Current and New HSCRC

Current and New HSCRC
Reporting Requirements
Oscar Ibarra & Katie Eckert
HSCRC Update: Abstract Tape
• Changes to reporting requirements under the
new Waiver Model
• New Tape Layout and Fields
• New timeline for reporting
• Issues with FY 2014 Q1 Data
• Quarterly Reconciliations
New Data Fields for FY 2014
• Separate variables for each race category to
accurately capture each component of the
patient’s race (i.e., White and Black, or Black
and Asian, etc.).
• Variable to capture the patient's country of
origin, and
• Variable to capture the patient’s preferred
spoken language for a health-related
New Timeline for FY 2014
Month-Ending Data
January and February 2014
Due Date
March 17th*
Updated January, February and March 2014
April 15th
April 2014
May 15th
Q3 Final (Jan – Mar 2014)
May 30th
Updated April and May 2014
June 16th
Updated April, May and June 2014
July 15th
Q4 Final (Apr – Jun 2014)
August 29th
Challenges with FY 2014
Medicaid ID errors
Preferred language
Race variables left blank
Variations in zip code to county mapping
Reconciliations between case mix and
financial data
Significant Changes for FY 2015
• Potentially add the CMS discharge
disposition for planned admissions
• New waiver requirements based on
residency, coding zip code accurately will be
• Transition to ICD -10
– Working with MHA around testing grouper
software and submission of test data to St. Paul
Data Workgroups
• Data & Infrastructure Workgroup
– Will develop Data recommendations to the
HSCRC for the new hospital All-Payer Model
– Public meetings
• Kick off Feb 6
• Data Workgroup
– Discuss new data elements for the coming FY
– Discuss data issues
– Case mix liaison participation
Brave New World: Changes to Hospital
Reporting Under the NEW Waiver
1. Changes to Traditional HSCRC Data Submissions
2. New Metrics to Monitor
3. New Platform for Reporting
Changes to Traditional HSCRC Data
1. Case Mix: Accelerated case mix reporting the
deadlines are changing.
2. Financials: “Enhanced” monthly financial
submissions more data elements
Accelerated Case Mix Reporting
• Final Data:
– OLD: Data reported approximately 90 days after quarter-end.
– NEW: Data reported approximately 60 days after quarter-end.
• Preliminary Data:
– OLD: Quarterly data reported approximately 45 days after quarterend
– NEW: Quarter-to-Date data reported approximately 15-17 days after
• HSCRC Goal: Monitor tenants of waiver on a more concurrent basis.
Operational Implications for Hospitals
• 20-30% reduction in the number of days to
finalize abstract data
– Chart Audits
– MHAC monitoring
– Clinical Documentation
– Curveball!: ICD-10 and additional HSCRC focus
on quality metrics
“Enhanced” Monthly Financial Submission
• “Enhanced” elements
– 4 data points now expanded
to 36 data points
– IP/OP now split into In-State
vs. Out-of-State
– IP/OP for Medicare (Fee-ForService vs. Non Fee-ForService) also split into InState vs. Out-of-State
Operational Implications for Hospitals
• New Internal Reports for Revenue and Utilization:
– State data and payer data are sourced from patient account data in
the patient accounting system and do not pass to traditional financial
– More data points from “live” patient data makes it even more
important to lock down posted financials in order to avoid reconciling
• Submission:
– Data Reporting 101: more data points = more room for error
– OLD: Manual Submission NEW: Upload Submission?
Operational Implications for Hospitals
• Reconciling:
– In-State vs. Out-of-State Split:
reconcile back to traditional Experience
Report data
– Payer Split: Only reporting Medicare
• A separate reconciliation outside of
the HSCRC submission is required
to make sure that the “sum of the
parts equals the whole” for all
Brave New World: Changes to Hospital
Reporting Under the NEW Waiver
1. Changes to Traditional HSCRC Data Submissions
2. New Metrics to Monitor
3. New Platform for Reporting
New Metrics
• Rate of Change in Cost per Capita
• Market Share
• Potentially Avoidable Utilization (PAUs)
– Inter/Intra Readmissions
– Monthly MHAC + PPC Reporting
Rate of Change in Cost per Capita
• Two explicit “per capita” tests under the new
– All Payer Revenue Growth Rate Test
– Medicare Savings Test
All Payer Revenue Limit Test
• What is it?
– Annual growth rate in total per capita hospital charges
must not exceed 3.58% for CY2014-CY2016 for
Maryland residents in Maryland hospitals
• Why is this important to Hospitals?
– HSCRC staff will need to take action to reduce hospital
charges if test is in jeopardy.
Medicare Savings Test
• What is it?
– Rate of growth in Medicare's per capita hospital
payments must be less than the national average growth
rate for Maryland residents by at least $330 million for
• Why is this important to Hospitals?
– HSCRC staff will need to take action to reduce hospital
charges if test is in jeopardy.
What Should Hospitals Monitor?
• Rate of Change in Charges
per Capita
• Time Period:
– Calendar Year
– Rate Year
• Changes in Charges
Hosptial Gross Charges
# of People in Defined Population
• Rate of Change in Medicare
Payments per Capita
Admit Source/Source of
• Changes in Population
Medicare Payments to Hosptial
# of Medicare Beneficiaries in Defined Population
– Hospital
– Primary Service Area
– State
Calendar Year!
Rate Year: July- June
Calendar Year: January- December
• The HSCRC will be monitoring Calendar Year performance
for the waiver.
• Consider creating additional internal reports for compliance
on a calendar year basis
Changes in Market Share
• What is it?
– a measurement of the population's utilization of a hospital’s
services in a given geographic area over a period of time as
compared to other hospitals.
• Why is this important to hospitals?
– Global budgets will be adjusted to match utilization.
– The methodology for market share adjustments hasn’t been
finalized. The HSCRC has requested white papers from the
• Recommendation for Hospitals:
– monitor market share as best you can with available data
• What is it?
– Reduce the Medicare readmissions rate to the
national level in 5 years (CY2014-CY2018)
Relative Readmission Rates
MD to Nation
• Why is this important to Hospitals?
– ALL Readmissions (no distinction between intra and
– Maryland’s focus up until now for reporting purposes has
been intra-hospital readmissions
– Value-based annual financial adjustment
Readmissions: What Should Hospitals Monitor?
• Time Period: CY vs. RY
• Intra vs. Inter
• Medicare vs. All Payers
• Benchmarks: State vs.
Nation vs. Peers
• Service Line
Raising the Bar: Quality-based Reimbursement (“QBR”)
and Maryland Hospital Acquired Conditions (“MHAC”)
• What is it?
– QBR and MHAC are Maryland’s versions of CMS’ Value Based
Purchasing (VBP) and Hospital Acquired Conditions (HAC)
– Quality-based policy tools
Why is this important to hospitals?
• New waiver
• Reduce Potentially Preventable Complications (a.k.a MHACs) by
30% in five years (CY2014-CY2015)
• Workgroups will be modifying MHAC policy to align
with the new waiver requirements
• Scaling:
• MHAC and QBR scaling will be even more relevant under GBR
because it’s one of the few variable update factors for hospitals
• More Financial Risk: FY2016 QBR: 0.5%  1.0% base approved
hospital inpatient revenues
Potentially Avoidable Utilization (PAUs)
• What are PAUs?
– 30- Day Readmissions/Rehospitalizations (includes ER)
– Preventable Admissions (Admissions for ambulatory sensitive
conditions) (based on AHRQ Prevention Quality Indicators)
– ER visits than can be treated in other settings
– Maryland Hospital Acquired Conditions (MHAC) a.k.a
Potentially Preventable Complications
Potentially Avoidable Utilization (PAUs)
• Why are they important?
– Cost & Quality: Crosses the 3 major tenants of waiver (cost
per capita, readmissions, quality)
– Financial Performance: In a GBR world if you can reduce
inappropriate volumes, you can reduce excess cost and
therefore improve operating margins (or reinvest).
Brave New World: Changes to Hospital
Reporting Under the NEW Waiver
1. Changes to Traditional HSCRC Data Submissions
2. New Metrics to Monitor
3. New Platform for Reporting
CRISP: NEW Platform for Hospital Analytics
• Chesapeake Regional Information System for our
Patients or (“CRISP”)
• Maryland’s state designated health information
exchange (“HIE”).
• Not-for-profit organization charged with
electronically connecting healthcare providers
across the region.
CRISP: NEW Platform for Hospital Analytics
• CRISP receives real-time encounter messages (called “ADTs”) which
carry facility, medical record number, visit IDs, and other important
information about visit.
• Unique Aspects of ADTs:
– Enable population-health analysis (unduplicated users across hospitals)
– Real –Time data flows
– Street address, enabling more granular level of geographic analysis
• Linked ADT and HSCRC Abstract Data enable more analysis
– Inpatient matching rate: 99.98%
– Outpatient matching rate: 99.86%
CRISP’s Data Model
Potential Linkage: AllPayer Claims Database
CRISP’s Unique Reporting Capabilities
• Unique patient ID assigned to each individual across hospitals
• Real-time ADT with geo-code
• Real-time ADT reconciles to HSCRC tapes
• Coordination of logic with HSCRC reimbursement policies
CRISP’s Data Utility
• Tape Data reconciled to CRISP’s
unique patient ID supports:
– New Policies: Data is a shared
resource to support policymakers,
payers, and providers respond to
new policy direction.
– Population Health: CRISP data can
support care coordination
activities/analytics for populationbased models (TPR/GBR).
Overview of CRISP Reports
CRISP has developed the capability to generate reports through a combination of
CRISP data and HSCRC tape data. Initial ideas have focused on:
Readmission analysis reports (HSCRC or CMS methodology)
 Monthly reports with patient drill downs
 Year-to-year and monthly
 By hospital, zip, region, county, HEZ
 By diagnosis or disposition
Market share analysis
 Clinical service line utilization by hospital PSA
 By majority of inpatient visits, total visits, etc.
 By diagnosis and charges
Analysis of Potentially Avoidable Volume
 Visits with ambulatory sensitive conditions
 Readmission
 Market share shifts
Uncompensated Care/ACA Impact
 Using CRISP EID to link insurance status and UCC use across time periods
High utilization analysis
 By # of visits, LOS, date, overlap, etc.
 By census tract or neighborhood
 By diagnosis, disposition, or charges
Hospital Utilization by diagnosis, disposition, charges using HSCRC data
 County reports (patients, discharges, readmits by diagnosis)
Patient attribution analysis
 Based on prior visits
 Identify exclusive patients and % of visit allocation by patient
 By census tract or neighborhood
 By diagnosis and charges
Episode of Care analysis
 All subsequent hospital visits after discharge
 By diagnosis or disposition
 By census tract or neighborhood
Stay Tuned….
• Hospitals are being asked to
– MORE data
– MORE accurately
• Lots of rapid changes happening for
hospital reporting
Contact Information
Oscar Ibarra
Chief, Information Management and Program
[email protected]
Katie Eckert, CPA
Director, Budget & Reimbursement
Bon Secours Baltimore Health System
[email protected]

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