FALL WEBINAR

1. FALL WEBINAR

2. LMHPCO FALL WEBINAR WELCOME OUR PRESENATATION WILL BEGIN IN A FEW MINTUES. IF YOU HAVE CALLED IN YOU MAY SEE A 4 DIGIT CODE NEXT TO YOUR NAME ON THE ATTENDEE LIST. PLEASE ENTER THE NUMBER FOLLOWED BY THE #. USING AN IPHONE? PLEASE TOUCH THE KEYPAD ICON ON YOUR PHONE AND ENTER YOUR CODE FOLLOWED BY THE #. A Q& A SESSION WILL FOLLOW THE PRESENTATION. USING THE CHAT ICON LOCATED AT THE TOP UPPER CORNER YOU MAY ENTER YOUR QUESTION. IF YOU REQUIRE ASSISTANCE DURING THE CONFERENCE PRESS *0 AND YOU WILL BE DIRECTLY CONNECTED TO THE OPERATIOR.

3. Medicare 2017 Wage Index Presented by LMHPCO+

4. LMHPCO+ DISCLAIMER The information contained in this presentation is intended for general informational purposes. Participants are encouraged to review this information and adapt to serve their individual purposes.

5. WHAT’S COMING? • CAP YEAR CHANGES TO OCTOBER 1, 2016 THRU SEPTEMBER 30, 2017 • TWO NEW QUALITY MEASURES • CAP AMOUNT FOR 2017 IS $28,404.99

6. AND IN ADDITION • DEVELOPMENT OF HOSPICE COMPARE. • STANDARIZED PATIENT ASSESSEMENT TOOL. • ANALYSIS OF HOSPICE DATA ULTIZATION. • HOSPICE HOSPITAL MARKET BASKET @ 2.1%.

7. CAP YEAR CHANGE • AGGREGATE CAP YEAR WILL ALIGN WITH THE FEDERAL FISCAL YEAR, OCT. 1, 2016-SEPT. 30, 2017. • CAP YEAR CHANGE AFFECTS THE INPATIENT CAP AND THE AGGREGATE CAP.

8. METHODOLOGYOF PAYMENT IS YOUR AGENCY STREAMLINED OR PROPORTIONAL? • FY 2017 IS A TRANSITIONAL YEAR FOR THE CMS HOSPICE CAP METHODOLOGY. • MEDICARE MONIES RECEIVED BETWEEN 11/01/16 THRU 09/30/17 WILL BE CONSIDERED IN CALCULATING THE 2017 CAP.

9. 2017 WAGE INDEX • STREAMLINED AGENCIES WILL COUNT FIRST ELECT HOSPICE PATIENTS BETWEEN SEPTEMBER 28TH, 2016 AND SEPTEMBER 30TH, 2017. • PROPORTIONAL AGENCIES WILL COUNT FIRST ELECT HOSPICE PATIENTS BETWEEN NOVEMBER 1ST, 2016 AND SEPTEMBER 30TH, 2017.

10. AROUND THE CORNER… • CAP DATES FOR STREAMLINED AND PROPORTIONAL METHODS CHANGE AGAIN. • PROVIDERS WILL COUNT FOR FIRST ELECT BENEFICARIES AND RECEIVED MEDICARE MONIES WITHIN THE SAME TIME FRAME. OCTOBER 1, 2017 THRU SEPTEMBER 30, 2018

11. QUALITY MEASURES • CMS IS DEVELOPING A HOSPICE PATIENT ASSESSEMENT TOOL. • UTLIZING DATA COLLECTED FROM THE HIS AND HOSPICE CAHPS SURVEY CMS WILL HOST A MEDICARE HOSPICE COMPARE SITE SOMETIMES IN SPRING/SUMMER OF 2017. • TWO ADDITIONAL QUALITY MEASURES ARE ADDED TO THE CURRENT HQRP EFFECTIVE APRIL 2017.

12. 2017 QUALITY MEASURES HOSPICE VISITS WHEN DEATH IS IMMINENT.

13. TWO MEASURES MEASURE #1 FOCUSES ON CASE MANAGEMENT AND CLINICAL CARE WITHIN THE LAST THREE DAYS OF THE PATIENT’S LIFE. • INDICATOR: PERCENTAGE OF PATIENTS RECEIVING VISITS WHICH ARE MADE BY AN RN, PHYSICIAN, NURSE PRACTITIONER, OR PHYSICIAN’S ASSISTANT.

14. MEASURE #2 GAUGES THE ADAPTABILITY OF THE HOSPICE PROVIDER TO INDIVIUALIZE CARE WHICH ADDRESSES THE PATIENT’S, FAMILY’S , AND CAREGIVER’S PREFERENCES AND GOALS THAT CONTRIBUTE TO OVERALL WELL BEING OF THOSE INVOLVED IN THE PATIENT’S LIFE WITHIN THE PATIENT’S LAST SEVEN DAYS OF LIFE. • INDICATOR: PERCENTAGE OF PATIENTS RECEIVING AT LEAST TWO VISITS FROM THE MEDICAL SOCIAL WORKER, CHAPLAIN OR SPIRITUAL COUNSELOR, OR CNA.

15. COMPOSITE PROCESS ULTIZING THE CURRENT HQRP* CMS WILL CALCULATE EACH PATIENT’S MEASUREMENTS AND AGGREGATE FINDINGS INTO ONE SCORE FOR THE HOSPICE. (*PAIN SCREENING AND ASSESSMENT, DYSPNEA, PATIENTS USING OPIODS WITH A BOWEL REGIMEN, TREATMENT PREFERENCES, AND BELIEFS AND VALUES) • DATA COLLECTION TO BEGIN APRIL 1, 2017. • UNMET COMPLAINCE THRESHOLDS FOR CMS HIS RECORD SUBMISSION WILL BE COSTLY TO THE PROVIDER.

16. HOSPICE HAS A 30 DAY TIME FRAME TO SUBMIT HIS RECORDS. • Calendar Year 2016 70% COMPLIANCE THRESHOLD NON-COMPLIANCE FY 2018* • Calendar Year 2017 80% COMPLIANCE THRESHOLD NON-COMPLIANCE FY 2019* • Calendar Year 2018 90% COMPLIANCE THRESHOLD NON-COMPLIANCE FY 2020* *Provider reimbursement will be financially penalized..

17. HOSPICE COMPARE • HIS AND HOSPICE CAHPS DATA TO BE USED. • CMS WILL REPORT DATA RECEIVED FOR LAST QUARTER 2014 AND FIRST THREE QUARTERS OF 2015. • HOSPICES WITH ESTABLISHED REPORTABLITY OF THE MEASURES, 71% TO 90%, MAY PARTICIPATE IN PUBLIC REPORTING, DEPENDING ON THE MEASURE.* (*Hospices should check for accuracy of their CASPER feedback reports prior to publicly reporting.)

18. MEDICARE. GOV • A CONSUMER MAY FIND HOSPICE CARE @ THE “MEDICARE.GOV “ WEB SITE. • HOSPICES MAY BE LOCATED BY ZIP CODE OR CITY SERVED. • QUALITY MEASURE DATA WILL BE AVAILABLE FOR THE CONSUMER ON ANY PARTICULAR HOSPICE AGENCY.

19. HOSPICE PATIENT ASSESSMENT INSTRUMENT • CMS IS IN THE DEVELOPMENT STAGES OF DESIGNING AN INSTRUMENT TO EVALUATE CONCURRENT PATIENT HOSPICE RECORDS. • THE INSTRUMENT WOULD PROVIDE A “MORE ROBUST DATA COLLECTION” THAT WOULD PROVIDE IN TIME DOCUMENTATION REFLECTIVE OF THE HOLISTIC APPROACH TO END OF LIFE CARE. • FROM THE INSTRUMENT PROVIDERS MAY SEE FURTHER DEVELOPMENT OF QUALITY MEASURES IN THE FUTURE.

20. HOSPICE UTILIZATION • MEDICARE HOSPICE HAS INCREASED FROM 513,000 PATIENTS IN 2000 TO 1.4 MILLION IN 2015. • COSTS FOR THESE TIME PERIODS HAVE INCREASED FROM $2.8 BILLION TO $15.5 BILLION. • THE LEADING HOSPICE DIAGNOSIS AS OF 2015 IS ALZHEIMER’S, FOLLOWED BY CHF, LUNG CANCER, AND COPD. • WITH MOUNTING HOSPICE COSTS HOSPICE PROVIDERS MUST JUSTIFY THE PATIENT’S TERMINAL PROGNOSIS AND RELATED CONDITIONS. • DATA REPORTING TO CMS IS OUR BEST METHOD TO COMMUNICATE TO CMS WHAT WE DO AND HOW WE DO IT.

21. WHAT DOES CMS EXPECT FROM PROVIDERS? • ALL DIAGNOSES BE LISTED ON THE CLAIM FORM, WHETHER RELATED OR UNRELATED. • ACCURATE, ICD-10 CODING VALIDATES YOUR PATIENT’S TERMINALILTY TO CMS. • THE HOSPICE MEDICAL DIRECTOR DEFINES RELATED/UNRELATED HOSPICE DIAGNOSES/CONDITIONS.

22. CMS DATA MONITORING HOSPICE REFORM IS A PART OF THE ACA. CMS CONTINUES TO MONITOR DATA: • PRE HOSPICE SPENDING. • NON-HOSPICE SPENDING. • LIVE HOSPICE DISCHARGE RATES. • SKILLED VISITS IN THE LAST DAYS OF LIFE.

23. LMHPCO+ SUGGESTIONS “QAPI” THE LIVE DISCHARGE RATE • ASTUTE INVESTIGATION OF HIGH LIVE DICHARGE RATES. • DEVELOPMENT OF RESOURCEFUL METHODS AND REVISING AS NEEDED. • ONGOING MONITORING AND FLEXIBITY TO REDRESS APPROACHES. ACKNOWLEDING ABOVE NATIONAL AVERAGE OF LIVE HOSPICE DISCHARGES AND A HOSPICE TAKING ACTION TO REDUCE THEIR AGENCY’S HIGHER THAN NORMAL RATES MAY EFFECTIVE SHOULD CMS/OIG INQUIRE.

24. LMHPCO+ SUGGESTIONS • HOSPICE DOCUMENTATION REFLECTIVE OF THE PATIENT’S LAST FEW DAYS OF LIFE. • HOSPICE CARE PLAN REVISION TO REFLECT SYMPTOM AND PAIN MANAGEMENT, PATIENT AND FAMILY EDUCATION, FREQUENCY OF VISITS INCREASED, ETC. • PROPER REPORTING OF MEDICATIONS USED IN THE LAST FEW DAYS OF LIFE WHEN BILLING. • UPDATING RELATED CONDITIONS (DIAGNOSES) IF APPROPRIATE.

25. FISCAL YEAR 2017 WAGE INDEX • BEGAN OCTOBER 1, 2016. • NEW CBSAs CODES INCLUDING RURAL AREAS. • WAGE INDEX VALUES ARE FOUND AT THE CMS WEBSITE. • AN INCREASE IN HOSPICE RATES OF 2.1%. • HOSPICES WHO FAILED TO SUBMIT QUALITY DATA ARE PENALIZED WITH A REDUCUTION OF MEDICARE MONIES RECEIVED BEGINNNG IN NOVEMBER.

26. CAP SELF REPORTING • CMS REQUIRES PROVIDERS TO SUBMIT THEIR CAP REPORT NO LATER THAN 5 MONTHS AFTER THE CAP YEAR AND NO SOONER THAN 3 MONTHS AFTER THE CAP YEAR CLOSES. • MACs (PALMETTO GBA) WILL ANNOUNCE THE DUE DATE FOR THE REPORTING OF THE SELF CAPS WITHIN THE NEXT FEW MONTHS.

27. LMHPCO+ SUGGESTIONS • ENROLL IN LISTSERV WITH PALMETTO GBA. • UTILIZE YOUR CASPER REPORTING FINDINGS. • STAY IN INFORMED VIA LMHPCO’S UPDATES. • READ THE MONTHLY LMHPCO JOURNAL. • UTILIZE THE BENEFITS OF YOUR LMHPCO MEMBERSHIP. • UTILIZE LMHPCO+

28. LMHPCO+ AFFORDABLE ACCESSIBLE WE TAILOR YOUR OPPORTUNTIES TO YOUR AGENCY’S NEEDS.

29. LMHPCO+ CONSULTANTS ARE LOCAL PEOPLE. CONSULTANTS HAVE SERVED OVER 40+ YEARS IN THE HOSPICE FIELD. CONSULTANTS WELL VERSED IN FEDERAL CoPs AND LA AND MS MINIMUM STANDARDS.

30. LMHPCO+ • YOUR FEEDBACK IS VITAL TO ENSURE LMHPCO IS MEETING THE NEEDS OF OUR MEMBERSHIP. • FEEDBACK CAN BE SUBMITTED TO LMHPCO+ TO ann@lmhpco.org or martha@lmhpco.org. • OR BY CALLING LMHPCO+AT 888-546-1500. CHOOSE OPTION #5 FOR MARTHA OR #6 FOR ANN.

31. LMHPCO+ THANK YOU! ANN MARTHA