Kathy Whitmire HomeTown Health, LLC

 Spending for health care in the United States has been growing faster than the economy for many years, posing a challenge not only for the federal government’s two major health insurance programs, Medicare and Medicaid, but also for the private sector. Measured as a percentage of the nation’s gross domestic product, total spending for health care increased from 4.7 percent in 1960 to 15.2 percent in 2007,

 The growth of health care spending in the long term will be determined primarily by growth in the cost of medical care per person /per capita.  Georgia = $6550  Florida = $16,000+

 Payment Incentives and penalties for quality and patient satisfaction – VBP  Payment reductions for readmissions,  Payment reductions for HAI’s and HAC’s  Meaningful Use – Quality + CPOE – Erx  HIPAA 5010 and ICD-10  HCAPHS – penalty for not reporting

 Value-based purchasing (VBP), a program authorized by the Patient Protection and Accountable Care Act of 2010, gives the Centers for Medicare & Medicaid Services (CMS) the power to base a portion of hospital reimbursement payments on how well hospitals perform in 25 core measures.  Quality + Patient Satisfaction (HCAPHS)  Based_Purchasing_Raises_the_Stakes.html Based_Purchasing_Raises_the_Stakes.html

 Hospitals’ baseline scores already have been set, and the initial nine-month performance evaluation period begins July 1.  Beginning with discharges on Oct. 1, 2012 (fiscal year 2013), the payment phase will kick in. CMS will start by withholding 1% of the base DRG reimbursement paid to hospitals. That money can be earned back based on how well each hospital scores on the performance measures during the evaluation period.  The amount initially withheld will rise by 0.25 percentage points per year until it is capped at 2% in 2017 and beyond.

 The move is intended to help CMS flex its muscles and move from being a passive bystander to an active buyer of what its officials have deemed higher-quality healthcare.

 October 26 th – Medicare Webinar ◦ Learn exactly what VBP is and what it means to your hospital next Wednesday-  SHIP GRANT PROGRAM ◦ Begins in Jan 2012 – Focusing on preparing our member hospitals for VBP and ACO’s  Partnering with Michelle Madison – MMM, Mike Scribner – SHP, and Beth Spoto – Spoto & Assoc.

 HOSPITAL READMISSIONS REDUCTION PROGRAM ◦ Beginning in fiscal year 2013, inpatient prospective payment system hospitals with higher-than expected readmissions rates will experience decreased Medicare payments for all Medicare discharges.

 For discharges occurring on or after October 1, 2008, Inpatient Prospective Payment System (IPPS) hospitals do not receive the higher payment for cases when one of the selected conditions is acquired during hospitalization (i.e., was not present on admission). The case is paid as though the secondary diagnosis is not present.

Example

 The American Recovery and Reinvestment Act of 2009 specifies three main components of Meaningful Use: ◦ The use of a certified EHR in a meaningful manner, such as e-prescribing. ◦ The use of certified EHR technology for electronic exchange of health information to improve quality of health care. ◦ The use of certified EHR technology to submit clinical quality and other measures.  Simply put, "meaningful use" means providers need to show they're using certified EHR technology in ways that can be measured significantly in quality and in quantity.

 Medicare will be reducing Physician fee schedule to 99% in 2015, 98% in 2016 and 97% in  Hospitals will receive a 1% reduction beginning in 2015 and continue to max 2% Further penalties could be imposed if 75% of EP's have not met meaningful use by The Secretary will be able to reduce the regular fee schedule to 96% and then 95% but no further.

 Begins November 9 th with training and checklists to ensure that all hospitals are ready! ◦ Discuss Example of changes ICD month - ICD-10 Readiness Program will be led by Sherry Milton, Coding & Documentation Expert will begin in January

NEWS:  New Members – Elbert Memorial & Chatuge Regional  New Partners – VendorMate and Data Rx – 340B for hospitals  New DCH Commissioner David Cook confirms keynote at Fall Conference EVENTS:  Oct 12 th – Medicare Monthly Webinar  Oct 12 th – Medicaid Redesign First Meeting – SAVANNAH  Oct 13 th – CNO – Case Mgr Workshop  Oct 18 th - Physicians’ Lunch and Learn – MU Series – Session 2  Oct 19 th – Interqual Cerme User Group Webinar  Nov 9 th, 30 th, Dec 7 th, 14 th – Countdown to HIPAA 5010  Nov 16 th -18 th – HTH Fall Conference  Dec 12 th -13 th – HIPAA Compliance Officer Training  Jan 25 th – 26 th – GA Rural HIT Conference – Macon

 Medicaid & CHIP Redesign  The Georgia Department of Community Health (DCH) issued a Request for Proposal for a comprehensive assessment and recommended redesign of Georgia's Medicaid Program and Children's Health Insurance Program (CHIP/PeachCare for Kids ® ).  The redesign initiative will focus on solution planning, innovation and strategic options for managing the care and financing of Georgia's Medicaid and CHIP populations. On July 26, 2011, DCH awarded the consulting contract to Navigant Consulting, Inc.  SAVANNAH – Oct 12 th – First Meeting

ANNOUNCING HOMETOWN HEALTH 12 TH ANNUAL FALL CONFERENCE November – Callaway Gardens SPEAKERS AND SESSIONS INCLUDE: KEY NOTE SPEAKER: David Cook, Commissioner of the Dept of Community Health DCH Medicaid – HP - CMO – Navigant Discussion PANEL: Dr Jerry Dubberly, Medicaid Director and Cheryll Collier, HP Georgia Redistricting Update - David Tatum, CHOA A New Day in the Future of Health Care SPEAKER: Kirk McGhee, Vice President and Regional Counsel for Kaiser Permanente GA Health Information Exchange – GA-HITREC – Dr Denise Hines Value Based Purchasing / ACO Discussion – Led by Michelle Madison, Attorney Health Insurance Exchange – What Hospitals Need to do to Prepare - Ryan Teague 4 Requirements for Survival in 2012 and Beyond – PANEL: Change -Sue Spivey, Technology- Brenda Jarrett, Leadership – Jeff Dunn, Revenue Mgmt – Lynn Byrd