
at MedAssets, Accuro Healthcare and
Innovative Health Solutions. Jim is a
graduate of the University of Virginia.
ELEMENTS OF CJR (continued)