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Maximizing Quality and Finance for Medicare Success

Explore the critical link between quality and finance in healthcare through Value-based Payments, Hospital-Acquired Conditions Reduction Program and more. Learn about key programs impacting hospitals' payments in Florida. Understand the significance of CMS Star Ratings and their impact on hospital performance.

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Maximizing Quality and Finance for Medicare Success

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  1. Quality and Finance: The Critical Link to Success FHA MTC HIIN Infection Bootcamp May 30-31, 2019

  2. During January 2015, HHS announced goals for value-based payments within the Medicare FFS system

  3. CMS Quality Strategy

  4. Quality-based Payment Reform • Hospital-acquired conditions reduction program* • Value-based purchasing program* • Readmissions reduction program* • Episode payment models (CJR/cardiac) • MACRA quality payment program * Focus of today’s presentation

  5. Hospital-Acquired Conditions Reduction Program

  6. Hospital Acquired Conditions Reduction Program • ACA mandated start in federal FY2015 • 1.0% reduction in IPPS payments for hospitals with highest Total HAC “scores” • Applies to total payment amount • Bottom quartile of hospitals will alwaysreceive a penalty

  7. HAC Reduction Program Measures

  8. HAC Timeframes

  9. HAC Reduction Payment ProvisionsImpact on Florida *estimated Potential Impact: 2019-2028: $203.2 million

  10. Value-Based Purchasing Program

  11. VBP Overview • Transitions hospitals from P4R to P4P • Programself-funded by hospital “contributions” • Began with 1.0 percent reduction in FY2013 • Reduction increased by 0.25 percent each year • 2.0 percent reduction for FY2017 and beyond • Budget-neutral • Redistributive • Best performers win, others break even or lose • VBP payments are netted against contributions

  12. VBP Provisions Impact on Florida *estimated Potential Impact: 2019-2028: $102.3 million

  13. Readmissions Reduction Program

  14. Readmissions Reduction Program • Began FY2013 • Readmissions 30-day post discharge • Based on higher than expected risk-adjusted readmissions rates • Any one of selected conditions • Medicare base payment rate is reduced for every discharge • Maximum payment reduction: 3 percent

  15. Readmissions Program Measures

  16. Impact of Readmission Penalties Florida

  17. STAR RATINGS

  18. First published July 2016 Combination of ~60 quality measures from Hospital Compare from 7 domains Ranges from 1(worst) to 5 (best) CMS delayed 2Q2018 ratings to review methodology Released in Feb 2019 Minor changes Solicited public comment Methodology Inclusion of socio-demographic status adjustment User-friendly tool for consumers Releasing once a year Star Ratings

  19. Star Ratings – Florida vs. National 60 1,263 1,087 40 799 32 28 293 282 9 Source: CMS Hospital Compare February 2019 Release

  20. Know Your Data

  21. Key Reminders For Hospitals • Payment levels are at stake • Historical data will continue to drive these programs • Program targets move with national performance, so hospitals must keep pace with the pack • Complexity of program measures • And other payers base their rates on Medicare….

  22. Questions?

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