Big data. Better decisions.

Transcription

1 Welcome! Big data. Better decisions. 1

2 How Analytics Shape the Future of Our Industry Mark Parkinson AHCA/NCAL President & CEO 2

3 The Good News Data has helped us tell the story of our profession. 3

4 Now Past All-Known 2014 Legislative Risks Next Deadlines Doc Fix April 1, 2015 Budget October 1, 2015 Debt Ceiling Spring

5 MedPAC has been helpful MedPAC data shows total margins are razor-thin. A June 2014 MedPAC report supports a site neutral payment system for SNFs and IRFs. 5

6 Demographics are in Our Favor 6

7 More People Will Need Our Post-Acute Services Total Medicare Enrollment Will Grow Substantially, Resulting in Increased Volume YEARLY MEDICARE SNF VOLUME (MILLIONS OF DAYS) TOTAL MEDICARE ENROLLMENT (MILLIONS OF BENEFICIARIES) Graphic courtesy of Avalere Conservative AVERAGE AGE FOR MEDICARE ADMISSIONS Moderate Aggressive

8 Challenging Times Data illustrates the challenges for our profession. 8

9 2013 Medicaid Shortfall $7.7 billion shortfall nationally $24.26 per Medicaid patient day 8.6% higher than % of projected allowable costs are reimbursed by Medicaid Rates increased 2.9%, but costs increased 3.8% 9

10 Medicaid Managed Care states states 10

11 Changing Medicare Payment Systems Graphic courtesy of Avalere 11

12 How We Win 1. Quality Solution 2. Political/Lobbying Powerhouse 3. United and Proactive Voice 12

13 Quality is Now a Reimbursement Issue In past, we improved quality because it was the right thing to do. In future, we must improve quality to survive. Government won t fund every health care practice Reimbursement will be tied to quality 13

14 Quality Metrics and Our Opportunity CMS ranks hospitals based on 30-day readmission rate for the top 3 diagnoses causing the majority of readmissions: heart attack heart failure pneumonia Hospitals in bottom quartile (nationally) from the prior year will have a % of total Medicare payments withheld: 2013: up to 1% 2014: up to 2% 2015: up to 3% Source: Sections 1151 and 3025 of the PPACA 14

15 Quality Metrics and the Reimbursement Connection Current ACOs/MCOs using the PointRight Pro 30 rehospitalization measure promoted by AHCA o 3 Massachusetts Pioneer ACOs, 1 Massachusetts MCO o 1 New Jersey ACO Ohio has increased the proportion of Medicaid payments linked to quality measures Centers that meet targets on at least five of 20 measures are rewarded by not having their Medicaid per diem rate reduced. Rehospitalizations linked to payments in recent doc fix Doc fix in 2014 links SNF rehospitalization to SNF Medicare Part A payments 15

16 We are the Quality Solution 50.0% 40.0% 30.0% 20.0% 10.0% 35.6% 11.8% 23.8% 46.9% 19.6% 27.3% 0.0% Star 5-Star 16

17 AHCA Action on Quality Creation of the Quality Department AHCA/NCAL Quality Initiative AHCA/NCAL National Quality Award Program LTC Trend Tracker SM 17

18 Political/Lobbying Powerhouse Who s Who of Outside Lobbyists BGR Group Gov. Haley Barbour Capitol Counsel Rep. Jim McCrery Podesta Group Tony Podesta Alston-Bird Dan Elling Lincoln Policy Group Sen. Blanche Lincoln Seasoned Internal Government Affairs Team 18

19 2014 Political Goals AHCA PAC History $3,500, $3,000, $2,500, $2,000, $1,500, $1,000, $500, GOAL GOAL Hard Dollars Soft Dollars $ *2014 represents money collected to date 19

20 A Unified and Proactive Voice AHCA/NCAL Member Facilities 12,600 12,400 12,200 12,023 12,091 12,249 12,245 12,275 12,245 12,396 12,438 12,000 11,800 11,600 11,433 11,539 11,648 11,685 11,722 11,745 11,400 11,200 11,000 10,800 Jul-12 Aug-12Sep-12 Oct-12Nov-12Dec-12 Jan-13 Feb-13 Mar- 13 Apr-13 May- 13 Jun-13 Jul-13 Aug-13Sep-13 Oct-13Nov-13Dec-13 Jan-14 Feb-14 Mar- 14 Apr-14 May- 14 Jun-14 Jul-14 Aug-14Sep-14 20

21 Using Metrics Works MODEST WINS Not a pay-for in the 2013, 2014 short-term doc fix Shaped pay-for in 2015 short-term doc fix Clean increase in the FY 2013 & 2014 SNF PPS final rule, and the FY 2015 proposed rule Our major concerns addressed in final HCBS rule 21

22 What You Can Do Understand and master the quality metrics that matter to your payer Use LTC Trend Tracker to learn about your own metrics Track important quality measures to help you improve Updated system will feature customized reports and easier access to important metrics 22

23 It s time to play offense. We control the payment models or others will. 23

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