1. Your Painless Medicare Update
Mike Everson, Director Reimbursement, Froedtert Health
Eddie Phibbs, Director, Eide Bailly

2. Electronic Health Records (E.H.R)
Continue to meet Meaningful Use
Audits of I/T assets are still on-going
Many new alternative payment models have I/T component
Is there potential similar program for SNF’s
Physicians and reporting requirements for MACRA – what happens if you haven’t invested in E.H.R.

3. Wage Index
Non-PPS hospitals are still competing for the same employees so you should understand your market
Wage index factor impacts SNF and other provider types for Medicare payments
One of the few remaining areas that you can directly impact your Medicare reimbursement

4. Occupational Mix Survey
Completing this accurately could help you significantly for PPS hospitals
Surveys are due by July 1 (which means Friday, June 30)
Forms and instructions are available on the CMS website

5. New Mandatory Medicare Bundles
The Models
Acute Myocardial Infarction (AMI) Model
Coronary Artery Bypass Graft (CABG) Model
Surgical Hip and Femur Fracture Treatment (SHFFT) Model
Cardiac Rehabilitation (CR) Incentive Payment Model
The first performance period for the new episode payment models will begin on July 1, 2017
The duration of the models is until December 31, 2021
Final rule issued December 20, 2016
In the final rule, CMS has delayed implementing downside risk until performance year (PY) 3.

6. Mandatory Cardiac Bundles
Two new payment models will support clinicians in providing care to patients who receive treatment for heart attacks, heart surgery to bypass blocked coronary arteries
Acute Myocardial Infarction (AMI) Model
Coronary Artery Bypass Graft (CABG) Model
The AMI and CABG Models will be implemented in 98 geographic areas, defined by MSAs

7. Updates of Joint Replacement Bundles
One new payment model will support clinicians in providing care to patients who receive surgery after a hip fracture, other than hip replacement. In addition, CMS is finalizing updates to the Comprehensive Care for Joint Replacement Model, which began in April 2016
Surgical Hip and Femur Fracture Treatment (SHFFT) Model
The SHFFT Model will be implemented in the 67 MSAs where the CJR Model is currently underway

8. Cardiac Rehab Incentive
New payment for cardiac rehabilitation following a heart attack or heart surgery
Cardiac Rehabilitation (CR) Incentive Payment Model
CMS will pay hospitals $25 per rehabilitation service provided to Medicare beneficiaries who receive care after a heart attack or bypass surgery
That payment rate will apply to 11 services per patient. CMS will pay $175 per service for those provided beyond those first 11 services
45 of the regions included in the cardiac rehabilitation program will overlap with the areas in which the new heart attack and bypass surgery initiative will be launched

9. MSA’s for New Bundles * Also Cardiac Rehab Incentive Market
98 MSA’s for Cardiac Bundles (AMI, CABG)
1,120 hospitals
Wisconsin & Minnesota impacted MSA’s include:
Madison
Milwaukee-Waukesha-West Allis *
Chicago-Naperville-Elgin, IL-IN-WI *
La Crosse-Onalaska, WI-MN
* Also Cardiac Rehab Incentive Market

10. Bundles Other Considerations
What impact are bundles having on you?
Wisconsin “narrow networks”
National employers, e.g. Walmart or Lowe's employees
Aurora Health Care, Aspirus in Wausau, Bellin Health in Green Bay, Gundersen Health System in La Crosse, ThedaCare in Appleton and UW Health in Madison - their hospitals and clinics are accessible to about 90% of Wisconsin's population. 
Integrated Health Network of Wisconsin, a competing consortium, includes Froedtert Health, the Medical College of Wisconsin, Columbia St. Mary's, Wheaton Franciscan Healthcare, Agnesian HealthCare and Ministry Health Care.

11. Hospital Outpatient Departments (HOPD)
HOPD's restriction on new departments
If you want to relocate an existing dept. what are the risks
Can you add new services
How will these get paid
Exception if you can demonstrate it's an ER

12. HOPDs
21st Century Cures Act passed in December 2016 newly built off-campus outpatient departments that were poised to accept patients prior to December 2, 2015, and submitted proper attestation to CMS are exempted from this site-neutral payment provisions
The 21st Century Cures Act also exempts facilities that had concrete plans in place to build a new off-campus outpatient department before Nov. 2, 2015

13. DSH Factor 3
DSH has been paid using Medicaid days and SSI days to estimate Factor 3 (DSH Uncompensated care)
CMS indicates they will begin using S-10 Bad Debt and Charity amounts no later than FFY2021
How are you tracking these amounts (Logs)
Can be a weak area for some facilities
CMS has estimated what Factor 3 would be using data from Worksheet S-10 (2014 cost reports)

14. Medicare Outpatient Observation Notice (MOON)
Enacted August 6, 2015, the Notice of Observation Treatment and Implication for Care Eligibility Act (NOTICE Act) requires hospitals and Critical Access Hospitals (CAH) to provide notification to individuals receiving observation services as outpatients for more than 24 hours explaining the status of the individual as an outpatient, not an inpatient, and the implications of such status
All hospitals and CAHs are required to provide the MOON beginning no later than March 8, 2017

15. 340B Drug Discount Program
Qualifications/Timing to Participate in 340B
January 2017 rule authorizes penalties for drug-makers who are found to be deliberately overcharging providers for drugs purchased under the 340B program
Fine up to $5,000
Also must offer refunds for the overcharges
New guidance on how the ceiling price is calculated
The new rule takes effect February 28 and will be enforced as of April 1
The federal 340B program requires drug manufacturers to provide outpatient drugs to eligible health care providers at discounts ranging from 20 percent to 50 percent.
The manufacturers must offer refunds - rather than requiring providers to request refunds, as is currently required.

16. 2017 Hospital Outpatient Prospective Payment
November 2015 Budget billed proposed Hospital Outpatient Departments (HOPDs) that began billing OPPS after November 1, 2015, would no longer be paid for most services under the OPPS after January 1, 2017
Reimbursed at a site-specific MPFS rate that is 50% of the OPPS rate starting January 1, 2017
The 21st Century Cures Act also exempts facilities that had concrete plans in place to build a new off-campus outpatient department before Nov. 2, 2015

17. Medicare Compare Websites
Compare websites – are you reporting data here on quality or somewhere else
More consumers will use the web to choose where to go
Same for your physicians and that is one component with MACRA

18. NGS Milwaukee Office Closing
Closing in summer 2017 – losing the personal connection
Cost report filing – can’t deliver in person

19. MAC (Audit) Issues
Home office costs – definitely a risk area with any MAC and seem to be scrutinized more and more
Commingling of visiting specialists space within RHC’s, Provider based clinics, other hospital space
Preventative visits, HCC Coding and everything around the move to value

20. CMS Innovation Center
New models for you to consider
Medicare Diabetes Prevention Program (MDPP) Expanded Model – begins January 1, 2018
The MDPP core benefit is a 12-month intervention that consists of at least 16 weekly core hour-long sessions, over months 1-6, and at least 6 monthly core maintenance sessions over months 6-12, furnished regardless of weight loss.
Oncology Care Model – began June 29, 2016
OCM-FFS episodes include all Medicare Part A and Part B services that FFS beneficiaries receive during the episode period; certain Part D expenditures are also included. Episodes will terminate six months after a beneficiary’s chemotherapy initiation.
The MDPP core benefit is a 12-month intervention that consists of at least 16 weekly core hour-long sessions, over months 1-6, and at least 6 monthly core maintenance sessions over months 6-12, furnished regardless of weight loss.

21. Questions?

22. Thank You! Mike Everson, Director Reimbursement, Froedtert Health
Eddie Phibbs, Director, Eide Bailly