Transcript MEDICARE WAGE INDEX - HFMA Western Michigan

MHA Update
Western Michigan HFMA Chapter
Nov. 14, 2012
Vickie R. Kunz
Senior Director
Health Finance
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Medicare
• Wage Index Data Scrubbing Deadline Extended to
Dec. 10.
• Inpatient
– CMS VBP Final Factors
– MHA Claims Level Analysis Distributed
• 2013 Final Rules
– Outpatient Prospective Payment System (OPPS)
– Home Health (HH)
– Physician Fee Schedule (PFS)
• Medicare Advantage
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Wage Index Timeline
• Early Oct. 2012 – Release of PUF for FY 2014 AWI
• Oct. 2012 – MHA Wage Index Webinars
• Dec. 10 – Deadline for change requests for
FY 2014 AWI.
– (note this date was changed from Dec 3)
• FY 2014 AWI will use data from cost report FYEs:
– Sept. 2010 – Aug. 2011
• Sep 30, 2010
Dec 31, 2010
Mar 31, 2011
June 30, 2011
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FY 2013 Medicare IPPS Rule
• Hospital financial impact of
readmissions reduction program and
inpatient value based purchasing
program (VBP) effective Oct. 1.
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VBP Adjustment Factor
• Oct 30 - CMS released actual
percentage payment summary reports
for year 1 of the hospital inpatient VBP
program on MyQualityNet.
• Hospitals are encouraged to review,
and if necessary, request recalculation
of their hospital’s performance scores
on each condition, domain and TPS by
Nov. 30.
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IPPS Impact Report – Pg 2
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Claims-Level DRG Analysis
• Reflects average CMI by clinical product
line, 2012 to 2013.
• Includes volume distribution among
severity levels.
• Comparison to Michigan and US.
• Includes both Medicare FFS and
Medicare Advantage claims.
• Distributed to CEOs/CFOs/RDs Nov. 8.
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2% Sequestration Cut
• No guidance issued regarding how
implementation of the Medicare FFS 2% acrossthe-board sequestration cut
– effective 2013 – 2021
– mandated by the Budget Control Act of 2011.
• Michigan annual impact projected at $144M.
– IPPS payments reduced $95 million
– OPPS payments reduced $34 million
• Takes effect Jan. 1, 2013, unless Congress
takes other action.
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2013 OPPS Final Rule
• Final rule released Nov. 1.
• Effective Jan. 1, 2013.
• See Nov. 12 Weekly Mailing for MHA
Advisory Bulletin.
• MHA will provide hospital-specific
analysis within next few weeks.
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Highlights OPPS Final Rule
• Net 1.9% increase after MB update and
ACA-mandated adjustments.
• No change in $2,025 outlier threshold.
• Change in methodology for developing
APC weights.
• Extension of non-enforcement of direct
supervision for OP therapeutic services
for CAHs and small rural hospitals with
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100 or fewer beds.
2013 OPPS Highlights
• Review of 2013 weights for top 20
APCs reflects a 1.2% decrease in
payments for Michigan hospitals.
• Significant decrease for high-volume
cardiac APCs
– Use June 18 OPPS detail report to
estimate impact for your hospital.
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Cont., 2013 OPPS Final Rule
• No major changes or expansion to the
hospital OQRP, which will require
hospitals to successfully report on 24
quality measures, up from 23 required
for 2013.
• No guidance on implementation of 2%
sequestration adjustment.
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2013 Physician Fee Schedule
• Absent Congressional action, Medicare
payments will drop by nearly 27% in
2013.
• MHA, AHA and others continue to urge
Congress to permanently fix the flawed
physician payment formula.
• Rule to be published in Nov. 16 Federal
Register.
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Cont., 2013 PFS
• New payment for primary care and care
coordination to physicians and qualified
NPP for post-discharge transitional care
management services in the 30 days
following a hospital, SNF, observation
or community mental health center
discharge.
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Outpatient Therapy Services
• 2013 collection of claims-based data on
patient functional status over an
episode of PT, OT and SLP services.
• All therapists will be required to report
new G-codes and modifiers on the claim
form:
– initial evaluation, every 10 visits and at
discharge.
– CMS will adopt testing period thru June 30.15
CRNAs
• Beginning Jan. 1, CRNAs may directly
bill and be reimbursed by Medicare for
services determined by the state to be
within their scope of practice, including
chronic pain management services.
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Imaging Services MPPR
• 25% multiple procedure payment reduction to
the technical component of diagnostic
cardiovascular services.
• 20% MPPR to the technical component of
diagnostic ophthalmology services provided
by the same physician (or group practice) to
the same patient on the same day.
• May impact hospital payments for technical
component for services performed.
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Value-Based Modifier (VBM)
• In 2015, CMS will implement a new VBM for
groups of physicians with 100+ eligible
professionals.
• Groups would have the option to participate
and place 1% of their payments at risk for
upward or downward adjustment based on
quality and cost of care provided.
• No program for hospital-based physicians at
this time.
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Medicare Advantage Plans
• As of Oct 2012, 30 plans in Michigan, with 455,000 or approximately
26% of Michigan’s 1.7 million Medicare beneficiaries enrolled.
– Up to 20 plans in some counties.
• Review MA payment rate for all plans.
• CAH entitled to Medicare cost reimbursement.
• Each MA plan may determine own utilization model and is not
required to maintain electronic transactions.
• Many MA have instituted “RAC-like” utilization programs.
• Matrix of MA plans by county available at MHA website – updated
quarterly, with MHA Monday Report article.
– See Oct 29 MHA Monday Report for latest info
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Medicaid Issues
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FY 2013 Budget
• MHA and hospital advocacy efforts resulted in
restoration of $8.8 million in GME funding and
$36 million pool for hospitals that provide
service to those in rural areas.
• MSA has not finalized its methodology for the
$36 million rural pool but has indicated that
$25 M will be distributed through HRA with
remaining $11 M to be distributed through
Medicaid FFS upon CMS approval.
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CSHCS Beneficiaries
• HMO enrollment for children dually
eligible for Title V and XIX.
• Change effective Oct. 1, with enrollment
staggered through March.
• Currently, hospital payments for this
population of 20,000 children are
approximately $135 million annually.
– MSA working on adjustment for MACI and
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HRA payment impact.
Historical Info - QAAPs
• See MHA Advisory Bulletin # 1331 in
Oct. 8, 2012 weekly mailing.
– Provides description of tax base and
revenue distribution for each of the 4
QAAPS
• FFS, HMO, DSH, Psych
• MSA updates hospital data for both
payment allocation and tax annually.
– FY 2013 based on FY 2011
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FY 2013 Pools
• MACI – pool not finalized but expected to
approximate FY 2012 at $640 million with
downward adjustment for CSHCS shift.
• HRA – same as FY 2012 target of $736
million with upward adjustment for CSHCS
shift.
• Psych – Same as FY 2012 at $45 million.
• DSH - $60 million - OP Uncomp DSH pool.
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Primary Care Physician Rate Increases
• Medicaid rates increased to Medicare rates
for certain E/M and vaccination administration
codes for services provided by designated
primary care physicians.
• MSA proposed policy released Oct 20, with
comments due Nov 20.
• CMS final rule released Nov 1.
• See MHA comment letter – Nov. 12 Monday
Report.
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Jan. 1, 2013 Hospital Rates
• MSA released a proposed policy
indicating that it will update hospital
DRG and per-diem rates to incorporate
updated hospital cost and wage data.
• Consistent with historical policy
• Draft rates to be distributed to hospitals
by mid-November, with final rates out by
Dec. 1.
• Statewide rate delayed until Jan. 2014. 26
Cont., DRG Rate Update
• Effective Jan. 1, Medicaid will change
from paying claims based on rates and
weights in effect on date of admission to
paying based on date of discharge.
– Consistent with Medicare and other payers
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FY 2009 DSH Audits
• Hospitals encouraged to review audit
adjustment reports from PHBV Partners
distributed in late Aug/early Sept.
• Prior year audit reports available on
MSA’s website.
• 2009 report due to CMS by Dec. 31.
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Final DSH Policy
• Oct. 1, MSA released its final policy
using a multiple-step DSH process:
– Initial DSH payment
– Interim DSH payment revision
– Final DSH audit-related redistribution
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GME & HRA Payments
• Nov GME Payments
• Nov HRA Payments
• Nov HRA Tax Due
-
Nov 27
Dec 3
Dec 24
• Dec GME Payments
• Dec HRA Payments
• Dec HRA Tax Due
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Dec 26
Jan 10
Jan 24
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AHA Survey Results
• Annual MHA Advisory Bulletin that
compares 2010 AHA Survey results for
Michigan hospitals to those nationally.
• Includes margins, ED visits, OP visits,
IP admissions, days, births, ALOS, etc.
• See MHA Advisory Bulletin # 1320,
included in 04/16/12 weekly mailing.
• Powerpoint and Excel files available.
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BCBSM Regulatory Overhaul Proposed
• Governor Snyder’s proposal announced Sept. 11.
• In 2014, BCBSM would transition from regulation
under PA 350 to become a nonprofit mutual
insurance company regulated under the insurance
code like all other Michigan health insurers.
Cont., BCBSM Proposed Changes
• MHA advocacy effort guided by MHA
Board of Trustees.
• General understanding and acceptance
of the need for BCBSM to convert to a
mutual disability company, with some
modifications.
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Cont., BCBSM Proposed Changes
• Codify the Office of Financial Insurance
Regulation (OFIR) Commissioner’s
order regarding BCBSM provider
reimbursement and the requirement that
the provider class plan address
governmental payment shortfalls for the
traditional product until a date certain.
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Cont., BCBSM Proposed Changes
• Alter the state insurance code to ensure
that the existing language in HIPAA
remains in place and require all insurers
and HMOs to offer coverage without
regard to pre-existing conditions for
people who were insured and lost their
coverage.
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Cont., BCBSM Proposed Changes
• Directed the hospital contingent of the
PHA to seek commitments from
BCBSM to ensure continuation of the
governance and PHA committee
activities and pursue shared strategic
objectives related to pay for
performance and other mutually
beneficial activities.
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Cont., Proposed BCBSM Changes
• Trust fund known as Michigan Health &
Wellness Foundation.
• Funded with up to $1.5 billion over 18 years.
• SB 1294 stipulates that the Governor will
maintain primary control over the
membership of the trust fund board.
• Senate established that 60% of annual
expenditures would be used to subsidize
Medicare supplemental policies by lower
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income seniors citizens.
Cont., Proposed BCBSM Changes
• It’s estimated that BCBSM would pay
approximately $100 million annually in
business and property taxes to state
and local government.
• Protect senior citizens by freezing
Medigap coverage rates for 4 years.
• Subject to approval by Michigan
legislature and BCBSM board.
MHA Resources
• Monday Report is available FREE to anyone and is distributed
via email each Monday morning.
– Go to website and select “Newsroom”, then Monday Report
• MHA Monday Report – electronic publication issued weekly
• Request password if you don’t have one.
– Email Donna Conklin at [email protected] to obtain MHA
member ID number
• Advisory Bulletins – Extensive communications available only to
MHA members, as needed. (Require password to obtain from
website).
• Hospital specific mailings as needed for various impact
analyses, etc.
• Periodic member forums
• See mha.org for other resources.
• Monthly Financial Survey provides free benchmarking of
financial and utilization statistics.
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???Questions???
Vickie Kunz, Senior Director, Health Finance
Michigan Health & Hospital Association
110 West Michigan Avenue, Suite 1200
Lansing, MI 48933
Phone: (517) 703-8608
Fax: (517) 703-8637
email: [email protected]
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