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Session 3 DATA – Collect, Analyze, Use, Share

Presented by:

Veronica M. Bencivenga, CPA Director HMM Consulting Office: (631) 265-6289 E-Mail: vbencivenga@horanmm.com www.horanmm.com

June 19, 2015

Complimentary webinar sponsored by:

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HMM BillTAG (Billing Transition Action Group)

Today’s Agenda… The DATA shows we have a Healthcare spending problem

Collecting the DATA – Electronic Medical Records

Analyzing, Using and Sharing DATA

Hot Off The Presses - New Resources

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The Problem

Soaring Cost of Healthcare • The US spends 16% of it’s GDP on healthcare –

nearly double all other countries – Schoolhouse Rock! Tyrannosaurus Debt

• New York spent nearly double the national average per recipient

• Not reflected in quality – ranked 50th in hospitalizations

• Unless spending is contained, the New York Medicaid Program will no longer be sustainable

www.health.ny.gov/health_care/medicaid/redesign/docs/mrtfinalreport.pdf

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• Fee for Service Credit Card

(Volume) – Medicaid and

traditional Medicare – Patient uses any

provider – Care not coordinated,

duplicative services

The Solution

• Managed Care Gift Card (Value)

– Costs are predictable – Services and

specialists are coordinated based on comprehensive plan of care

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Numerous Major Initiatives

Payment Reform tied to QUALITY

New York State Nursing Home Quality Pool

(NHQP)

Immunizations

Health Information Exchange

Source: http://healthbizdecoded.com/2013/05/hies-meeting-the-sustainability-challenge/

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NATIONAL STATE LOCAL PROVIDER CONSUMER

NHIN National Health Information Network is a group of stakeholders and integrated delivery networks that are collaborating to securely exchange health information electronically. The group includes federal agencies, local, regional and state-level Health Information Exchange Organizations (HIOs) and private organizations

Statewide Networks

SHIN-NY

RHIOs Regional Health Information Exchange Organizations, or RHIOs, are the nodes connecting together the statewide health network.

EMR/EHR Electronic Medical Record – Records maintained by individual providers and insurance plans to document treatment and coordination of benefits

PHR Personal Health Record - Where individuals can track and aggregate their health information

• Insurance Companies

• Other companies that provide health services and products

Health Information Exchange

http://nyehealth.org/what-we-do/statewide-network http://www.healthit.gov/policy-researchers-implementers/nationwide-health-information-network-nwhin

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Collecting the Data: Electronic Medical Records

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Claims Clearing House

CPOE

Labs

eMedNY MDS 3.0

Is this It?

Immunizations

Data Collection Initiatives

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Pepper

eFINDS

QAPI

eMedNY

MLTC

A&I Reporting

5 Star Rating

MDS 3.0

Claims Clearing House

Therapy

CQM

eMAR

RHCF

HIE CPOE

Immunizations

NHQI

Data Collection Initiatives

PBJ

CMS-Payroll-Based Journal (PBJ) System for SNF’s to submit staffing and census information

http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/NursingHomeQualityInits/Staffing-Data-Submission-PBJ.html

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EMR 1.0

INTUITIVE • Predictive software

• Identify potential care issues

• Early detection of patient decline

• Suggest corrective actions based on accepted clinical guidelines

DYNAMIC • Assessments, Discharge

Tracking, Clinical Decision Support Software (CDSS), QI/QA, Tasking/Workflows, Interfaces

• Quarterly Updates

• Analyzing Data

• Dashboards

• Business Intelligence

STATIC • Census, MDS,

Careplans, Therapy, Billing

• Annual Updates

• Collecting Data

EMR Evolution

EMR 2.0 EMR 3.0

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• Selecting an EMR is HARD-NO PERFECT EMR

• People make decisions, EMR is just a TOOL that helps

• EMR WILL NOT fix poor workflow/performers • ALL departments need to be included • On-going software maintenance and

training are CRITICAL to success • Workflow MUST be changed • Productivity is REDUCED when implementing

new features • EMR is a series of overlapping investments

whose benefit accumulates OVER TIME

8 Truths

of EMR

Truth about EMR

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Increasing EMR Adoption

• Make list of things you wish your EMR could do

• Schedule an “optimization” or “tune-up” session with vendor

• Create plan to implement new features

• Review updates and release notes for new features/functions and get trained

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Multiple Systems

Risk Factors when Clinical and Financial systems not integrated:

Information at Risk

Which system's data will you rely on? Which do you give to the OMIG, RAC, other auditors Discrepancies will need to be investigated

Demographic Financial Payers (to send out with patient), Authorizations (Case management) Census

Usually admission interface only, discharges have to be done independently in both systems

Contacts Emergency and ordering, notes by social workers, etc. Level of Care clinical determination, changes with condition of patient

MDS Missing, corrections, in-activations Diagnosis

Increasing importance on accuracy and maintenance as payment bundling coming soon

Analytics/Stastics (i.e., Hospital

Readmissions)

Which system's data will you rely on? Discrepancies will need to be investigated

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Analyzing, Using and Sharing

DATA

Metrics important for SNF CMS, DOH and Payers monitoring: • Length of stay • Functional outcomes/improvement • Patient satisfaction • Admissions and readmission rates • Infection and fall rates • Five-star ratings • Survey and inspection results • EHR adoption and use

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Analyzing Data

• Interpret – What does it mean • What reports are you getting, when

and why • This should be evolving

• Understand your outcomes • IDT approach to investigating • Consultant – Fresh eyes

• What value do you bring to a partnership

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Using Data

• Use – Take action • Show staff what is working

(Celebrate the GOOD STUFF) • Identify focus areas for change

or improvement • i.e., Admissions, Clinical

Operations, Discharge Planning, Billing and Collections, etc.

• Make meaningful operational changes

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Sharing Data

• Share – Communicate • Staff • Families • Partners (Hospitals, Providers) • Payers • Community • Be proactive!

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Tell your DATA story!

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Transition Issues Being Worked on by

DOH

Current Issues • Bedhold

• Plans required to cover Bedhold (page 13 of OHIP). If plan not paying, contact Vallencia Lloyd (Mainstream) or Mark Kissinger (MLTC)

• Vallencia Lloyd - vallencia.lloyd@health.ny.gov • Mark Kissinger – mark.kissinger@health.ny.gov

• Discharging • Homeless or no place to discharge to • SNF/Patient doesn’t agree with the Plan – Appeal Rights • Can current permanent residents be discharged via managed

care? – YES, but this isn’t new • NHTD, Money Follows the Person, etc.

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Current Issues

• Plan needs to submit a demographic change which will make the address be the nursing home so notices are going to the right place.

• Guiding patients to plans you contract with – YES YOU CAN!

• Plans have restrictions on “marketing”, facilities aren’t marketing

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• Medicaid Recertification • NYC issues - HRA providing

training

DOH Responds • Uniform Coding effective 1/1/2016 • DOH Working on new universal 3559 • Rosters

• Step 1 – make current NH Roster electronic via HCS • Step 2 – Build enhanced Roster to include Managed Care enrollees

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Resources

Transition Resources

WHAT’S NEW

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“Dear Provider” letter from John Ulberg, Medicaid CFO • Benchmark Rates • NAMI Collection • Standard Billing Codes

DOH Contact Info

• State Complaint Number for MLTC Problems: (866) 712-7197 – e-mail DOH Technical Assistance Center (TAC): mltctac@health.ny.gov – You can also cc: your e-mail to: ican@complaints@cssny.org

• State Complaint Number for Mainstream (MMCP) Problems: (800) 206-8125 • Request Conflict-Free MLTC Assessment:

– call NY Medicaid Choice at 1-855-222-8350 – complaints re Conflict-Free - CF.Evaluation.Center@health.ny.gov

• For MLTC enrollment complaints call NY Medicaid Choice – (855) 886-0570 (Advocates line) – (888) 401-6582 (Consumers line) – E-mail: mltctac@health.ny.gov

• ICAN - OMBUDSPROGRAM FOR FIDA & MLTC – (844) 614-8800 – Website: icannys.org – E-mail: ican@cssny.org

26 Source: http://www.wnylc.com/health/news/41/

Transition Resources

Source: http://www.health.ny.gov/health_care/medicaid/redesign/docs/nursing_home_transition_final_policy_paper.pdf

Source: https://www.health.ny.gov/health_care/medicaid/redesign/docs/2015-01-22_nh_transition_rev.pdf

Source: https://www.health.ny.gov/health_care/medicaid/redesign/docs/formatted_nh_faq_part_a.pdf

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Transition Resources

Source: https://www.health.ny.gov/health_care/medicaid/redesign/2015-march_transition_nursing_home_population_benefits_to_mmc_faq.htm

Source: http://www.leadingageny.org/linkservid/C66B6D15-A63A-4ADC-4443557902B1CB66/showMeta/0/

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Managed Medicaid Plans

• Do you qualify for Medicaid? • What level/type of health care service do you need?

– Routine (CHP, FHP)

– Episodic (Maternity, joint replacement)

– Chronic (Community based LTSS, Nursing Home)

• Are you eligible for Medicare (Dual Eligible)? • Are you in a FIDA County (NYC, Nassau, Suffolk, Westchester)?

MMC

Medicaid Managed Care (aka Mainstream)

MLTC

Managed Long Term Care

or

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MLTC Plans – By County

Source: http://www.health.ny.gov/health_care/managed_care/mltc/consumer_guides/

Select region, then scroll to bottom on page to see county info:

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Topics for Remaining Webcasts

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Future Topics 6/26:

What’s in a PLAN Get a look inside how Plans work, how they get paid and what a rate sheet looks like

7/24:

Comprehensive Review of Managed Care Transition for SNF

7/31:

- Value Based Purchasing (VBP) – What is it and where do SNF’s fit in - Uniform Coding effective 1/1/2016

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Have questions, want to suggest a specific topic, or want to review something in greater detail:

e-mail us at: HMMBillTAG@horanmm.com

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Questions?

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Thank you.

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