Hospital VBP: FY 2013 Actual Percentage Payment Summary Report NPC 10/4/12


Uploaded by CMSHHSgov on 22.01.2013

Transcript:
Charlie Eleftheriou: Welcome to this video slideshow presentation from
the National Provider Call on Hospital Value-Based Purchasing for the FY
2013 Actual Percentage Payment Summary Report. This educational call was
hosted by the CMS Provider Communications Group within the Center for
Medicare on Thursday, October 4, 2012.
Thank you. Hello. And as Brooke mentioned, this is Charlie Eleftheriou
from the Provider Communications Group here at CMS, and Ill serve as
your moderator today. Id like to welcome everyone to this Hospital
Value-Based Purchasing National Provider Call. This call is part of the
Medicare Learning Network, your source for official CMS information for
Medicare fee-for-service providers.
Todays call will provide an opportunity for CMS to discuss the
Percentage Payment Summary Report and operational details for the first
year of the program. Our CMS team will be going over slides to help you
be better prepared to use the reports that will be available on your
QualityNet account.
Following the presentation, well hold a question and answer session for
participants to call in and provide input and ask questions, and we
encourage you to use this opportunity to seek clarification about the
program and the report youll be receiving by the end of the month.
Before we get started, there are a few items that Id to cover. One,
there is a slide presentation for this session. A link to the
presentation and todays announcements was e-mailed to all registrants
earlier this afternoon.
If you did not receive the e-mail, please check your spam or junk mail
folders for an e-mail from the CMS National Provider Calls resource box,
or the presentation can be found by visiting the CMS National Provider
Calls Web page at www.cms.gov/npc, as in National Provider Calls.
Thats cms.gov/npc, and then click on the National Provider Calls and
Events link on the left side of the screen and find todays call by date
in the list.
Next, a reminder that this call is being recorded and transcribed, and
an audio recording and written transcript will be posted to the Hospital
Value-Based Purchasing and CMS National Provider Calls Web sites within
approximately three weeks.
Also, wed like to thank those of you who submitted questions when you
registered. Your questions were shared with todays speakers to help
prepare for this and future calls.
Lastly, please note that resources and contact information related to
todays call are available on slides 43 and 45 of todays presentation.
With all that said, Id like to now turn the call over first presenter,
Jean Moody-Williams who will provide opening remarks and give an
overview of goals for todays presentation. Jean?
Jean Moody-Williams: Thank you so much, Charlie, and hello. This is
Jean, and I am the Group Director for the Quality Improvement Group in
the Center for Clinical Standards and Quality. Id really like to,
again, thank you for joining the call today.
This National Provider Call was developed specifically for hospitals
that will be included in the Hospital Value-Based Purchasing program.
And as Im sure many of you know, this program is designed to promote
better clinical outcomes for hospital patients as well as really to
improve the experience of care during the hospital stay. And we do this
by rewarding acute care hospitals with incentive payments for quality of
care they provider to Medicare beneficiaries.
Our goal today is to provide you with an overview of what to expect when
your receive your fiscal year 2013 Percentage Payment Summary Report,
and this will be coming in the next several weeks. We will also be
discussing important operational details for fiscal year 2013, which is
the first year in which value-based incentive payments will be made
under the Hospital Value-Based Purchasing program.
After this presentation, as was mentioned, we will provide you with the
opportunity to ask questions. We encourage your questions, but we do ask
that you hold them until the end of the presentation.
Before we get started, I wanted to just take a moment to thank you for
your feedback on the FY 2013 Hospital VBP Estimated Percentage Payment
Report. As you know, this was released back in July. And your feedback
about this report through the polling questions on the registration
pageits going to be used to help improve future reports, how we
communicate with hospitals about hospital value-based purchasing, and
just for continuous improvements. We want to make sure that what we are
providing is useful to you and providing good information, so, again,
thank you for those comments.
So, in addition to the presenters from CMS that will take part in
todays presentation, I also wanted to acknowledge our partners at the
MITRE Corporation. They are a federally funded research and development
center, and they may assist us with responding to some of the questions
today. So I just wanted you to know who will be on the call. And I also
thank my CMS colleagues who have worked hard to bring this program to
reality.
So now Id like to turn this over to our next presenter, Don Howard,
from the Center for Clinical Standards and Quality. Don?
Donald Howard: Thank you, Jean, and good afternoon, everybody. I just
want to reiterate Jeans point that the call is for the hospitals, and
the questions at the end of the call or presentation will also be for
those hospital providers. Again, my name is Don Howard, from the Center
for Clinical Standards and Quality and I am the Project Lead for the
Hospital VBP program.
Today were going to briefly review the key aspects of the Hospital VBP
program and the critical dates and milestones for the current program
year. We will discuss the Percentage Payment Summary Report that
hospitals will be receiving through their QualityNet accounts. Well be
describing the review and corrections process, as well as the appeals
process for denied corrections requests. We will also provide an
explanation of the methodology used to calculate the value-based
incentive payment and conclude our presentation, again, with your
questions and answers.
Slide 3: the Hospital VBP program was established by the Congress and
the Affordable Care Act, which added Section 1886(o) to the Social
Security Act. This program is designed to transform the payment of care
from a system based on volume of patient visits and procedures performed
to one based on quality of care provided to the Medicare beneficiaries.
Hospital VBP is a quality incentive program which is built on the
Hospital Inpatient Quality Reporting measure reporting infrastructure
and is considered the next step in promoting higher quality of care for
Medicare beneficiaries. The Hospital VBP section of the Patient
Protection and Affordable Care Act strives to reward hospitals for
providing high-quality care to patients at a lower cost.
We view the value-based purchasing as an important driver in that change
and moving toward rewarding better value and outcomes, which in turn
will lead to better health outcomes.
The Hospital VBP is funded through a 1 percent reduction in fiscal year
2013 from the participating hospitals diagnosis-related group or DRG
payments and will gradually increase to 2 percent by fiscal year 2017.
The money that is reduced will be redistributed to the hospitals based
on their total performance scores, or TPS, as required by statute. And
the actual amount earned by the hospitals will depend on the actual
range and distribution of all of the total performance scores.
The Hospital VBP program can only use measures that have been in the
Hospital IQR program, and results published on Hospital Compare for at
least one year. There are no additional data submissions required for
the program.
Slide 4: Who is eligible for the Hospital VBP program? The Hospital VBP
program defines hospitals by statute as Section D hospitals located in
the 50 States and the District of Columbia. Not every hospital is
eligible for the Hospital VBP program; however, more than 3,000
hospitals nationwide will be eligible for the fiscal year 2013 Hospital
VBP program.
Slide 5: The Hospital VBP program does not apply to hospitals subject
to payment reductions because they did not meet the requirements for
Hospital IQR program for the applicable fiscal year. This program also
does not apply to hospitals and hospital units excluded from the
Inpatient Prospective Payment System, or IPPS, such as psychiatric
rehabilitation, long-term care, childrens, and cancer hospitals.
Other exclusions for the Hospital VBP program include hospitals cited by
the Secretary for deficiencies during the performance period that pose
an immediate jeopardy to patients health or safety of patients, as well
as hospitals that do not meet the minimum number cases, measures, or
completed surveys.
Finally, Hospital VBP does not apply to hospitals that have received a
waiver from the Secretary of the Department of Health and Human Services
after an exemption request by their State. An example of this is:
Maryland received a waiver for the fiscal year 2013 program year through
this process, which requires submission of a new exemption request
annually.
It is important to note that excluded hospitals will not have the
program years reduction percentage withheld from their DRG payments for
the Hospital VBP program. For fiscal year 2013, that reduction is 1
percent.
Next slide, slide 6. This slide represents an overview of where we are
in the current program year. As you can see on the slide, hospitals were
provided their Estimated Payment Percentage Summary Report in late July
of this year. By November 1, CMS intends to notify hospitals of their
actual fiscal 20-year excuse me, fiscal year 2013 value-based
incentive payment through the fiscal year 2013 Payment Percentage
Summary Report.
Hospitals will have 30 days for review and to submit a corrections
request once the report is posted to QualityNet. For any denied
corrections request, hospitals may submit an appeal within 30 days of
receiving CMSs evaluation of their request. CMS requires that a
hospital first submit a corrections request and receive an unfavorable
decision as part of the review and corrections process before a hospital
can request further reconsideration under the appeals process.
Hospitals will not have their base operating DRG payment amounts reduced
by 1 percent until the value-based incentive payments begin in January
2013. CMS intends to incorporate the 1 percent reduction and value-based
incentive payment adjustments simultaneously into the claim system in
January of 2013. CMS will also reprocess the claims submitted for the
first quarter of the fiscal year 2013 in January 2013.
Next slide, slide 7: The purpose of the reports. This table provides an
overview of the reports for the calendar year 2012, along with the
purpose of each of these reports and the time periods used in the report
development.
On February 29, CMS made available to hospitals their dry run reports to
help educate them about Hospital VBP program and its scoring process.
The dry run reports are an educational opportunity to understand and
prepare for the future impact of the Hospital VBP program. CMS is not
anticipating updating the dry run reports for future years because they
are a product of a one-time simulation.
In late July, CMS provided each hospital participating in the Hospital
VBP program with its Estimated Value-Based Incentive Payment Percentage
Report. The purpose of this report was to give hospitals an idea of what
their total performance score and value-based incentive payment
adjustments percentage might be for the first year of the program.
The Estimated Percentage Payment Summary Report used a different
performance period than was published in the Hospital VBP Final Rule
because the data for the entire fiscal year 2013 performance period was
not available at the time of the Estimated Reports creation. This was
due to the timeframe for data submission. CMS is not anticipating
updating this report for future years.
The focus for todays presentation is the Actual Percentage Payment
Summary Report. Your hospitals Actual Percentage Payment Summary Report
will use the performance period that was published in the Hospital VBP
Final Rule which is July 1st of 2011 to March 31st of 2012. Only the
results in this Actual Percentage Payment Summary Report will have an
actual financial impact on your hospital. CMS intends to provide
eligible hospitals with this report on an annual basis that will reflect
each fiscal years actual program results.
Hospitals ineligible due to exclusions, such as not meeting the minimum
number of cases, measures, or completed surveys, will also receive a
report with indicators and footnotes to help explain the rationale for
the ineligibility.
Next slide, slide 8: Your hospitals Percentage Payment Summary Report
for fiscal year 2013 program will look very similar to your hospitals
Estimated Percentage Payment Summary Report. It will be divided into
three main sections.
The Percentage Payment Summary Section summarizes the results of the
Hospital VBP program and shows the hospital score for the total
performance, for the clinical process of care domain, and patient
experience of care domain, along with the hospitals value-based
incentive payment percentage.
The Clinical Process of Care Domain Summary Section shows the details
for the 12 clinical process of care measures used to calculate your
hospitals Clinical Process of Care Domain score.
Lastly, the Patient Experience of Care Domain Summary Section shows the
details for the eight patient experience of care dimensions used to
calculate your hospitals patient experience of care domain score. Well
discuss each of these sections of this report in more detail in the
following slides.
Next slide, slide 9. As you can see in this slide, the Percentage
Payment Summary Section of the report shows a hospitals total
performance score or TPS, the average score in its State, and the
national score. It is important to note that the data on this slide and
the data in the subsequent slides are simulated numbers provided for
illustrative purposes only.
In this example, the hospital received a total performance score of 71,
which is higher than its State and national average. The total
performance score is comprised of the weighted clinical process of care
domain score of 51.8 and weighted patient experience of care domain
score of 19.2, shown in the second table.
The weighting of 70 percent and 30 percent are applied, respectively, to
the unweighted domains to arrive at these numbers. If your hospital did
not meet the requirements to receive a score, N/A, or not
applicable, will appear in the field. Note that the clinical process of
care domain will always show N/A for the HCAHPS base score and the
consistency score fields as these are not applicable for this domain.
The Actual Value-Based Payment Summary Fiscal Year 2013 Section, which
is the third table in this report, summarizes the change to your
hospitals base operating DRG payments for fiscal year 2013. These
calculations are performed according to the methodology in the fiscal
year 2013 IPPS Final Rule which was published in the Federal Register on
August 31st of this year.
In this example, a TPS of 71 for this hospital will yield a percent of
base operating DRG earn-back of 1.42 percent, a net positive change in
base operating DRG amount of 0.42 percent, and a value-based multiplier
of 1.0042.
The value-based multiplier is the number that CMS will multiply by the
base operating DRG amount for each discharge at your hospital occurring
in fiscal year 2013 due to the Hospital VBP program. Well explain how
the total performance score is converted into the value-based multiplier
later in this presentation.
Slide 10: The clinical process of care domain summary section provides
details on the 12 clinical process of care measures for fiscal year
2013. This section shows the baseline and the performance rates for the
clinical process of care measures, as well as the numerators,
denominators that were used to calculate these rates.
Each of the 12 measures is listed by their measure identifier, followed
by the measure title. If your hospital did not meet minimum case
requirements, or no data was submitted for a particular measure, N/A
will appear in the applicable field.
Slide 11: Additionally, the Clinical Process of Care Domain Summary
Section will display the benchmarks and the thresholds for each measure
along with the hospitals achievement points, improvement points, and
measure scores, as well as displays the conditional excuse me
condition procedure scores.
Remember that the points are awarded on each measure for improvement and
achievement. Improvement points are rewarded by comparing your
hospitals performance on a measure during the performance period with
your hospitals performance on that same measure during the baseline
period, whereas achievement points are awarded to your hospital by
comparing your hospitals performance on a measure during the
performance period with all hospitals performance during the baseline
period.
The measure score shown on the fifth column is the greater of the
improvement or achievement points. The last column in the report
presents your hospitals score for the condition or procedure and is the
sum of the measures that the condition of that condition or procedure.
Next slide, slide 12: An example: We will look at the first condition
on this sample report, acute myocardial infarction. There are two
measures listed under this condition, AMI-7a and AMI-8a. For AMI-7a,
this hospital was awarded no points, indicated by N/A. For AMI-8a, this
hospital was awarded 6 points for that measure, which is the higher of
the improvement and achievement scores for that measure. The sum of
these two measures resulted in a score of 6 for the acute myocardial
infarction condition score.
Next slide, slide 13: When you take a closer look at the AMI-8a, we see
that the hospital received zero improvement points, since this
hospitals performance rate of 0.9667 is less than this hospitals
baseline rate of 1.0000, whereas the hospital received 6 achievement
points, since its performance rate of 0.9667 is more than the
achievement threshold of 0.9186.
The improvement and achievement points awarded for this hospital are
calculated using formulas defined in the Hospital VBP Final Rule. Using
the greater of the improvement or achievement points, the measure score
for AMI-8a is 6.
Next slide, slide 14: For AMI-7a, N/A is shown for improvement points
since this hospital has no baseline rate and no performance rate.
Looking at the top of the graphic on this slide, this hospital did not
meet the minimum case requirement during the baseline period to receive
a baseline rate. Both the numerator and denominator showed two cases,
resulting in N/A for the baseline rate. This hospital also did not
submit data during the performance period, resulting in N/A for
performance rate.
Please remember the numerator represents the number of patients that
received a specific care on a given quality of measure, while the
denominator represents that number of measure-specific discharges used
for quality of measure calculations.
The measure score for AMI-7a is N/A since the hospital was not awarded
achievement or improvement points. However, the condition score is 6
since this is the sum of AMI-7a and 8a measures. The calculations for
the other clinical process of care measures will follow the same scoring
methodology.
Next slide, slide 15: Clinical Process of Care Domain Summary. At the
bottom of the Clinical Process of Care Domain Summary page, youll see
that the clinical process of care summary totals. This shows the number
of measures used to compute a hospitals clinical process of care domain
score. A minimum of 4 measures with 10 cases per measure is required to
compute a hospitals clinical process of care domain score.
For this example, this hospital has 10 eligible measures out of the 12
clinical process of care measures. The unweighted and weighted clinical
process of care domain scores are also listed on this page. The
unweighted normalized clinical process of care domain score is your
hospitals total earned points for the clinical process of care domain
divided by the total possible points, multiplied by 100.
An example: This hospital earned 74 out of the possible 100 points from
the 10 eligible measures. Using the formula, the unweighted normalized
clinical process of care domain score is 74. The weighted clinical
process of care domain score is the hospitals unweighted score of 74
multiplied by 70 percent, to arrive at the 51.8.
Next slide, slide 16: The Patient Experience of Care Domain Summary
Sections provide details on the eight patient experience of care
dimensions, which includes the four values, the benchmarks, the
thresholds, and a hospitals dimension scores, which are based on the
rates associated with the patient experience of care dimensions from the
baseline and performance periods.
The scoring methodology for the patient experience of care domain is the
same as the clinical process of care domain. The score awarded for each
dimension is the greater of the improvement or achievement points. N/A
would appear if your hospital did not meet the minimum 100 completed
surveys to receive a score.
Next slide, slide 17: The dimension appearing in the bold italic font
would be your hospitals lowest dimension score from the performance
period. Note: This score is based on a formula and not the value of the
performance rate.
This lowest dimension score is used to calculate your HCAHPS consistency
score. It is important to note that hospitals can earn consistency
points only on their lowest patient experience of care dimension.
Next slide, slide 18: At the bottom of the Patient Experience of Care
Domain Summary page, you will see the patient experience of care domain
summary totals. This shows a hospitals basic base score and the
consistency score used to calculate the unweighted and weighted patient
experience of care domain score, along with the total number of
completed HCAHPS surveys for the performance period.
Remember that the HCAHPS base score is the sum of the hospitals score
from the eight patient experience of care dimensions. A hospital can
earn a total of 80 points towards this patient experience of care domain
score. For this example, this hospital earned 49 points out of the total
80 points.
The HCAHPS consistency score is the points that would be awarded based
on your hospitals lowest dimension score during the performance period.
The higher your scores lowest dimension score is above the floor, the
more consistency points your hospital will receive. A hospital can earn
between zero and 20 points towards your patient experience of care
domain score.
For this example, the hospital earned 15 out of the total 20 points. The
sum of the HCAHPS base score of 49 and the HCAHPS consistency score of
15 is the unweighted patient experience of care domain score. The
unweighted patient experience of care domain score of 64 is multiplied
by 30 percent to arrive at the weighted patient experience of care
domain score of 19.2.
This last field shows your hospitals total number of completed surveys
during the performance period. At least 100 completed surveys are
required to receive a patient experience of care domain score. In this
example, the hospital had 810 completed surveys.
Next slide, slide 19: Reviewing corrections process. Hospitals will
have an opportunity to review their hospital VBP data and submit any
necessary corrections within 30 days of when the reports are posted to
QualityNet. This requirement will enable CMS to evaluate corrections
requests and provide decisions on the requests to hospitals prior to the
appeals process.
The review and corrections process is designed to allow hospitals
corrections to condition-specific, domain-specific, and total
performance scores that will be made available on the Hospital Compare
Web site. It is not to be used to request reconsideration of a
hospitals eligibility status.
The review and corrections process is also a prerequisite to the appeals
process. Hospitals that believe their condition-specific scores,
domain-specific scores, or excuse me total performance scores have
errors should submit a corrections request through this process and must
be denied before pursuing any appeal. By adopting this review and
corrections process CMS believes that we will ensure that hospitals are
able to fully and fairly review their submitted data.
Next slide, slide 20: Hospitals seeking a correction must submit a
review and corrections request via QualityNet with the following
information: the date of the review and corrections request; the
hospitals CMS certification number or CCN; your hospital name for both
your hospitals CEO and excuse me QualityNet system administrator
(include their name, e-mail address, telephone number, and physical
mailing address); the type of the correction being requested; the reason
or reasons for the correction; and any supporting documentation as
necessary.
Next slide, slide 21: The appeals process. If a corrections request is
denied by CMS, hospitals may seek an appeal. A hospital must submit the
appeals request to CMS through QualityNet and within 30 days of CMS
evaluation determination from their corrections request.
CMS believes the appeals process allows hospitals to seek
reconsideration for errors that may have been introduced during the
total performance score calculation that may affect a hospitals
payment. The appeals process is not intended for hospitals to correct
underlying data errors, because those errors should have been corrected
as part of the review and corrections process which I just described.
The appeals process provides hospitals with the opportunity to appeal
the calculation of their performance assessment with respect to the
performance standards, as well as their total performance score. While a
hospital VBP program appeals process could potentially result in changes
to value-based incentive payments, we do not intend for the appeals
process to allow appeals of the value-based incentive payments. It is
important to reiterate that appeals process requires that hospitals must
submit a corrections request prior to submitting an appeal.
Next slide, slide 22: If CMS denies a hospitals corrections request
under the review and corrections process, a hospital may appeal based on
any of the nine scenarios which are listed on this slide. This includes
whether the achievement improvement points were calculated correctly,
the higher of the achievement or improvement for each measures or
dimension scores [was] properly used, the domain scores including the
normalization calculation for the clinical process of care domain [were]
calculated correctly, the proper lowest dimension score was used to
calculate the patient experience of care consistency points, the patient
experience of care consistency points were correctly calculated, the
correct domain scores were used to calculate the TPS, each domain was
weighed properly, the weighted domain scores were properly summed to
arrive at the total performance score, and/or a hospitals open and
closed status is properly specified in the CMS systems. The basis for
the appeal must be indicated on the appeals request form.
Next slide, slide 23: Again, hospitals seeking an appeal must submit an
appeals request via QualityNet with the following information, again:
the date of the appeal request, the date of the review and corrections
request, the date of the review and corrections decision from CMS, your
hospitals CMS certification number, your hospitals name; and, again,
the for your hospitals CEO and QualityNet system administrator,
include their name, their e-mail address, telephone number, and physical
mailing address; the basis for requesting an appeal; reasons for an
appeal; and any supporting documentation.
Next slide, slide 24: Review and corrections request and appeals
request forms. The review and corrections request and appeals request
forms can be found on the Hospital VBP section of the QualityNet Web
site.
From the Hospital VBP page, select the fiscal year of 2013 and choose
Review and Corrections Appeals, or you may enter the URL listed on
this page. Once youve completed the form you must submit the form via
My QualityNet and upload it to the HVBP Feedback Global Exchange Group.
For any assistance with this, please contact the QualityNet helpdesk at
qnetsupport@sdps.org.
Next slide, slide 25: Performance information posting on Hospital
Compare. Section 1886(o) of the Act requires that the Secretary make
information available to the public regarding individual hospital
performance in the Hospital VBP program.
CMS intends to publish hospital scores on Hospital Compare, which will
include measure scores, condition-specific scores, domain-specific
scores, and total performance scores. CMS anticipates we will post
hospitals performance information on the Hospital Compare Web site in
April of 2013. Financial postings such as incentive payment adjustments
to the Hospital Compare Web site will be discussed in future rulemaking.
I would like to now turn the next section over to Craig Caplan from the
Performance-Based Payment Policy Group in the Center for Medicare so he
can discuss the methodology used to convert a hospitals total
performance score into a value-based multiplier.
Craig Caplan: Thank you, Don. Next slide, slide 26: Listed on this
slide are the six steps to convert a hospitals total performance score
into a value-based multiplier, which we will discuss in further detail,
including a numerical example in later slides.
First, we estimate each hospitals total annual base operating DRG
payment amount using Medicare inpatient claims data. Second, we
calculate the total annual estimated base operating DRG payment amount
reduction across all eligible hospitals. Third, we calculate the linear
exchange function slope.
Fourth, we calculate each hospitals value-based incentive payment
percentage, which is also known as the percent of base operating DRG
earned back. Fifth, we compute the net percentage change in a hospitals
base operating DRG payment amount for each Medicare discharge. And,
lastly, we compute the value-based multiplier, which is also known as
the value-based incentive payment adjustment factor. On the following
slides we will discuss each step in detail, and then we will present a
numerical example of the calculation in a hypothetical situation.
Next slide please. Step 1: In order to determine the estimated
available amount for value-based incentive payments and to calculate the
payment exchange function slopes, we must first estimate each hospitals
total annual base operating DRG payment amount using Medicare inpatient
claims data. This amount is estimated using the MedPAR or Medicare
Provider Analysis and Review file.
For the fiscal year 2012 program year, we used the March update of the
fiscal year 2011 MedPAR file. An inflation factor is used for the
purpose of expressing the amount in fiscal year 2013 dollars. So, as we
noted in the fiscal year 2013 IPPS Final Rule, this inflation factor
does not affect the slope of the payment exchange function or the
resulting value-based incentive payment adjustment factors because it is
applied across all hospitals.
Our actuaries provided us with this inflation factor, which included
assumptions on changes in Medicare fee for service case mix and
discharge levels. In the fiscal year 2013 IPPS Final Rule, the estimated
available amount for value-based incentive payments was $963 million.
Based on the hospitals eligible for the actual fiscal year 2013 program,
the new estimated available amount is $964 million.
Next slide please. Were on slide 28. Step 2 is to calculate the total
annual estimated base operating DRG payment amount reduction across all
eligible hospitals. Statute requires that the total amount available for
value-based incentive payments to all hospitals must be equal to the
amount of the base operating DRG payment reduction as estimated by the
Secretary.
This amount is estimated by, first, we multiply each hospitals
estimated total annual base operating DRG payment amount from step 1 by
the applicable percent reduction which is 1 percent for fiscal year
2013. Then we sum that 1 percent of base operating DRG payment amounts
across all hospitals to determine the total annual base operating DRG
payment amount reduction.
Next slide please. Slide 29: Were on step 3, which is calculating the
linear exchange function slope. Statute requires that value-based
incentive payments be based on hospitals total performance scores, or
TPSs. CMS will use a linear exchange function to distribute the
estimated available amount of value-based incentive payments to
hospitals based on hospitals total performance scores, or TPSs.
On this slide, you can see the steps to calculate the linear exchange
function slope. Later, on slide 36, we present these steps as a
mathematical equation.
Next slide please. Slide 30 shows a graphic depiction of the linear
exchange function. As you can see, the linear exchange function slope
for the fiscal year 2013 program is 1.837.
Next slide please. Were on slide 31 and step 4, which is to calculate
each hospitals value-based incentive payment percentage. A hospitals
value-based incentive payment percentage is defined as the percentage of
the base operating DRG payment amount for each discharge that a hospital
has earned with respect to a fiscal year based on total performance
score, or TPS, for that fiscal year.
The formula to calculate each hospitals value-based incentive payment
percentage is shown on this page. The value-based incentive payment
percentage can be multiplied by the base operating DRG payment amount to
calculate the value-based incentive payment amount. The sum of all
value-based incentive payment amounts across all hospitals is equal, by
statute, to the total amount available for value-based incentive
payments to all hospitals, which is the total amount of base operating
DRG payment amount reductions across all hospitals in that fiscal year,
as estimated by the Secretary.
Next slide please. On slide 32, step 5, which is to compute the net
percentage change in the hospitals base operating DRG payment amount
for each Medicare discharge. This number is calculated as an interim
step in order to calculate the value-based multiplier, which is also
known as the value-based incentive payment adjustment factor. The net
percent change is the difference between the value-based incentive
payment percentage and the applicable percent reduction. The net percent
change may be positive, zero, or negative for the purpose of
calculating the value-based multiplier, which is, again, also known as
the value-based incentive payment adjustment factor, we express the net
percent change and base operating DRG payment amount as a number by
dividing the net percent change by 100 and removing the percent sign.
Next slide please. On slide 33, which is step 6, the final step to
compute the value-based multiplier. This is the number CMS would
multiply by the base operating DRG payment amount for each Medicare
discharge in the fiscal year. This represents the total effect of the
applicable percent reduction and the value-based incentive payment
percentage on the base operating DRG payment amount.
The value-based multiplier may be greater than, equal to, or less than
one. It is computed as 1 plus the net percentage change in base
operating DRG payment amount, which was from step 5, and this, again,
was expressed as a number.
Next slide please. Slide 34 shows an example. We will now show a
numerical example of the value-based multiplier calculation in a
hypothetical situation. For this example, we will show how to convert a
hospitals TPS of 71 to a value-based multiplier of 1.0042 using the six
steps we just discussed. Remember, these are simulated numbers for
illustrative purposes only.
Next slide please. On slide 35, step 1: This was to estimate each
hospitals total annual base operating DRG payment amount. This is
accomplished by adding together the estimated base operating DRG payment
amount for each Medicare discharge in fiscal year 2013.
This is calculated using the most recently available MedPAR files and
applying the inflation factor that was discussed earlier. For this
example, the hospitals estimated total annual base operating DRG
payment amount is $1 million.
Next slide please. Were on slide 36, step 2: To calculate the total
annual estimated base operating DRG payment amount reduction across all
eligible hospitals. To calculate this amount across all eligible
hospitals, we must first take each hospitals total annual base
operating DRG payment amount, and we multiply that number by the
applicable percentage for the program year. For this example, in step
2a, $1 million from the previous step is multiplied by the 1 percent for
fiscal year 2013, to arrive at $10,000. This would be repeated for each
eligible hospital fiscal year 2013.
In step 2b, we would sum this amount across all hospitals to arrive at
the total annual estimated base operating DRG payment amount reduction.
For this example, the total annual estimated base operating DRG payment
amount reduction across all hospitals equals $1 billion.
Next slide please. On slide 37, step 3: Here we calculate the linear
exchange function slope using the formula shown. For this example, the
linear exchange function slope would be equal to the $1 billion, which
was given in step 2, divided by $500 million to arrive at a linear
exchange function slope of 2; $500 million in this example is the sum
across all hospitals of each hospitals base operating DRG payment
amount reduction times its TPS score.
This is not the 2 that was used for this example is not the actual
linear exchange function slope for the fiscal 2013 annual excuse me
Actual Percentage Payment Summary Reports.
Next slide please. On slide 38, step 4: Here we calculate each
hospitals value-based incentive payment percentage. As you can see, the
1 percent reduction for fiscal year 2013, or 0.01, is multiplied by this
hospitals total performance score of 71, divided by 100, then
multiplied by the slope of 2, which was from the previous slide, to
equal 1.42 percent.
As we stated earlier, you could calculate a value-based incentive
payment amount by multiplying the value-based incentive payment
percentage by the base operating DRG payment amount. Recall that the
value-based incentive payment amounts to all hospitals in a given fiscal
year are required by statute to equal the total amount of base operating
DRG payment amount reductions to all hospitals in that fiscal year, as
estimated by the Secretary. We know that the actual value-based
incentive payment amount in a given fiscal year will depend on the
hospitals case mix and discharge volume.
Next slide please. Were on slide 39, step 5. We compute the net
percentage change by subtracting the applicable percentage reduction of
1 percent from the hospitals value-based incentive payment percentage
of 1.42 percent, to arrive at 0.42 percent. For the purpose of
estimating this example hospitals annual change in base operating DRG
payment amounts, you could take 0.42 percent of $1 million to arrive at
a $4,200 estimated net change.
Next slide please. On slide 40, step 6: In this final step, we compute
the hospitals value-based multiplier by expressing the net change in
base operating DRG payment amount as a number and then adding that
number to 1. So we remove the percent sign from the 0.42 percent, and we
divide that by 100 to get 0.0042. When we add that number to 1, we get
1.0042.
Because the net percentage change in base operating DRG payment amount
in this example scenario is a positive 0.42, the value-based multiplier
will be greater than 1. So for each discharge occurring at this hospital
in this example in fiscal year 2013, the hospital will receive a base
operating DRG payment amount under the Hospital VBP program that is
higher than it would have otherwise received.
In the event that the hospitals net percentage change in base operating
DRG payment amount is negative, then that hospitals value-based
multiplier for the fiscal year will be less than 1, and it will receive
a lower base operating DRG payment amount per discharge in the fiscal
year under the Hospital VBP program.
Next slide please. Were on slide 41. To summarize, this example of
hospitals fiscal year 2013 base operating DRG payment amount for each
discharge will be multiplied by 1.0042 under the Hospital VBP program.
This is a 0.42 percent increase.
The result is that this hospitals estimated annual base operating DRG
payment amount of $1 million would be increased to $1,004,200 million,
estimated $4,200 total increase for the fiscal year. The actual payment
in the fiscal year will depend on the hospitals discharge during that
fiscal year.
Next slide please. Were on 42. As previously discussed, CMS will
incorporate the 1 percent reduction and value-based incentive payment
adjustment simultaneously into the claims system in January 2013. We
will also reprocess the claims for fiscal year 2013 discharges that are
paid prior to the implementation of the 1 percent reduction in the
value-based incentive payments in January 2013.
Going forward, after the applicable percent reduction and value-based
incentive payment amounts for fiscal year 2013 are incorporated into the
claims processing system in January, CMS will make the adjustment
simultaneously on a claim-by-claim basis by applying the value-based
incentive payment adjustment factor to the excuse me to the base
operating DRG payment amount for each claim paid. In future years, CMS
intends to incorporate the reduction and value-based incentive payment
adjustment into the claims system at the beginning of each fiscal year
in October.
I will now turn this presentation back to Don Howard to conclude the
presentation.
Donald Howard: Thanks, Craig. Just real quickly, on slide 43 we have
some bullet points that talk about where you can go with questions.
One, we hope the presentation has been useful in helping to prepare you
for when you receive your fiscal year 2013 Percentage Payment Summary
Report. On the slide you can see youll see a number of resources that
provide more details regarding the fiscal year 2013 Actual Percentage
Payment Summary Report as well as help you in assessing your report on
the QualityNet Web site should you need any assistance.
You may also refer to the Hospital-Inpatient Questions and Answers tool
located on the QualityNet Web site for Frequently Asked Questions. If
the FAQs do not answer your questions, you may submit the question using
the Questions and Answers tool. And as you can see on that last bullet
point, basically submitting questions using that URL but going to the
QualityNet site, selecting the Hospitals and Inpatient link in the
Questions and Answers box on the right-hand column.
So this concludes our presentation for today. Now we would like to turn
it over to the operator for any questions that you all may have.
Operator: Your first question comes from Deborah Brown.
Deborah Brown: Yes. This is Deborah Brown at Fort Loudoun Medical
Center. My question is, how do you determine the number of surveys? In
the example there were 810 surveys. I just wondered how did you arrive
at that number?
Craig Caplan: Hi. Yes. That is the number of completed surveys during
the performance period, that three-quarter period. All of the surveys
all the data is submitted through the hospital IQR program and CMS
calculates or determines the number of completed surveys in that
process.
Deborah Brown: So thats the surveys that the hospital conducts on
themselves?
Donald Howard: Its the number of HCAHPS surveys for patients
discharged from that hospital during the performance period.
Deborah Brown: OK. OK. Thank you.
Charlie Eleftheriou: Thank you. Next question.
Operator: Your next question comes from Sharon James-Nelson.
Sharon James-Nelson: . . . from Banner Ironwood Medical Center. I have
a question about the baseline and performance period. If our hospital
didnt open until November 2010, how does that affect our baseline
period?
Donald Howard: Sure. If you can just give us one second. Thank you.
Charlie Eleftheriou: Just one second please.
Donald Howard: Sharon, I just want this is Don Howard I just want
to clarify. You were saying that your hospital was open when in 2010?
Sharon James-Nelson: November 2010.
Donald Howard: OK. So, you know, again, depending on the number of
cases, meeting the program case minimums during that period of time
would make a difference on whether you would have a sufficient number
for baseline, and, in the end, that could then be an impact of whether
we are looking at your hospital more from a performance score versus the
achievement scores.
Sharon James-Nelson: But if we werent open during the baseline
period, which was July 1st, 2009 to March 31st, 2010, we would have no
baseline at all for any of the measures.
Donald Howard: So we would be looking at your hospital for
achievement only.
Sharon James-Nelson: Achievement only. All right. Thank you.
Donald Howard: Thanks.
Operator: Your next question comes from Rebeccca Schickling.
Rebeccca Schickling: Yes. I notice that, on slide 15, you had broken
out health-care-associated infections as the SCIP measure infections,
and thats different than our Estimated Percentage Payment Report, where
SCIP is all together with the VTE. Is that going to be broken out in the
future?
Donald Howard: Yes. This is Don Howard. Yes. Weve identified that,
and for this actual report that you will be receiving it is going to be
split out or separated and will be for subsequent years.
Rebeccca Schickling: And will that be expanded with some of the HS-7
measures as well, as far as other hospital infections?
Donald Howard: Again, depending on what measures are identified for
future years, you know, there is there is potential for that. That
will be indicated through future rulemaking.
Rebeccca Schickling: OK. Thank you.
Donald Howard: Yes.
Operator: Your next question comes from Lillian Rodgers.
Lillian Rodgers: Yes. This is Lillian Rodgers, Holzer Health System.
My question was, I know you gave a date that we could expect it on QNet,
but I did not hear itthe date that we can get our actual payment
report.
Donald Howard: CMS intends to have that report by November 1.
Lillian Rodgers: OK. Thank you.
Operator: Your next question comes from Dorothy Wright.
Charlie Eleftheriou: Hello, Dorothy?
Dorothy Wright: Yes. I was wondering if hello?
Charlie Eleftheriou: Hi.
Dorothy Wright: I was wondering if the slides would be available.
Donald Howard: Yes. Dorothy, this is Don Howard. Yes, the slides
actually for this presentation are already available. So those are going
to be available through and actually I believe you should have
received an e-mail that contained those as well. But
Charlie Eleftheriou: Yes. That and if you visit the National Provider
Calls Web page on the CMS Web site, the URL is
Dorothy Wright: OK.
Charlie Eleftheriou: . . . cms.gov/npc. In the left nav area on the
left on the left side of the screen youll see a link to presentation
and national call materials. You just find the call by todays date, and
on that call details page youll find the pertinent materials including
the presentation.
Dorothy Wright: OK. Thank you much.
Charlie Eleftheriou: Youre welcome.
Operator: Your next question comes from Mary-Michael Brown.
Mary-Michael Brown: Hi, good afternoon. Im with Mary-Michael Brown
with MedStar Washington Hospital Center in Washington, D.C. Thank you
very, very much for going over this the slide deck with us today. Its
very helpful.
Id like to refer to slide 13 please because I think I learn something
new every time I hear this. On slide 13, for AMI-8a, it looks like this
particular hospital had a baseline rate of 100 percent or 1. In their
performance period, their performance actually dropped, and it dropped
to about 97 percent.
I was always under the impression if you went backwards, you werent
going to get any points. But in this particular scenario, because, even
though they backslid, their performance rate exceeded the achievement
target, they actually got points?
Donald Howard: Yes. This is Don Howard. Hang on one second for me,
and well answer that for you.
Mary-Michael Brown: OK. Thank you.
Donald Howard: So, I just want to kind of reiterate, based on the
statute, it is the higher of either the achievement or the improvement.
So, in this particular case, they had no points for improvement, but
they did for the achievement.
Mary-Michael Brown: OK. But OK. Because it was my always my
understanding if we went backwards regardless, you forfeited points. So
this is very good news then.
Donald Howard: OK.
Mary-Michael Brown: Thank you.
Donald Howard: Im happy its good news. And but, yes, that has
that has been the case all along, although I apologize if we, in any
way, in previous calls have, you know, not communicated that clearly.
Mary-Michael Brown: Well, thats very kind of you. Its entirely
possible I misunderstood the first several times around, so thank you
very much.
Donald Howard: All right. Thank you.
Operator: Your next question comes from Claire Kapilow.
Claire Kapilow: Yes. Hi. I was wondering you know the table 16 that
was in the final rule? I was wondering if and I know those were just
temporary numbers but is there going to be a real table 16 published
on the CMS Web site sometime and, if so, when?
Donald Howard: Hang on one this is Don Howard. Hang on one second
for me, and well get a response to you here.
Claire Kapilow: Thank you.
Kimberly Spalding Bush: Hi. This is Kim Spalding Bush from CMS. And the
values in that table 16 in the IPPS final rule, I believe are the proxy
value-based incentive payment adjustment factors, and those are based on
a historical period of performance, and theres a note at the bottom
just for everyones information that gives you the historical baseline
and performance periods that those were based on.
So we will be publicly releasing the actual value-based incentive
payment adjustment factors. That cant happen until after the final
incentive payment reports are released, the review and correction
process happens, and the adjustments are made as a result of that, and
CMS has final total performance scores.
So after that is over we will publicly post those, and well try to make
it clear Im not exactly sure which Web site they will go up on. But
we will let you know where you can find them, and we will make them
publicly available.
Claire Kapilow: So probably like January then?
Kimberly Spalding Bush: Probably no sooner than January.
Claire Kapilow: Yes. OK. Thank you very much.
Kimberly Spalding Bush: Thank you.
Operator: Your next question comes from Tammy Porter.
Tammy Porter: Hello?
Charlie Eleftheriou: Hi.
Tammy Porter: Yes. I had a question about slide 18. You had mentioned
that there were 20 additional points possible with the HCAHPS. Could you
explain that a little further?
(Bill Hammer): Hello. This is (Bill Hammer) from CMS.
Tammy Porter: Yes.
(Bill Hammer): Yes. Consistency points run from zero to 20, and they
are intended to incentivize hospitals to improve the dimension on which
they score least. So they apply to the lowest scoring dimension. So we
look at the scores, and we figure out which of the hospitals eight
patient experience of care dimensions is actually lowest, and the
hospital then accrues points based upon that lowest dimension.
So the higher if that lowest dimension is at or above the national
median, the hospital would accrue all 20 points. If that lowest
dimension is near the bottom or the floor, it might get down to 1 or
even zero points in the consistency score component of patient
experience patient experience of care domain score.
Tammy Porter: And you would get that at the end of the fiscal year
that the additional points which show up on this payment summary
thats coming out?
(Bill Hammer): Thats right. Theyre all part of this theyre all
part of the patient experience of care domain score in this Hospital VBP
program, so theyre all calculated at the same time.
Tammy Porter: OK, very good. Thank you.
Operator: Your next question comes from Karen Silva.
Karen Silva: Hi. This is Karen Silva from San Juan Regional Medical
Center, and Id like to refer to slide 15, and its under the
Improvement section. There is a maximum point given of 10. I thought
you could only get 9 points maximum.
Donald Howard: Karen, if you can just give us a second please. Thank
you.
Karen Silva: Certainly.
Donald Howard: Karen, you know, we appreciate your keen eye in
pointing out that. You are correct. The maximum is 9. I apologize for
any confusion that we have presented.
Karen Silva: Well, thats good to know because our vendor is using
10, and I dont think they quite understand why I think there is I
assumed there was an error, so this is nice to know. Now, granted the 10
would it doesnt matter what the improvement, because 10 would beat
out that number anyway but well just be cognizant of that. Thank you.
Donald Howard: Thank you.
Operator: Your next question comes from Jennifer Snide. Jennifer,
your line is open. If you have your own phone muted, please unmute.
Jennifer Snide: Hi. Jennifer Snide at Dartmouth-Hitchcock.
Donald Howard: Hello, Jennifer.
Jennifer Snide: Im sorry. I didnt realize she was talking about me.
So my question was about the value-based estimate report versus the
report of that was in table 6 the number reported there. Were
noticing a tenfold difference, and I didnt know which one we should
trust. I mean, is it possible that there is a mistake somewhere?
Donald Howard: I just want to clarify: You said table 6?
Jennifer Snide: Table 16, excuse me, in the final rule.
Kimberly Spalding Bush: The difference is the performance periods and
the dates in the final rule on that table, and I apologize that I dont
remember them offhand, but it gives you the baseline and the performance
period that were used. And then
Jennifer Snide: Yes. Its just like a big difference even for those
two even with the difference in time period.
Kimberly Spalding Bush: Im not sure. And those were the dry run
performance periods, so the dry run report you got, that was based on
the TPS scores from that time period. I dont know if you saw a
difference between those two numbers, or do you think that the number in
the table isnt reflective . . . ?
Jennifer Snide: Im thinking our estimated report is incorrect. But
Im not sure if theres anything we can do about that.
Donald Howard: Im sorry? Which hospital are you with? I just want to
clarify.
Jennifer Snide: Im at Dartmouth-Hitchcock in Lebanon, New Hampshire.
Donald Howard: Thank you.
Charlie Eleftheriou: Give us one quick second to confer please.
Donald Howard: I tell you what, it would probably be helpful if so
we do a little more, you know, I think, digging into this, if you would
be able to go through the URL that we had listed towards the end of the
presentation here on QualityNet.
Jennifer Snide: Yes.
Donald Howard: And kind of give us, again, some of those details
which is going to be on the QualityNet.org. Again, thats going to be on
the Questions and Answers box, right-hand column.
Jennifer Snide: Yes. Can I respond to the question Ive already put
up there? Yes. Can I respond to the question Ive already put up there
or . . . ?
Donald Howard: Oh, you already submitted a question then, Im sorry.
Jennifer Snide: Yes, I have. I havent really got an answer though.
Donald Howard: OK. Yes. We are actually still compiling questions and
then working on the answers for those. So if you already submitted that
question, we will we will take a little closer look at this, and we
will respond back to you.
Jennifer Snide: OK. Thank you.
Donald Howard: Thanks.
Operator: Your next question comes from Mark Gross.
Mark Gross: Yes. I had a question regarding the 1 percent thats
being withheld and then redistributed based on the scores, and how that
relates to the correction and appeal process. Are you going to have to
recalculate all the hospital scores if that impacts the 1 percent
reduction?
Kimberly Spalding Bush: Hi. This is Kim Spalding Bush. Thank you for
that question. So we take the 1 percent reduction for the purpose of
estimating the available pool for value-based incentive payments,
because we are required by law to have the value-based incentive
payments to all hospitals, that that amount be equal to the amount of
reductions as estimated by the Secretary.
So once we have made that estimate, we use that amount to calculate the
exchange function slope, and then we calculate everybodys adjustment
factors prior to the review and correction period. Then if we found a
difference, we would just do a correction for that one hospital using
the exchange function slope that we established at the beginning of the
period.
So to answer your question: no, we are not going to change everyones
adjustment factors, because then they wouldnt have a chance to review
and correct those. So itll just be a correction to the one hospital or,
you know, whichever hospital is found an error through the review and
correction process. If CMS corrects their total performance score they
would get a new resulting value-based incentive payment adjustment
factor.
Mark Gross: OK. Thank you.
Operator: Your next question comes from Tom Jendro.
Tom Jendro: Yes. Good afternoon. This is Tom Jendro from the Illinois
Hospital Association, and thank you for taking my call. I had a question
on the claims that are going to be submitted beginning October 1st and
the ones that will be reprocessed after the final adjustment factors are
determined.
For the claims that are going to be processed after October 1st, will
the factors from the table 16 in the IPS final rule be used as an
interim? And then they will be corrected based on the final adjustment
factors that are published in January? So on an interim basis, will CMS
be using the VBP adjustment factors that were published in the table 16
final 2013 rule?
Kimberly Spalding Bush: This is Kim Spalding Bush, and no, the table
the factors in table 16 will never be used to adjust payments. They were
just proxy adjustment factors that we provided for the purpose of the
final rule.
So for claims for FY 2013 discharges that come in before we implement
the value-based incentive payment adjustment through the claims
processing system, they will just be paid as though they wont have
any adjustment. They wont have the 1 percent reduction taken, they
wont have a value-based incentive payment made, they will just be paid
as though they were being processed in the absence of the Hospital VBP
program. And then, come January, were going to reprocess them using the
final value-based payment adjustment factors. So those proxy factors are
never used in the payment system.
Tom Jendro: However, can I ask one corollary question? But the
readmissions factor that was published in table 15, that will be
incorporated beginning October 1?
Kimberly Spalding Bush: We dont have anyone from the readmission
reduction program in the room. So I dont think were able to answer
that question.
Tom Jendro: OK. Thank you.
Kimberly Spalding Bush: Sure.
Operator: Your next question comes from David Menashy.
David Menashy: Yes. Hello. My question was this, I was based on the
report we received I was trying to calculate the value-based
multiplier using the linear exchange function number you gave us on
slide 30. And Im and Im not getting to that number. Is there is
there a reason for that? Is that number not the final number?
Kimberly Spalding Bush: That is the number that was used for these
estimated reports.
David Menashy: Yes. So in other words just so I can just so I
understand, I would I would take my total performance score, divide it
by 100, times 0.01, times the linear exchange function. Right? Was that
was that the formula?
Kimberly Spalding Bush: OK. Were looking to make sure we got this
straight.
Charlie Eleftheriou: Give us one quick second please.
David Menashy: Sure.
Charlie Eleftheriou: Just one more second please.
David Menashy: No problem.
Kimberly Spalding Bush: So were not exactly sure where the issue might
lie. I think I mean, that is the correct payment exchange function, so
if you could send in your specific numbers to the e-mail address through
the question submission tool
David Menashy: OK.
Kimberly Spalding Bush: wed be happy to take a look at it and get
back to you.
David Menashy: OK. Thank you.
Operator: Your next question comes from Patrick Smith.
Patrick Smith: Hi. Can you hear me?
Charlie Eleftheriou: Yes, we can.
Patrick Smith: OK. My hopefully, this is a forum where you can
address my question. I work for Kaiser Permanente, and most of our
most of the importance of value-based purchasing for our organization is
reputation.
And so Im wondering if you can tell us what the plans are for making
the value-based purchasing scores and results available publicly, and if
thats going to be in Hospital Compare, or how this information will be
distributed?
Donald Howard: Yes. This is Don Howard. Youre correct. It will be on
Hospital Compare. And in the presentation I think we had talked about in
April 2013 is when we intend to have that information posted.
Patrick Smith: Do you give measure-level detail on performance, or
would it just be the total performance score, or domain-level scores and
a total?
Donald Howard: Well be giving measure-detail information.
Patrick Smith: OK. Thank you very much.
Donald Howard: Thank you.
Operator: Your next question comes from Katie Strasburg.
Katie Strasburg: Hello. This is Katie Strasburg from the Mayo Clinic
Health System in Eau Claire, Wisconsin, and my question is related to
the timeline on slide 42, where you were talking about the reprocessing
of the claims between October and January.
From previous communication, I had gotten the impression that hospitals
would need to resubmit claims in order for them to be reprocessed. Has
that changed? Im just kind of getting the impression that perhaps CMS
is going to do that automatically.
Kimberly Spalding Bush: Right. CMS will reprocess the claims, and the
hospital will not have to resubmit them.
Katie Strasburg: Wonderful. Thank you.
Operator: Your next question comes from the Melissa McFadden.
Melissa McFadden: Hi. This is Melissa McFadden with Parkview Health
System in Fort Wayne, Indiana, and I just had a question regarding the
estimate-based operating DRG payment amount for each Medicare discharge
fiscal year 2013. Where would I be able to access MedPAR files? Because,
for some reason, I thought that our assessment would come from 2010, so
Im kind of confused on that.
Kimberly Spalding Bush: So we actually, Im sorry, I should have the
answer to that and I dont. But we use the March update to the FY 2011
MedPAR file, because thats the most recent MedPAR file version that we
have. But if you could send the question in through the Web site, I can
respond with the actual URL where you can get the MedPAR files, because
I dont know.
Melissa McFadden: OK. That would be great. Thank you so much.
Operator: Your next question comes from Manal Almaghafi.
Manal Almaghafi: Hi. This is Manal Almaghafi from Oakwood Health
System in Dearborn, Michigan, and my question is about, will you be
will CMS be releasing the distribution of the adjustment factors with
the total performance scores that we can use to kind of gauge where we
are in comparison to the nationwide distribution of scores?
Kimberly Spalding Bush: We will release the actual payment adjustment
factors as soon as possible after we finalize the total performance
scores.
Manal Almaghafi: Will they be matched with the total performance
score?
Kimberly Spalding Bush: You mean will they be displayed like in a table
together?
Manal Almaghafi: Right. Yes. You have something similar to that on
in the previous document released in the but it had the right
percentiles for each estimated incentive rates percentile for each
region and according to bed size and urban versus rural hospitals, but
it didnt have the total performance scores.
Kimberly Spalding Bush: OK. Well, I think thats a very good
suggestion, and we can take it under consideration. As I said, we
havent finalized the exact format that were going to use to release
the final payment adjustment factors.
So if you could submit that through the Web site it would be useful,
because Im not exactly sure which document youre referencing, so we
could take a look at that and see if thats something that we could
provide.
Manal Almaghafi: Right, and I have done so. But it wasnt brought
up so thats why I wanted to bring it up.
Kimberly Spalding Bush: OK. Thank you for that.
Manal Almaghafi: Thank you.
Operator: Your next question comes from Ronald Low.
Ronald Low: On page 27, you talk about the inflation adjustment. Is
that used for anything other than to move the 1 percent up or down
according to inflation? And which inflation factor are you
usingConsumer Price Index or medical inflation or what?
Kimberly Spalding Bush: That was an adjustment factor that was used
specifically for the Hospital Value-Based Purchasing program, and it was
developed by CMSs actuaries. Its an inflation factor of 9.75 percent,
and it also takes into account increases expected increases in case
mix and discharge volume. And its used for the purpose of expressing
the estimated available pool in FY 13 dollars. But as we know, it
doesnt actually change the calculation of the payment exchange function
slope that we use. Its more just to give people an idea of what those
dollars look like in FY 13 dollars.
Ronald Low: So it doesnt have any impact on the checks you will
write or not write?
Kimberly Spalding Bush: It doesnt affect the payment exchange function
slope that we use to translate a total performance score into a payment
adjustment. So I think the answer is no, it doesnt affect your payment
amount.
Because the way that the exchange function slope is calculated, its in
the numerator and the denominator, and weve inflated it both places,
and so it doesnt it doesnt change it. We could have just expressed
it in FY 11 dollars, but then that doesnt give people a real clear
picture of what type of money potentially is in play under the program
in FY 13, but it doesnt affect your actual payment adjustment.
Ronald Lowe: Thank you.
Operator: Your next question comes from (Jeremy Gerard).
(Jeremy Gerard): Hi. This is (Jeremy Gerard) from the University of
Pittsburgh Medical Center. I was just wondering how the multipliers work
for our payments. I know theyre applied to our DRGs, but what happens
if we see a large rise in volumes of admissions, and then each DRG is
increased the same amount, but by the end of the year were ended up
paid more than we said we were supposed to be? Or the opposite could
happenwe could see a decrease.
Kimberly Spalding Bush: Right. If so we estimate the available amount
based on the MedPAR file for each hospital. But youre right: If one
hospital discharges more patients and another discharges fewer, we you
know, we think our estimate will be still pretty good, but it is an
estimate, and, as we said throughout the presentation, the hospitals
actual, you know, net result at the end of the year will depend on your
volume of discharges and also the case mix that you have. So if you are
discharging a lot of high-dollar DRGs, and they are all adjusted
upwards, then thats going to be a higher dollar amount change at the
end of the year.
(Jeremy Gerard): So theres no point where you say, OK. Well, they
got back the money that we said they would in total, and were going to
stop adjusting the DRGs.
Kimberly Spalding Bush: Right. Youre correct. We make an estimate of
the available pool prior to the beginning of the fiscal year. We
calculate the exchange function, and then we adjust everyones scores
based on their TPS, which is the best way we have to redistribute that
available amount. And we dont put a ceiling on that; we dont stop the
adjustment. So your factor will be your factor for all discharges
occurring in a given fiscal year.
(Jeremy Gerard): Great. Thank you.
Kimberly Spalding Bush: Sure.
Charlie Eleftheriou: And, Brooke, I think we have time for one more
question.
Operator: Your next question comes from Michael Moore.
Michael Moore: Hi, this is Michael. In terms of the January payments
for the October through December claims, will these be more of a GL
bottom-line repayment, or will they be done claim-by-claim level, and
will we be able to see, like, on the claims when you reprocess all the
claims?
Kimberly Spalding Bush: I think I need to talk to someone in the actual
claims processing area to get the correct answer for you on that. I
dont want to venture a guess. All I know is that they are going to be
reprocessed by the claims processing contractors, and I thought it was
through the usual claim adjustment process, but if that could mean more
than one thing, I should talk to a claims processing expert for you. So
can you submit that through the Web site, and I can give you the exact
answer?
Michael Moore: Sure. Thank you.
Kimberly Spalding Bush: Thanks.
Charlie Eleftheriou: OK. Thank you. Unfortunately, thats all the
time we have for today. Wed like to thank you for attending this
National Provider Call on the fiscal year 2013 Actual Percentage Payment
Summary Report. We hope this provided with a better understanding of
what to expect when you receive your report in the coming weeks.
Again, additional resources can be found on slides 43 and 45 of todays
presentation, and additional questions can be sent in through
qualitynet.org. The Web site, or the URL, is on slide 43. If we did not
to your question, that is the Web site to use. Please note that we
while we may not be able to answer every question, we will review them
all to help us develop Frequently Asked Questions, educational products,
and future messaging. Hope everyone has a great day and thanks again for
attending.
Thank you for viewing this Hospital Value-Based Purchasing video
slideshow presentation. The information presented in this presentation
was correct as of the date it was recorded. This presentation is not a
legal document. Official Medicare program legal guidance is contained in
the relevant statutes, regulations, and rulings.