Estimation of Standardized Hospital. Costs from Claims Data that Reflect Resource Requirements for Care

Size: px
Start display at page:

Download "Estimation of Standardized Hospital. Costs from Claims Data that Reflect Resource Requirements for Care"

Transcription

1 Estimation of Standardized Hospital 1 Costs from Claims Data that Reflect Resource Requirements for Care JOHN T. SCHOUSBOE, MD, PHD 1,2 MISTI L. PAUDEL MPH 3 BRENT C. TAYLOR, PHD, MPH 3,4 LIH-WEN MAH, PHD, MPH 5 BETH A. VIRNIG, PHD, MPH 2 KRISTINE E. ENSRUD, MD, MPH 3,4,6 BRYAN E. DOWD, PHD 2 1 PARK NICOLLET INSTITUTE FOR RESEARCH & EDUCATION 2 DIVISION OF HEALTH POLICY AND MANAGEMENT, UNIVERSITY OF MINNESOTA 3 DIVISION OF EPIDEMIOLOGY, UNIVERSITY OF MINNESOTA 4 CHRONIC DISEASE OUTCOMES RESEARCH, MINNEAPOLIS VAMC 5 CHRONIC DISEASE RESEARCH GROUP, MINNEAPOLIS, MN 6 DEPARTMENT OF MEDICINE, UNIVERSITY OF MINNESOTA

2 Disclosures 2 None

3 Agenda 3 Demonstrate a DRG-weight based method to estimate standardized costs of hospital care for prospective cohort studies linked to Medicare claims Describe rationale for DRG-weight based method Compare Medicare payments to hospital providers with standardized cost estimates of patient care 795 participants in Study of Osteoporotic Fractures (SOF) who had a hip fracture 1/1/1992 through 12/31/2009 Is this method applicable for cost studies across different hospital providers (e.g., HMORN members)?

4 Background 4 $0 $50,000 $100,000 $150,000 Total Costs One Year Post Hip Fracture Variation in Health Care Costs is only partially explained Cost Predictors Health care system structure Socioeconomic milieu Individual characteristics Prospective cohort studies merged w/ Medicare Claims Data to study individual predictors of health care costs Patient self-report health status & other variables Mental status Physical performance capability Biomarkers

5 True Resource Estimates Required 5 for Care Medicare payments to providers often used to estimate costs of care Medicare strives to base reimbursement on true resource costs required to care Hospital cost reports provide detailed resource utilization to Medicare Detailed data on local labor and capital costs Under Prospective Payment System, standard base payment for hospital stays established each fiscal year Diagnosis Related Group (DRG) weights are assigned based on; Constellation of patient discharge diagnoses & procedures required during hospital stay Relative resource costs required based on patient medical and surgical acuity

6 Challenges of Using Medicare to Estimate Resource Costs for Cohort-Claims linked Data Medicare payments are adjusted for geographic variation in labor and capital input prices Cohort studies recruit from limited geographic regions of the United States How do we generalize to the entire country? Medicare pays extra to hospitals for; Passthru payments for direct medical education and bad debts Additional teaching responsibilities (Indirect Medical Education, IME) With higher proportion of indigent patients (Disproportionate Share Payments, DSH) These may not be relevant to estimated associations of individual characteristics with true resource costs required for inpatient care 6

7 Challenges of Using Medicare to Estimate Resource Costs for Cohort-Claims linked Data Cohort studies follow patients over many years DRG codes change over time Payment policies change over time Cost inflation Some hospitals not paid according to Prospective Payment System Hospitals in State of Maryland Critical access hospitals How do we make cost estimates for non-pps stays comparable to cost estimates for PPS stays? Need to account for outlier stays Extra long outlier stays due to circumstances not captured in the DRG weight Extra short stays where patient is transferred to another hospital or skilled nursing facility 7

8 Medicare Hospital Payment & 8 Proposed DRG-Weight Based Method: Payments to Providers Under Prospective Payment System (PPS) Standard_Amount GEO_ADJUSTED *DRG WEIGHT + outlier payment + IME + DSH + Passthru Standardized Payments Standard Amount UNADJUSTED *DRG WEIGHT + outlier payment

9 Proposed Method: Standardized 9 Costs for Extra Short Stays + Transfer to another Facility Daily_amount UNADJUSTED = Standard_Amount UNADJUSTED *DRG WEIGHT /Geo_Mean_LOS Total standardized cost of extra short stay plus transfer to another facility = 2*Daily_amount UNADJUSTED + (LOS-1)*Daily_amount UNADJUSTED + outlier payment

10 Research Question 10 How do Standardized Costs compare to cost estimates based solely on MedPAR payment variables? Is the rank order of inpatient costs the same for standardized costs as for cost estimates based on MedPAR? Each hospital stay as unit of analysis Total inpatient costs for one year after hip fracture with individual as unit of analysis Study population: 795 individuals who had 1,397 hospitalizations for one year following hip fracture Incident hip fracture (hospital discharge diagnosis of 820.0x or ) Enrollment in Medicare Fee for Service Part A for 1 year after hip fracture (or until death)

11 Merged Dataset: Study of Osteoporotic Fractures and Medicare Claims 11 9,704 women recruited at four geographic sites in the United States Study visits every 2 to 4 years for active surviving participants through 2006 to 2008 Medicare claims successfully matched for 92% of participants surviving and still enrolled in the cohort as of 1/1/1991

12 Methods Cost estimates based on MedPAR Payment variables Medicare hospital payment (includes IME, DSH, passthru, outliers adjustments) Deductible and co-insurance amounts Standard cost estimates DRG weights & geometric mean length of stay (LOS) for each DRG for each year from Medicare tables on CMS website Standard base hospital payment amounts for each fiscal year (Standard_amount UNADJUSTED ) from Federal Register From MedPAR: DRG assigned to hospital stay Outlier payments LOS for each hospitalization Discharge to another facility 12

13 Results: Number Admissions Year After 13 Proportion of SOF Participnts with Hip Fracture* Number of Hospital Admissions Year after Hip Fracture^ Hip Fracture ^ Includes acute hospital stay to surgically treat hip fracture

14 Characteristic State of Hospital Stay: Maryland Pennsylvania Minnesota Florida Oregon Other* Paid Under Prospective Payment System (n=845) & 0 (0%) 456 (53.8%) 191 (22.5%) 38 (4.5%) 30 (3.5%) 133 (15.7%) NOT Paid Under Prospective Payment System (n=552) & 541 (97.3%) 6 (1.1%) 7 (1.3%) 1 (0.2) 0 (0.0%) 1 (0.2%) Number (%) with IME payments 338 (39.9%) 0 (0%) Number (%) with DSH payments 328 (38.7%) 0 (0%) Number (%) w/ Outlier payments 9 (1.1%) 0 (0%) Number (%) with Pass Thru payments 622 (73.3%) 2 (0.4%) Proportion with Extra Short Stay^ & Transfer to 206 (24.3%) 134 (24.1%) Another Facility^^ Estimated Cost (SD), MedPAR Payment $10,414 (5,674) $12,623 (8,099) Variables Estimated Cost (SD), DRG weight based $9,403 (4,945) $8,903 (3,685) 14

15 Standard Cost Estimates vs. Costs Based on MedPAR Payment Variables 15 Panel A: 845 Stays Paid Under PPS Panel B: All 1,397 Hospitql Stays Cost Calculated from MedPAR Cost Variables* $100,000 $80,000 $60,000 $40,000 $20,000 $0 $0 $20,000 $40,000 $60,000 $80,000 $100,000 Costs Calculated from Standard Base Amounts & DRG Weights* Cost Calculated from MedPAR Cost Variables* $100,000 $80,000 $60,000 $40,000 $20,000 $0 $0 $20,000 $40,000 $60,000 $80,000 $100,000 Cost Calculated from Standard Base Amounts & DRG Weights* *2010 U.S. Dollars Source of Hospital Stay Cost Estimates MedPAR Payment Variables Standard Base Amounts & DRG Weights *2010 U.S. Dollars Source of Hospital Stay Cost Estimates MedPAR Payment Variables Standard Base Amounts & DRG Weights **Spearman Rank Correlation 0.85 Spearman Rank Correlation 0.71** Spearman Correlation: 0.85 Spearman Correlation: 0.71

16 Change of Quintile Using Standardized Costs vs. MedPAR Payment Variables 16 Panel A: 1,397 Hospital Stays Panel B: Costs over 1 year (795 women ) 50% 50% Percentage of Acute Hospital Stays 40% 30% 20% 10% Percent of 795 Persons with Hip Fracture 40% 30% 20% 10% 0% Change of Quintile with Standardized Costs vs. MedPAR Payment 0% Change of Quintile Using Standardized Costs vs. MedPAR Payment over 1 Year

17 Can DRG-weight based method be applied outside Medicare? 17 Can make costs across different Hospital providers comparable Different payment polices among health care insurers Different payment contracts between specific insurers and hospital providers HMORN providers Are hospital costing methods the same across the network?

18 Limitations of DRG-weight based method & this study 18 Method is NOT appropriate where local geographic and hospital characteristics are relevant to the research question DRG weight based method depends on DRG weights to fully capture individual differences in resource intensity need to care for that individual DRG codes were substantially expanded in 2007 to better capture diagnoses, procedures, and health status that drive required resources for care DRGs prior to 2008 do not fully capture that variation Our analyses limited to hospital costs after hip fracture (included 182 separate DRGs) Further studies across entire breadth of DRGs, and among those younger than age 65 years are needed

19 Conclusions DRG weight based method can be used to estimate acute hospital costs Reflect resources required for care based on patient medical and surgical acuity Applicable to all hospital stays, regardless of hospital characteristics or whether or not Medicare payment was based on Prospective Payment System Data required from MedPAR (or other inpatient claims file) DRG assigned to hospital stay Length of hospital stay, whether or not patient was transferred to another facility Outlier payments based on medical & surgical acuity Additional Required data (available from author upon request) DRG weight and geometric mean length of stay tables Standard base payment amounts for fiscal year in which hospital stay took place 19 Full Reference: Schousboe JT et. al., Health Services Research 2014 (online): DOI: /

20 Acknowledgments 20 Main grant: 1 R01 AG A1 (Predictors of Health Care Utilization and Costs Attributable To Hip Fracture), National Institute on Aging The Study of Osteoporotic Fractures (SOF) is supported by National Institutes of Health funding. The National Institute on Aging (NIA) provides support under the following grant numbers: R01 AG005407, R01 AR35582, R01 AR35583, R01 AR35584, R01 AG005394, R01 AG027574, and R01 AG027576

Facilities contract with Medicare to furnish

Facilities contract with Medicare to furnish Facilities contract with Medicare to furnish acute inpatient care and agree to accept predetermined acute Inpatient Prospective Payment System (IPPS) rates as payment in full. The inpatient hospital benefit

More information

Using Medicare Hospitalization Information and the MedPAR. Beth Virnig, Ph.D. Associate Dean for Research and Professor University of Minnesota

Using Medicare Hospitalization Information and the MedPAR. Beth Virnig, Ph.D. Associate Dean for Research and Professor University of Minnesota Using Medicare Hospitalization Information and the MedPAR Beth Virnig, Ph.D. Associate Dean for Research and Professor University of Minnesota MedPAR Medicare Provider Analysis and Review Includes information

More information

Inpatient Transfers, Discharges and Readmissions July 19, 2012

Inpatient Transfers, Discharges and Readmissions July 19, 2012 Inpatient Transfers, Discharges and Readmissions July 19, 2012 Discharge Status Codes Two-digit code Identifies where the patient is at conclusion of encounter Visit Inpatient stay End of billing cycle

More information

NAPH Summary of Proposed Medicare DSH Regulations

NAPH Summary of Proposed Medicare DSH Regulations NAPH Summary of Proposed Medicare DSH Regulations On Friday, April 26, the Centers for Medicare & Medicaid Services (CMS) released a proposed rule implementing the Medicare disproportionate share hospital

More information

Medicare Hospital Prospective Payment System How DRG Rates Are Calculated and Updated

Medicare Hospital Prospective Payment System How DRG Rates Are Calculated and Updated Medicare Hospital Prospective Payment System How DRG Rates Are Calculated and Updated August 2001 OEI-09-00-00200 Office of Inspector General Office of Evaluation and Inspections Region IX This white paper

More information

Claims Data: Source and Processing. Barbara Frank, M.S., M.P.H. Director of Workshops, Outreach, and Research University of Minnesota

Claims Data: Source and Processing. Barbara Frank, M.S., M.P.H. Director of Workshops, Outreach, and Research University of Minnesota Claims Data: Source and Processing Barbara Frank, M.S., M.P.H. Director of Workshops, Outreach, and Research University of Minnesota Overview of CMS Claims Data What is a claim? How are claims processed?

More information

The PFFS Reimbursement Guide

The PFFS Reimbursement Guide The PFFS Reimbursement Guide SecureHorizons Direct reimburses claims based on Medicare Fee Schedules, Prospective Payment Systems (PPS) and estimated Medicare payments amounts. Payment methodologies are

More information

Payment Methodology Grid for Medicare Advantage PFFS/MSA

Payment Methodology Grid for Medicare Advantage PFFS/MSA Payment Methodology Grid for Medicare Advantage PFFS/MSA This applies to SmartValue and Security Choice Private Fee-for-Service (PFFS) plans and SmartSaver and Save Well Medical Savings Account (MSA) plans.

More information

Chapter 7 Acute Care Inpatient/Outpatient Hospital Services

Chapter 7 Acute Care Inpatient/Outpatient Hospital Services Chapter 7: Acute Care Inpatient/ Outpatient Hospital Services Executive Summary Description Acute care hospitals are the largest group of enrolled hospital providers. Kansas Medicaid has 144 acute care

More information

STATE PLAN UNDER TITLE XIX OF THE SOCIAL SECURITY ACT MEDICAL ASSISTANCE PROGRAM

STATE PLAN UNDER TITLE XIX OF THE SOCIAL SECURITY ACT MEDICAL ASSISTANCE PROGRAM Pagel STATE PLAN UNDER TITLE XIX OF THE SOCIAL SECURITY ACT MEDICAL ASSISTANCE PROGRAM lntrodll(tion State of Maryland Reimbursement and payment criteria will be established which are designed to enlist

More information

How Will Hospital Readmission Penalties Impact Skilled Nursing Facilities?

How Will Hospital Readmission Penalties Impact Skilled Nursing Facilities? How Will Hospital Readmission Penalties Impact Skilled Nursing Facilities? Patrick V. Trotta, CPA Director of ElderCare Provider Services Glass Jacobson patrick.trotta@glassjacobson.com 410 356 1000 Presentation

More information

benchmarking tools for reducing costs of care

benchmarking tools for reducing costs of care APRIL 2009 healthcare financial management COVER STORY William Shoemaker benchmarking tools for reducing costs of care In the face of the nation s economic challenges, hospitals are under increasing pressure

More information

Rural Policy Brief Volume Five, Number Five (PB2000-5) June, 2000 RUPRI Rural Health Panel

Rural Policy Brief Volume Five, Number Five (PB2000-5) June, 2000 RUPRI Rural Health Panel Rural Policy Brief Volume Five, Number Five (PB2000-5) June, 2000 RUPRI Rural Health Panel Calculating and Using the Area Wage Index of the Medicare Inpatient Hospital Prospective Payment System Guest

More information

2014: Volume 4, Number 1. A publication of the Centers for Medicare & Medicaid Services, Office of Information Products & Data Analytics

2014: Volume 4, Number 1. A publication of the Centers for Medicare & Medicaid Services, Office of Information Products & Data Analytics 2014: Volume 4, Number 1 A publication of the Centers for Medicare & Medicaid Services, Office of Information Products & Data Analytics Medicare Post-Acute Care Episodes and Payment Bundling Melissa Morley,¹

More information

Glossary. Adults: Individuals ages 19 through 64. Allowed amounts: See prices paid. Allowed costs: See prices paid.

Glossary. Adults: Individuals ages 19 through 64. Allowed amounts: See prices paid. Allowed costs: See prices paid. Glossary Acute inpatient: A subservice category of the inpatient facility clams that have excluded skilled nursing facilities (SNF), hospice, and ungroupable claims. This subcategory was previously known

More information

Improving Inpatient Psychiatric Payment Methods

Improving Inpatient Psychiatric Payment Methods Improving Inpatient Psychiatric Payment Methods Donald M. Steinwachs, Ph.D Professor and Director Health Services Research and Development Center Bloomberg School of Public Health Funded by NIMH Grant

More information

Value-Based Purchasing Program Overview. Maida Soghikian, MD Grand Rounds Scripps Green Hospital November 28, 2012

Value-Based Purchasing Program Overview. Maida Soghikian, MD Grand Rounds Scripps Green Hospital November 28, 2012 Value-Based Purchasing Program Overview Maida Soghikian, MD Grand Rounds Scripps Green Hospital November 28, 2012 Presentation Overview Background and Introduction Inpatient Quality Reporting Program Value-Based

More information

Long-Term Acute Care Hospitals

Long-Term Acute Care Hospitals Long-Term Acute Care Hospitals What are they? What services do they offer? Presented by: Maxi Adams MBA, BSN, RN LTACH STACH LTACH = Long-Term Acute Care Hospital STACH = Short-Term Acute Care Hospital

More information

Selection of a DRG Grouper for a Medicaid Population

Selection of a DRG Grouper for a Medicaid Population Selection of a DRG Grouper for a Medicaid Population Introduction The goal of diagnosis related groupers is to define patients into categories based on similar clinical conditions and on similar levels

More information

MEDICARE PART B DRUGS. Action Needed to Reduce Financial Incentives to Prescribe 340B Drugs at Participating Hospitals

MEDICARE PART B DRUGS. Action Needed to Reduce Financial Incentives to Prescribe 340B Drugs at Participating Hospitals United States Government Accountability Office Report to Congressional Requesters June 2015 MEDICARE PART B DRUGS Action Needed to Reduce Financial Incentives to Prescribe 340B Drugs at Participating Hospitals

More information

California Children s Services Program Analysis Final Report

California Children s Services Program Analysis Final Report California Children s Services Program Analysis Final Report Paul H. Wise, MD, MPH Vandana Sundaram, MPH Lisa Chamberlain, MD, MPH Ewen Wang, MD Olga Saynina, MS Jia Chan, MS Kristen Chan, MASc Beate Danielsen,

More information

Impact of Critical Care Nursing on 30-day Mortality of Mechanically Ventilated Older Adults

Impact of Critical Care Nursing on 30-day Mortality of Mechanically Ventilated Older Adults Impact of Critical Care Nursing on 30-day Mortality of Mechanically Ventilated Older Adults Deena M. Kelly PhD RN Post-doctoral Fellow Department of Critical Care University of Pittsburgh School of Medicine

More information

Eligibility of Rural Hospitals for the 340B Drug Discount Program

Eligibility of Rural Hospitals for the 340B Drug Discount Program Public Hospital Pharmacy Coalition www.phpcrx.org (A Coalition of the National Association of Public Hospitals and Health Systems) Eligibility of Rural Hospitals for the 340B Drug Discount Program Prepared

More information

CHAPTER 4 MEDICARE. Introduction. Supplementary Medical Insurance Part D

CHAPTER 4 MEDICARE. Introduction. Supplementary Medical Insurance Part D CHAPTER 4 MEDICARE Medicare by the Numbers (2007) Part A: Total Beneficiaries Elderly beneficiaries Disabled beneficiaries Total Income Hospital Insurance Part A Supplementary Medical Insurance Part B

More information

PUBLIC HEALTH TRUST OF MIAMI-DADE COUNTY, FLORIDA A Department of Miami-Dade County, Florida. September 30, 2014 and 2013

PUBLIC HEALTH TRUST OF MIAMI-DADE COUNTY, FLORIDA A Department of Miami-Dade County, Florida. September 30, 2014 and 2013 Financial Statements, Required Supplementary Information, and Schedules (With Independent Auditors Report Thereon) Table of Contents Independent Auditors Report 1 Management s Discussion and Analysis (Unaudited)

More information

University of Mississippi Medical Center. Access Management. Patient Access Specialists II

University of Mississippi Medical Center. Access Management. Patient Access Specialists II Financial Terminology in Access Management University of Mississippi Medical Center Access Management Patient Access Specialists II As a Patient Access Specialist You are the FIRST STAGE in the Revenue

More information

Hospital Financing Overview

Hospital Financing Overview Texas Hospital Association 1108 Lavaca, Suite 700, Austin, TX, 78701-2180 www.tha.org Hospital Financing Overview Under federal law, hospitals are required to provide care to anyone who seeks it in their

More information

Measure Information Form (MIF) #275, adapted for quality measurement in Medicare Accountable Care Organizations

Measure Information Form (MIF) #275, adapted for quality measurement in Medicare Accountable Care Organizations ACO #9 Prevention Quality Indicator (PQI): Ambulatory Sensitive Conditions Admissions for Chronic Obstructive Pulmonary Disease (COPD) or Asthma in Older Adults Data Source Measure Information Form (MIF)

More information

Rouch, Jean. Cine-Ethnography. Minneapolis, MN, USA: University of Minnesota Press, 2003. p 238

Rouch, Jean. Cine-Ethnography. Minneapolis, MN, USA: University of Minnesota Press, 2003. p 238 Minneapolis, MN, USA: University of Minnesota Press, 2003. p 238 http://site.ebrary.com/lib/uchicago/doc?id=10151154&ppg=238 Minneapolis, MN, USA: University of Minnesota Press, 2003. p 239 http://site.ebrary.com/lib/uchicago/doc?id=10151154&ppg=239

More information

Total Cost of Care and Resource Use Frequently Asked Questions (FAQ)

Total Cost of Care and Resource Use Frequently Asked Questions (FAQ) Total Cost of Care and Resource Use Frequently Asked Questions (FAQ) Contact Email: TCOCMeasurement@HealthPartners.com for questions. Contents Attribution Benchmarks Billed vs. Paid Licensing Missing Data

More information

Medicaid IMD Exclusion and Options for MHDS February 29, 2012

Medicaid IMD Exclusion and Options for MHDS February 29, 2012 Medicaid IMD Exclusion and Options for MHDS February 29, 2012 This white paper is intended to provide policy guidance regarding the impact and options associated with the Medicaid Institution for Mental

More information

Accountable Care and Value Based Payments 101: Government Programs Update

Accountable Care and Value Based Payments 101: Government Programs Update 1 Accountable Care and Value Based Payments 101: Government Programs Update June 24 th, 2014 Dave Neiman, FSA, MAAA Senior Consulting Actuary DaveN@Wakely.com (720) 226-9806 2 Caveats Opinions expressed

More information

Rehabilitation Reimbursement Update By: Cherilyn G. Murer, JD, CRA

Rehabilitation Reimbursement Update By: Cherilyn G. Murer, JD, CRA Rehabilitation Reimbursement Update By: Cherilyn G. Murer, JD, CRA Introduction The Centers for Medicare & Medicaid Services (CMS) and legislators in this country remain dedicated to ensuring that beneficiaries

More information

Florida Medicaid Inpatient Prospective Payment System

Florida Medicaid Inpatient Prospective Payment System Florida Medicaid Inpatient Prospective Payment System Justin Senior Deputy Secretary for Medicaid, Agency for Health Care Administration Malcolm Ferguson Associate Director, Navigant Healthcare Senate

More information

114.6 CMR: DIVISION OF HEALTH CARE FINANCE AND POLICY 114.6 CMR 14.00: HEALTH SAFETY NET PAYMENTS AND FUNDING

114.6 CMR: DIVISION OF HEALTH CARE FINANCE AND POLICY 114.6 CMR 14.00: HEALTH SAFETY NET PAYMENTS AND FUNDING 14.01: General Provisions 14.02: Definitions 14.03: Sources and Uses of Funds 14.04: Total Hospital Assessment Liability 14.05: Surcharge Payments 14.06: Payments to Hospitals 14.07: Payments to Community

More information

APPENDIX 1. Medicaid Emergency Psychiatric Demonstration Application Proposal Guidelines

APPENDIX 1. Medicaid Emergency Psychiatric Demonstration Application Proposal Guidelines APPENDIX 1 Medicaid Emergency Psychiatric Demonstration Application Proposal Guidelines INTRODUCTION Section 2707 of the Affordable Care Act authorizes a 3-year Medicaid Emergency Psychiatric Demonstration

More information

Use and Integration of Freely Available U.S. Public Use Files to Answer Pharmacoeconomic Questions: Deciphering the Alphabet Soup

Use and Integration of Freely Available U.S. Public Use Files to Answer Pharmacoeconomic Questions: Deciphering the Alphabet Soup Use and Integration of Freely Available U.S. Public Use Files to Answer Pharmacoeconomic Questions: Deciphering the Alphabet Soup Prepared by Ovation Research Group for the National Library of Medicine

More information

Coding with. Snayhil Rana

Coding with. Snayhil Rana Coding with ICD-9-CM CM Snayhil Rana ICD-9-CM CM Index Pre-Test Introduction to ICD-9-CM Coding The Three Volumes of the ICD-9-CM ICD-9-CM Coding Conventions Other ICD-9-CM Sections ICD-9-CM for Claim

More information

National Medicare Readmission. Centers for Medicare and Medicare Services

National Medicare Readmission. Centers for Medicare and Medicare Services National Medicare Readmission Findings: Recent Data and Trends Office of Information Products and Data Analytics Office of Information Products and Data Analytics Centers for Medicare and Medicare Services

More information

Bundle Care Care Tool Affordable Insurance Exchanges

Bundle Care Care Tool Affordable Insurance Exchanges See attached resources for further information about the Health Care Reform buzz words for 2013. Bundle Care Care Tool Affordable Insurance Exchanges CMS - Bundled Payments for Care Improvement Initiative

More information

Data Shows Reduction in Medicare Hospital Readmission Rates During 2012

Data Shows Reduction in Medicare Hospital Readmission Rates During 2012 Medicare & Medicaid Research Review 2013: Volume 3, Number 2 A publication of the Centers for Medicare & Medicaid Services, Office of Information Products & Data Analytics Data Shows Reduction in Medicare

More information

Southwestern Vermont Medical Center Operating Budget Fiscal Year 2016

Southwestern Vermont Medical Center Operating Budget Fiscal Year 2016 Southwestern Vermont Medical Center Operating Budget Fiscal Year 2016 Southwestern Vermont Medical Center s (hereafter SVMC or Medical Center ) Operating Budget for Fiscal Year (hereafter FY ) 2016 has

More information

Medicare Long-Term Care Hospital Prospective Payment System

Medicare Long-Term Care Hospital Prospective Payment System Medicare Long-Term Care Hospital Prospective Payment System Payment Rule Brief PROPOSED RULE Program Year: FFY 2015 Overview, Resources, and Comment Submission On May 15, the Centers for Medicare and Medicaid

More information

Using the Inpatient Rehabilitation Facility (IRF) PEPPER to Support Auditing and Monitoring Efforts: Session 1

Using the Inpatient Rehabilitation Facility (IRF) PEPPER to Support Auditing and Monitoring Efforts: Session 1 Using the Inpatient Rehabilitation Facility (IRF) PEPPER to Support Auditing and Monitoring Efforts: Session 1 March, 2015 Kimberly Hrehor Agenda Session 1: History and basics of PEPPER IRF PEPPER target

More information

Media Packet 10-2009. NPAM@npedu.com 888-405-NPAM. PO Box 540 Ellicott City, MD 21041

Media Packet 10-2009. NPAM@npedu.com 888-405-NPAM. PO Box 540 Ellicott City, MD 21041 Media Packet What is a Nurse Practitioner NP Facts Who are the Nurse Practitioners in Maryland State of the State Quality of NP Practice NP Cost Effectiveness 10-2009 NPAM@npedu.com 888-405-NPAM PO Box

More information

Medicare- Medicaid Enrollee State Profile

Medicare- Medicaid Enrollee State Profile Medicare- Medicaid Enrollee State Profile The National Summary Centers for Medicare & Medicaid Services Introduction... 1 Data Source and General Notes... 2 Types and Ages of Medicare-Medicaid Enrollees...

More information

IWCC 50 ILLINOIS ADMINISTRATIVE CODE 7110 7110.90. Section 7110.90 Illinois Workers' Compensation Commission Medical Fee Schedule

IWCC 50 ILLINOIS ADMINISTRATIVE CODE 7110 7110.90. Section 7110.90 Illinois Workers' Compensation Commission Medical Fee Schedule Section 7110.90 Illinois Workers' Compensation Commission Medical Fee Schedule a) In accordance with Sections 8(a), 8.2 and 16 of the Workers' Compensation Act [820 ILCS 305/8(a), 8.2 and 16] (the Act),

More information

Assessment of Patient Outcomes of Rehabilitative Care Provided in Inpatient Rehabilitation Facilities (IRFs) and After Discharge

Assessment of Patient Outcomes of Rehabilitative Care Provided in Inpatient Rehabilitation Facilities (IRFs) and After Discharge Assessment of Patient Outcomes of Rehabilitative Care Provided in Inpatient Rehabilitation Facilities (IRFs) and After Discharge PREPARED FOR: ARA Research Institute PRESENTED BY: Al Dobson, Ph.D. PREPARED

More information

Westchester Medical Center. 2014 Operating Budget

Westchester Medical Center. 2014 Operating Budget Westchester Medical Center 2014 Operating Budget December 4, 2013 WESTCHESTER COUNTY HEALTH CARE CORPORATION Operating Budget 2014 Table of Contents Page Executive Summary 1 Detailed Discussion of Revenue

More information

Using Data to Understand the Medicare Spending Per Beneficiary Measure

Using Data to Understand the Medicare Spending Per Beneficiary Measure Using Data to Understand the Medicare Spending Per Beneficiary Measure Mary Wheatley, AAMC Jacqueline Matthews, Cleveland Clinic Keely Macmillan, Partners Healthcare December 17, 2013 Webinar Details The

More information

UnitedHealthcare Medicare Solutions Readmission Review Program for Medicare Advantage Plans

UnitedHealthcare Medicare Solutions Readmission Review Program for Medicare Advantage Plans UnitedHealthcare Medicare Solutions Readmission Review Program for Medicare Advantage Plans General Clinical Guidelines for Payment Review Updated May 2015 Introduction The UnitedHealthcare Medicare Solutions

More information

Finances of Home Dialysis: Facility and Physician Payments

Finances of Home Dialysis: Facility and Physician Payments Finances of Home Dialysis: Facility and Physician Payments Thomas A. Golper, MD, FACP, FASN Vanderbilt University Medical Center Nashville, TN thomas.golper@vanderbilt.edu Potential Conflict of Interest

More information

A Comparison of Costs Between Medical and Surgical Patients in an Academic Pediatric Intensive Care Unit

A Comparison of Costs Between Medical and Surgical Patients in an Academic Pediatric Intensive Care Unit ORIGINAL RESEARCH A Comparison of Costs Between Medical and Surgical Patients in an Academic Pediatric Intensive Care Unit Benson S. Hsu, MD, MBA; Thomas B. Brazelton III, MD, MPH ABSTRACT Objective: To

More information

HEALTHCARE FINANCE: AN INTRODUCTION TO ACCOUNTING AND FINANCIAL MANAGEMENT. Online Appendix B Operating Indicator Ratios

HEALTHCARE FINANCE: AN INTRODUCTION TO ACCOUNTING AND FINANCIAL MANAGEMENT. Online Appendix B Operating Indicator Ratios HEALTHCARE FINANCE: AN INTRODUCTION TO ACCOUNTING AND FINANCIAL MANAGEMENT Online Appendix B Operating Indicator Ratios INTRODUCTION In Chapter 17, we indicated that ratio analysis is a technique commonly

More information

POLICY BRIEF. Which Rural and Urban Hospitals Have Received Readmission Penalties Over Time? October 2015. rhrc.umn.edu

POLICY BRIEF. Which Rural and Urban Hospitals Have Received Readmission Penalties Over Time? October 2015. rhrc.umn.edu POLICY BRIEF October 2015 Which Rural and Urban Hospitals Have Received Readmission Penalties Over Time? Peiyin Hung, MSPH Michelle Casey, MS Ira Moscovice, PhD Key Findings Over the first three years

More information

Table of Contents. This file contains the following documents in the order listed:

Table of Contents. This file contains the following documents in the order listed: Table of Contents State/Territory Name: South Carolina State Plan Amendment (SPA) #: 13-002 This file contains the following documents in the order listed: 1) Approval Letter 2) CMS 179 Form/Summary Form

More information

Statewide Hospital Quality Care Assessment Frequently Asked Questions

Statewide Hospital Quality Care Assessment Frequently Asked Questions Statewide Hospital Quality Care Assessment 1. Q: Why are hospitals being assessed? A: Federal regulations, CFR 42 Part 433 - Fiscal Administration, allows states to assess 19 classes of providers under

More information

Revenue Integrity Boot Camp. Coding. Agenda

Revenue Integrity Boot Camp. Coding. Agenda Annie Lee Sallee MBA, RHIT, CPC, CPMA AHIMA Approved ICD-10-CM/PCS Trainer Revenue Cycle Education Specialist Home Town Health Jenan Custer CPC, CCS AHIMA Approved ICD-10-CM/PCS Trainer and Ambassador

More information

EXECUTIVE SUMMARY OBJECTIVE The objective of our review was to confirm that disproportionate share hospital (DSH) payments to St. Vincent Charity Hospital and St. Luke s Medical Center (collectively, the

More information

Center for Medicaid and State Operations SMDL #01-032. December 5, 2001

Center for Medicaid and State Operations SMDL #01-032. December 5, 2001 DEPARTMENT OF HEALTH & HUMAN SERVICES Centers for Medicare & Medicaid Services 7500 Security Boulevard, Mail Stop S2-26-12 Baltimore, Maryland 21244-1850 Center for Medicaid and State Operations SMDL #01-032

More information

Fiscal Year 2016 proposed Inpatient and Long-term Care Hospital policy and payment changes (CMS-1632-P)

Fiscal Year 2016 proposed Inpatient and Long-term Care Hospital policy and payment changes (CMS-1632-P) Fiscal Year 2016 proposed Inpatient and Long-term Care Hospital policy and payment changes (CMS-1632-P) Date 2015-04-17 Title Fiscal Year 2016 proposed Inpatient and Long-term Care Hospital policy and

More information

Leveraging Predictive Analytic and Artificial Intelligence Technology for Financial and Clinical Performance

Leveraging Predictive Analytic and Artificial Intelligence Technology for Financial and Clinical Performance Leveraging Predictive Analytic and Artificial Intelligence Technology for Financial and Clinical Performance Matt Seefeld CEO & Co-Founder mseefeld@interpointpartners.com www.interpointpartners.com (404)446-0051

More information

PATTERNS OF POST-ACUTE UTILIZATION IN RURAL AND URBAN COMMUNITIES: HOME HEALTH, SKILLED NURSING, AND INPATIENT MEDICAL REHABILITATION.

PATTERNS OF POST-ACUTE UTILIZATION IN RURAL AND URBAN COMMUNITIES: HOME HEALTH, SKILLED NURSING, AND INPATIENT MEDICAL REHABILITATION. PATTERNS OF POST-ACUTE UTILIZATION IN RURAL AND URBAN COMMUNITIES: HOME HEALTH, SKILLED NURSING, AND INPATIENT MEDICAL REHABILITATION Final Report March 2005 Janet P. Sutton, Ph.D. NORC Walsh Center for

More information

HFMA s Revenue Cycle Forum

HFMA s Revenue Cycle Forum A peer-to-peer online discussion community REPRINT July/August 2013 HFMA s Revenue Cycle Forum www.hfma.org/forums Understanding a Declining CMI: A Step-by-Step Analysis By Garri Garrison The first step

More information

Westchester Medical Center. 2012 Operating Budget

Westchester Medical Center. 2012 Operating Budget Westchester Medical Center 2012 Operating Budget December 7, 2011 WESTCHESTER COUNTY HEALTH CARE CORPORATION Overview Westchester Medical Center s (WMC) 2012 Operating Budget reflects significant reductions

More information

2019 Healthcare That Works for All

2019 Healthcare That Works for All 2019 Healthcare That Works for All This paper is one of a series describing what a decade of successful change in healthcare could look like in 2019. Each paper focuses on one aspect of healthcare. To

More information

Lowering Costs and Improving Outcomes. Patient Engagement Issues. Nancy Davenport-Ennis President & CEO. September 8 th, 2009

Lowering Costs and Improving Outcomes. Patient Engagement Issues. Nancy Davenport-Ennis President & CEO. September 8 th, 2009 The Healthcare Imperative: Lowering Costs and Improving Outcomes Patient Engagement Issues Nancy Davenport-Ennis President & CEO National Patient Advocate Foundation September 8 th, 2009 Institute of Medicine

More information

The Cost-Effectiveness of Homecare

The Cost-Effectiveness of Homecare The Cost-Effectiveness of Homecare Homecare Reduces Costs by 37 Percent for Heart Failure Patients The May 2004 Journal of the American Geriatrics Society reports a study conducted at six Philadelphia

More information

Medicare Inpatient Rehabilitation Facility Prospective Payment System

Medicare Inpatient Rehabilitation Facility Prospective Payment System Medicare Inpatient Rehabilitation Facility Prospective Payment System Payment Rule Brief FINAL RULE Program Year: FFY 2014 Overview and Resources On August 6, 2013, the Centers for Medicare and Medicaid

More information

Insurance 101. Infant and Toddler Coordinators Association. July 28, 2012 Capital City Hyatt. Laura Pizza Plum Plum Healthcare Consulting

Insurance 101. Infant and Toddler Coordinators Association. July 28, 2012 Capital City Hyatt. Laura Pizza Plum Plum Healthcare Consulting Insurance 101 Infant and Toddler Coordinators Association July 28, 2012 Capital City Hyatt Laura Pizza Plum 1 Agenda Basics of Health Insurance Frequently Asked Questions Early Intervention and working

More information

Presented by Kathleen S. Wyka, AAS, CRT, THE AFFORDABLE CA ACT AND ITS IMPACT ON THE RESPIRATORY C PROFESSION

Presented by Kathleen S. Wyka, AAS, CRT, THE AFFORDABLE CA ACT AND ITS IMPACT ON THE RESPIRATORY C PROFESSION Presented by Kathleen S. Wyka, AAS, CRT, THE AFFORDABLE CA ACT AND ITS IMPACT ON THE RESPIRATORY C PROFESSION At the end of this session, you will be able to: Identify ways RT skills can be utilized for

More information

ALASKA COMPREHENSIVE HEALTH INSURANCE ASSOCIATION MEDICARE SUPPLEMENT PLAN F

ALASKA COMPREHENSIVE HEALTH INSURANCE ASSOCIATION MEDICARE SUPPLEMENT PLAN F ALASKA COMPREHENSIVE HEALTH INSURANCE ASSOCIATION MEDICARE SUPPLEMENT PLAN F The premiums you paid, the application you complete and our reliance on your answers to the application questions have put this

More information

Today s Agenda. Statement of Conflicts of Interest 7/9/2015

Today s Agenda. Statement of Conflicts of Interest 7/9/2015 Geri Brennan Assistant Director, Health Care United States Government Accountability Office Statement of Conflicts of Interest Geri Brennan has no actual or potential conflict of interest in relation to

More information

Health Care Finance 101

Health Care Finance 101 Alaska Health Care Commission Health Care Finance 101 Ken Tonjes CFO PeaceHealth Ketchikan Medical Center June 20, 2013 Basics: Glossary of Terms Common Financial Terminology Gross Charges (Revenue) Total

More information

Attachment A Minnesota DHS Community Service/Community Services Development

Attachment A Minnesota DHS Community Service/Community Services Development Attachment A Minnesota DHS Community Service/Community Services Development Applicant Organization: First Plan of Minnesota Project Title: Implementing a Functional Daily Living Skills Assessment to Predict

More information

RE: Medicare s Post-acute Transfer Policy and Condition Code 42 BACKGROUND

RE: Medicare s Post-acute Transfer Policy and Condition Code 42 BACKGROUND Memorandum TO: FROM: Glenn Hendrix Doug M. Hance DATE: RE: Medicare s Post-acute Transfer Policy and Condition Code 42 BACKGROUND Medicare s post-acute transfer policy distinguishes between discharges

More information

OFFICE OF INSPECTOR GENERAL

OFFICE OF INSPECTOR GENERAL DEPARTMENT OF OF HEALTH AND AND HUMAN SERVICES OFFICE OF INSPECTOR GENERAL WASHINGTON, WASHINGTON, DC DC 20201 20201 MAR IIARO 0 62013 6 2013 TO: FROM: Marilyn Tavenner Acting Administrator Centers for

More information

June 22, 2012. Dear Administrator Tavenner:

June 22, 2012. Dear Administrator Tavenner: Submitted Electronically Marilyn Tavenner Acting Administrator Centers for Medicare & Medicaid Services Department of Health and Human Services Room 445-G Hubert H. Humphrey Building 200 Independence Avenue

More information

Appendix C. Examples of Per-Case and DRG Payment Systems

Appendix C. Examples of Per-Case and DRG Payment Systems Appendix C. Examples of Per-Case and DRG Payment Systems Diagnosis Related Groups (DRGs) have been used in three State ratesetting systems, as well as in the Medicare reimbursement system under the Tax

More information

Summary of Medicare s special payment provisions for rural providers and criteria for qualification

Summary of Medicare s special payment provisions for rural providers and criteria for qualification A P P E N D I XB Summary of Medicare s special payment provisions for rural providers and criteria for qualification A P P E N D I X B Summary of Medicare s special payment provisions for rural providers

More information

Health Economics Program

Health Economics Program Health Economics Program Issue Brief 2004-07 November 2004 Minnesota Mental Health and Chemical Dependency Treatment Utilization Trends: In a recent task force report, the Minnesota Psychiatric Society

More information

MEDICAID DRGS GET READY, CUZ HERE THEY COME!

MEDICAID DRGS GET READY, CUZ HERE THEY COME! MEDICAID DRGS GET READY, CUZ HERE THEY COME! TODAY S PROGRAM All about Medicaid DRGs AHCA and HP implementation plan APR-DRGs details Panel discussion on hospital implementation BACKGROUND Required by

More information

Deciphering the Details:

Deciphering the Details: Deciphering the Details: An update on implementing PPS for inpatient rehabilitation facilities. By: Cherilyn G. Murer, J.D., C.R.A. President & CEO - The Murer Group Reimbursement for operating costs of

More information

Essential Hospitals VITAL DATA. Results of America s Essential Hospitals Annual Hospital Characteristics Survey, FY 2012

Essential Hospitals VITAL DATA. Results of America s Essential Hospitals Annual Hospital Characteristics Survey, FY 2012 Essential Hospitals VITAL DATA Results of America s Essential Hospitals Annual Hospital Characteristics Survey, FY 2012 Published: July 2014 1 ABOUT AMERICA S ESSENTIAL HOSPITALS METHODOLOGY America s

More information

Hospitals. Complete if the organization answered Yes to Form 990, Part IV, question 20. Attach to Form 990. See separate instructions.

Hospitals. Complete if the organization answered Yes to Form 990, Part IV, question 20. Attach to Form 990. See separate instructions. SCHEDULE H (Form 990) Department of the Treasury Internal Revenue Service Name of the organization Hospitals Complete if the organization answered to Form 990, Part IV, question 20. Attach to Form 990.

More information

Hospitals. Complete if the organization answered Yes to Form 990, Part IV, question 20. Attach to Form 990. See separate instructions.

Hospitals. Complete if the organization answered Yes to Form 990, Part IV, question 20. Attach to Form 990. See separate instructions. SCHEDULE H (Form 990) Department of the Treasury Internal Revenue Service Name of the organization Hospitals Complete if the organization answered Yes to Form 990, Part IV, question 20. Attach to Form

More information

Aiming for Fewer Hospital U-turns: The Medicare Hospital Readmission Reduction Program

Aiming for Fewer Hospital U-turns: The Medicare Hospital Readmission Reduction Program Aiming for Fewer Hospital U-turns: The Medicare Hospital Readmission Reduction Program Cristina Boccuti and Giselle Casillas For Medicare patients, hospitalizations can be stressful; even more so when

More information

DISCLOSURE STATEMENTS

DISCLOSURE STATEMENTS Incorporated Document (5) DISCLOSURE STATEMENTS Instructions for Use of the Disclosure Statements for Health Insurance Policies Sold to Medicare Beneficiaries that Duplicate Medicare 1. Section 1882 (d)

More information

All Patient Refined DRGs (APR-DRGs) An Overview. Presented by Treo Solutions

All Patient Refined DRGs (APR-DRGs) An Overview. Presented by Treo Solutions All Patient Refined DRGs (APR-DRGs) An Overview Presented by Treo Solutions Presentation Highlights History of inpatient classification systems APR-DRGs: what they are, how they work, and why they are

More information

Critical Access Hospital (CAH) and CAH Swingbed Questions and Answers

Critical Access Hospital (CAH) and CAH Swingbed Questions and Answers Critical Access Hospital (CAH) and CAH Swingbed Questions and Answers The following questions and answers are from the April 2012 CAH and CAH Swingbed web-based trainings: Q1. Is a non-covered/no pay bill

More information

Reducing Readmission: A Systems Analysis

Reducing Readmission: A Systems Analysis Reducing Readmission: A ystems Analysis Abigail Kroch, Epidemiology and Program Evaluation ara Levin, Internal Medicine Natasha Pinto, Family Medicine Why Readmissions? Affordable Care Act emphasizes new

More information

Early mortality rate (EMR) in Acute Myeloid Leukemia (AML)

Early mortality rate (EMR) in Acute Myeloid Leukemia (AML) Early mortality rate (EMR) in Acute Myeloid Leukemia (AML) George Yaghmour, MD Hematology Oncology Fellow PGY5 UTHSC/West cancer Center, Memphis, TN May,1st,2015 Off-Label Use Disclosure(s) I do not intend

More information

1 Comorbidities are specific patient conditions that are secondary to the patient s primary diagnosis, and that require treatment during the stay.

1 Comorbidities are specific patient conditions that are secondary to the patient s primary diagnosis, and that require treatment during the stay. Psychiatric Hospital PPS The Inpatient Psychiatric Facility Prospective Payment System (IPF PPS) covers inpatient psychiatric services that are furnished in specialized hospitals, psychiatric distinct

More information

NOVOSTE BETA-CATH SYSTEM

NOVOSTE BETA-CATH SYSTEM HOSPITAL INPATIENT AND OUTPATIENT BILLING GUIDE FOR THE NOVOSTE BETA-CATH SYSTEM INTRAVASCULAR BRACHYTHERAPY DEVICE This guide is intended solely for use as a tool to help hospital billing staff resolve

More information

ICD-9 Basics Study Guide

ICD-9 Basics Study Guide Board of Medical Specialty Coding ICD-9 Basics Study Guide for the Home Health ICD-9 Basic Competencies Examination Two Washingtonian Center 9737 Washingtonian Blvd., Ste. 100 Gaithersburg, MD 20878-7364

More information

Use and Value of Data Analytics. Comparative Effectiveness Study Inpatient Rehab Hospital (IRH) vs. Skilled Nursing Facility (SNF)

Use and Value of Data Analytics. Comparative Effectiveness Study Inpatient Rehab Hospital (IRH) vs. Skilled Nursing Facility (SNF) Use and Value of Data Analytics Comparative Effectiveness Study Inpatient Rehab Hospital (IRH) vs. Skilled Nursing Facility (SNF) Ryan Wilson Vice President of Managed Care HealthSouth Corporation Gerry

More information

Leighton Ku, PhD, MPH Director, Center for Health Policy Research, GW. Maryland Community Health Resources Commission Oct. 2, 2014

Leighton Ku, PhD, MPH Director, Center for Health Policy Research, GW. Maryland Community Health Resources Commission Oct. 2, 2014 Leighton Ku, PhD, MPH Director, Center for Health Policy Research, GW Maryland Community Health Resources Commission Oct. 2, 2014 Two Health Safety Nets Insurance Safety Net: Medicaid, CHIP, MD Health

More information

Correctional Health Care Cost Saving Strategies. July 24, 2014

Correctional Health Care Cost Saving Strategies. July 24, 2014 Correctional Health Care Cost Saving Strategies July 24, 2014 Agenda Facility health care issues Medicaid reimbursements Claims administration strategies Preferred provider partnerships Prescription medicine

More information

3/11/15. COPD Disease Management Tackling the Transition. Objectives. Describe the multidisciplinary approach to inpatient care for COPD patients

3/11/15. COPD Disease Management Tackling the Transition. Objectives. Describe the multidisciplinary approach to inpatient care for COPD patients Faculty Disclosures COPD Disease Management Tackling the Transition Dr. Cappelluti has no actual or potential conflicts of interest associated with this presentation. Jane Reardon has no actual or potential

More information

Medicare Inpatient Rehabilitation Facility Prospective Payment System

Medicare Inpatient Rehabilitation Facility Prospective Payment System Medicare Inpatient Rehabilitation Facility Prospective Payment System Payment Rule Brief PROPOSED RULE Program Year: FFY 2015 Overview, Resources, and Comment Submission On May 7, 2014, the Centers for

More information