Big data. Better decisions.

Welcome!

Big

data.

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How Analytics Shape the Future of Our

Industry

Mark Parkinson

The Good News

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Now Past All-Known

2014 Legislative Risks

 Next Deadlines

 Doc Fix – April 1, 2015

 Budget – October 1, 2015

MedPAC has been helpful

 MedPAC data shows total margins are razor-thin.

 A June 2014 MedPAC report supports a site neutral payment system for SNFs and IRFs.

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More People Will Need Our

Post-Acute Services

Conservative Moderate Aggressive

TOTAL MEDICARE ENROLLMENT (MILLIONS OF BENEFICIARIES)

YEARLY MEDICARE SNF VOLUME (MILLIONS OF DAYS)

Graphic courtesy of Avalere

Total Medicare Enrollment Will Grow Substantially, Resulting in Increased Volume

AVERAGE AGE FOR MEDICARE ADMISSIONS

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Challenging Times

2013 Medicaid Shortfall

 $7.7 billion shortfall nationally

 $24.26 per Medicaid patient day

 8.6% higher than 2012

 88.3% of projected allowable costs are reimbursed by Medicaid

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Medicaid Managed Care

2011

11 states

2014

27 states

Changing Medicare Payment Systems

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How We Win

1. Quality Solution

2. Political/Lobbying Powerhouse

Quality is Now a

Reimbursement Issue

 In past, we improved quality because it was the right thing to do.

 In future, we must improve quality to survive.

 Government won’t fund every health care practice

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Quality Metrics and

Our Opportunity

 CMS ranks hospitals based on 30-day readmission rate for the top 3 diagnoses causing the majority of readmissions:

 heart attack

 heart failure

 pneumonia

 Hospitals in bottom quartile (nationally) from the prior year will have a % of total Medicare payments withheld:

 2013: up to 1%

 2014: up to 2%

 2015: up to 3%

Quality Metrics and the Reimbursement

Connection

 Current ACOs/MCOs using the PointRight® Pro 30™ rehospitalization measure promoted by AHCA

o 3 Massachusetts Pioneer ACOs, 1 Massachusetts MCO o 1 New Jersey ACO

 Ohio has increased the proportion of Medicaid payments linked to quality measures

 Centers that meet targets on at least five of 20 measures are rewarded by not having their Medicaid per diem rate reduced.

 Rehospitalizations linked to payments in recent doc fix

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We are the Quality Solution

35.6% 46.9% 23.8% 27.3% 11.8% 19.6% 0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 2009 2013 4-Star 5-Star

AHCA Action on Quality

 Creation of the Quality Department

 AHCA/NCAL Quality Initiative

 AHCA/NCAL National Quality Award Program

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Political/Lobbying Powerhouse

 Who’s Who of Outside Lobbyists

 BGR Group – Gov. Haley Barbour

 Capitol Counsel – Rep. Jim McCrery

 Podesta Group – Tony Podesta

 Alston-Bird – Dan Elling

 Lincoln Policy Group – Sen. Blanche Lincoln

2014 Political Goals

*2014 represents money collected to date

$0.00 $500,000.00 $1,000,000.00 $1,500,000.00 $2,000,000.00 $2,500,000.00 $3,000,000.00 $3,500,000.00 2010 2011 2012 2013 2014

AHCA PAC History

Hard Dollars Soft Dollars

GOAL GOAL

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A Unified and Proactive Voice

11,433 11,539 11,648 11,685 11,722 11,745 12,023 12,091 12,249 12,245 12,275 12,245 12,396 12,438 10,800 11,000 11,200 11,400 11,600 11,800 12,000 12,200 12,400 12,600

Jul-12 Aug-12Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13

Mar-13 Apr-13 May-13 Jun-13 Jul-13 Aug-13Sep-13 Oct-13 Nov-13 Dec-13 Jan-14 Feb-14 Mar-14 Apr-14 May-14 Jun-14 Jul-14 Aug-14Sep-14 AHCA/NCAL Member Facilities

Using Metrics Works

MODEST WINS

 Not a pay-for in the 2013, 2014 short-term doc fix

 Shaped pay-for in 2015 short-term doc fix

 Clean increase in the FY 2013 & 2014 SNF PPS final rule, and the FY 2015 proposed rule

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What You Can Do

 Understand and master the quality metrics that matter to your payer

 Use LTC Trend Tracker to learn about your own metrics

 Track important quality measures to help you improve

 Updated system will feature customized reports and easier access to important metrics

It’s time to play offense.

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