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WSHPCO Annual Conference, Session 5C 1. 2 3 Payer20132012 Medicare Hospice Benefit87.2%83.7% Managed Care or Private Insurance6.2%7.6% Medicaid Hospice.

Published byMarlene Martin Modified over 8 years ago

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Presentation on theme: "WSHPCO Annual Conference, Session 5C 1. 2 3 Payer20132012 Medicare Hospice Benefit87.2%83.7% Managed Care or Private Insurance6.2%7.6% Medicaid Hospice."— Presentation transcript:

1 WSHPCO Annual Conference, Session 5C 1

2 2

3 3

4 Payer20132012 Medicare Hospice Benefit87.2%83.7% Managed Care or Private Insurance6.2%7.6% Medicaid Hospice Benefit3.8%5.5% Uncompensated or Charity Care0.9%1.2% Self Pay0.8%0.9% Other Payment Source1.2% 42014 NHPCO Facts and Figures on Hospice Care

5 Payer20132012 Medicare Hospice Benefit91.2%89.0% Managed Care or Private Insurance4.0%4.4% Medicaid Hospice Benefit3.1%4.3% Uncompensated or Charity Care0.6%0.8% Self Pay0.5%0.6% Other Payment Source0.6%0.9% 52014 NHPCO Facts and Figures on Hospice Care

6 WashingtonNational Total Deaths51,0522,529,792 Medicare Beneficiary Deaths41,5602,081,847 Medicare Hospice Beneficiary Admissions 24,021 58% of Medicare deaths 1,304,994 63% of Medicare deaths Medicare Hospice Beneficiary Deaths 17,961 43.2% of Medicare deaths 946,017 45.4% of Medicare deaths Medicare Hospice Total Days of Care1,385,256 days91,044,459 days Medicare Hospice Mean Days/Beneficiary Medicare Hospice Median Days/Beneficiary 58 days 23 days 70 days 24 days Medicare Hospice Total Payments Medicare Hospice Mean Payment/Beneficiary $240,695,096 $10,021 $14,917,921,218 $11,444 6www.HospiceAnalytics.com

7 2013 Hospice Utilization (Medicare Hospice Deaths / Total Medicare Deaths) www.HospiceAnalytics.com 7

8 2013 Medicare Hospice Mean Days of Care / Beneficiary WA #40: 58 National: 70 www.HospiceAnalytics.com 8

9 2013 Medicare Hospice Median Days of Care / Beneficiary National: 24 WA #28: 23 www.HospiceAnalytics.com 9

10 2013 Medicare Hospice Beneficiaries Levels of Care (days) www.HospiceAnalytics.com 10

11 2013 Mean Medicare Hospice Payments/Beneficiary WA #31: $10,021 National: $11,444 www.HospiceAnalytics.com 11

12 BNAF 12 2009-2016 2017 ACA Prod Adjustment Sequestration Quality Reporting Penalty 2 Tier RHC + SIA

13 MEDICARE PAYMENT: HISTORICAL REVIEW

14 Show me the money…

15 www.HospiceAnalytics.com 15 8/6/15: http://www.gpo.gov/fdsys/pkg/FR-2015-08-06/pdf/2015-19033.pdfhttp://www.gpo.gov/fdsys/pkg/FR-2015-08-06/pdf/2015-19033.pdf

16 16www.HospiceAnalytics.com

17 17 MEDICARE PAYMENT

18 18www.HospiceAnalytics.com

19 19www.HospiceAnalytics.com

20 20 Type of CareNew RateVersus Continuous Home Care (CHC)$944.79$929.91 Inpatient Respite Care (IRC)$167.45$164.81 General Inpatient Care (GIP)$720.11$708.77 Wage Index Adjustments Market Basket Increase 1.6% Final Year BNAF Phase Out Adjustment Factor 1.018% -2% for Hospice Agencies that DO NOT Submit Required Quality Data

21 Revenue Modeling Dec. 2015 January 2016 100 * 161.89 * 31Days 1-6060 + $501,859.00 10186.890146.8$467,576.10 20186.880146.8$479,979.20 30186.870146.8$492,382.30 Census = 10040186.860146.8$504,785.40 50186.850146.8$517,188.50 60186.840146.8$529,591.60 70186.830146.8$541,994.70 27 DeathsSIA: 2 hrs x 2 days4252 30 DeathsSIA: 3 hrs x 3 days10630 30 DeathsSIA: 3 hrs x 4 days14173

22 Revenue Modeling Dec-15 January 2016 - $34,283 100 * 161.89 * 31Days 1-6060 + $501,859.00 10 186.8 90 146.8 $467,576.10 20186.880146.8$479,979.20 30186.870146.8$492,382.30 40186.860146.8$504,785.40 Census = 100 50186.850146.8$517,188.50 60186.840146.8$529,591.60 70186.830146.8$541,994.70 27 DeathsSIA: 2 hrs x 2 days4252 30 DeathsSIA: 3 hrs x 3 days10630 30 DeathsSIA: 3 hrs x 4 days14173

23 Revenue Modeling Dec-15 January 2016 100 * 161.89 * 31Days 1-6060 + $501,859.00 10186.890146.8$467,576.10 20186.880146.8$479,979.20 30186.870146.8$492,382.30 40186.860146.8$504,785.40 Census = 10050186.850146.8$517,188.50 60186.840146.8$529,591.60 70186.830146.8 $541,994.70 27 DeathsSIA: 2 hrs x 2 days4252 + $40,000 30 DeathsSIA: 3 hrs x 3 days10630 30 DeathsSIA: 3 hrs x 4 days14173

24 Revenue Modeling Dec-15 January 2016 100 * 161.89 * 31Days 1-6060 + $501,859.00 10186.890146.8$467,576.10 20186.880146.8$479,979.20 30186.870146.8$492,382.30 Census = 100 40186.860146.8$504,785.40 50186.850146.8$517,188.50 60186.840146.8$529,591.60 70186.830146.8$541,994.70 27 DeathsSIA: 2 hrs x 2 days4252 30 DeathsSIA: 3 hrs x 3 days10630 30 DeathsSIA: 3 hrs x 4 days14173

25 Revenue Modeling Dec-15 January 2016 100 * 161.89 * 31Days 1-6060 + $501,859.00 10186.890146.8$467,576.10 20186.880146.8$479,979.20 30186.870146.8$492,382.30 Census = 100 40186.860146.8$504,785.40 50186.850146.8$517,188.50 60186.840146.8$529,591.60 70186.830146.8$541,994.70 27 DeathsSIA: 2 hrs x 2 days4252 30 DeathsSIA: 3 hrs x 3 days10630 30 DeathsSIA: 3 hrs x 4 days14173

26 Summary of the 8/6/15 Hospice Final Rule www.HospiceAnalytics.com 26

27 Hospice Reimbursement Modeling (based on levels of care only, no SIA or wage index adjustment) www.HospiceAnalytics.com 27

28 28www.HospiceAnalytics.com

29 29www.HospiceAnalytics.com

30 30

31 Routine Home Care 31

32 32 5Cost Reporting Period (mm/dd/yyyy) From:01/01/2013To:12/31/2013 6Provider Identification Number 6National Provider Identifier (NPI) Number 7Type of Control (see instructions) 1 PART II Title XVIIITitle XIXTitle XVIIITitle XIX Unduplicated Enrollment DaysUnduplicated Skilled NursingNursingOtherTotal Medicare DaysMedicaid DaysFacility Days UnduplicatedUnduplicated Days 123456 8Continuous Home Care 27 9Routine Home Care 144,0545,22927,075 17,946167,229 10Inpatient Respite Care 12614126 8148 11Inpatient General Care 40491 150645 12Total Hospice Days 144,5845,33427,201 18,131168,049 PART III Title XVIIITitle XIX Skilled NursingNursing Title XVIIITitle XIXFacility OtherTotal 123456 13Number of Patients Receiving Hospice Care 1811 109327 3412,773 Total Number of Unduplicated Countinuous 14 Care Hours Billable to Medicare 15Average Length of Stay 634860 4660 16Unduplicated Census Count1874157387 2,633

33 33 CON- RECLAS- EMPLOYEE TRACTED SIFICATION SALARIESBENEFITSTRANSPOR-SERVICES (Increase/ COST CENTER DESCRIPTIONS(From TATION(From TOTALDecrease) Wkst A-1)Wkst A-2)(See inst.)Wkst A-3)OTHER(col. 1-5)(Fr Wkst A-6)SUBTOTAL 12345678 GENERAL SERVICE COST CENTERS 10100Capital Related Costs-Bldg and Fixtures 691,567 20200Capital Related Costs-Movable Equipment 235,254 30300Plant Operation and Maintenance 17,204 40400Transportation - Staff 50500Volunteer Service Coordination125,14656,4921,296 66,334249,268 60600Administrative and General1,232,703556,4556,0012,962,3512,847,5107,605,020 INPATIENT CARE SERVICE 101000Inpatient - General Care 111100Inpatient - Respite Care VISITING SERVICES 151500Physician Services116,71452,686 355,663 525,063 161600Nursing Care7,474,4773,374,055516,33387,970256,55311,709,388-2,079,1859,630,203 ####1620Nursing Care -- Continuous Home Care 171700Physical Therapy 181800Occupational Therapy 213,929 191900Speech/ Language Pathology 202000Medical Social Services 1,340,082 212100Spiritual Counseling 525,174 222200Dietary Counseling 232300Counseling - Other152,14668,68010,8821,862564234,134 242400Home Health Aide and Homemaker476,637215,15927,14335,03455,581809,554 ####2420HH Aide & Homemaker -- Cont Home Care 25 Other 36,758

34 34 CONT- RECLAS- EMPLOYEE RACTED SIFICATION SALARIESBENEFITSTRANSPOR-SERVICES (Increase/ COST CENTER DESCRIPTIONS(From TATION(From TOTALDecrease) Wkst A-1)Wkst A-2)(See inst.)Wkst A-3)OTHER(col. 1-5)(Fr Wkst A-6)SUBTOTAL 12345678 OTHER HOSPICE SERVICE COSTS 303000Drugs, Biological and Infusion Therapy 1,411,342 ####3030Analgesics ####3031Sedatives / Hypnotics ####3032Other -- Specify 313100Durable Medical Equipment/Oxygen 1,429,230 323200Patient Transportation 333300Imaging Services 3,448 343400Labs and Diagnostics 23,109 353500Medical Supplies 202,627 363600Outpatient Services (incl. E/R Dept.) 722,344 373700Radiation Therapy 383800Chemotherapy 39 Other HOSPICE NONREIMBURSABLE SERV. 505000Bereavement Program Costs487,292219,96917,72116548,890774,037 515100Volunteer Program Costs 525200Fundraising 53 Other Program Costs209,88894,7463,702 182,388490,724 100 Total11,309,6015,105,270583,0783,443,0458,230,70328,671,697

35 35

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