July 2015 Newsletter
Volume 4 Number 7
July 1, 2015
Bundled Payments for Care Improvement Initiative
July 1st signifies yet another milestone for St. Vincent’s Health Partners and St. Vincent’s Medical Center as we embark on our journey with the Bundled Payments for Care Improvement Initiative!
The Bundled Payments for Care Improvement (BPCI) Initiative was developed by the CMS Innovation Center as a result of the Affordable Care Act. The purpose is to test innovative payment and service delivery models that have the potential to reduce Medicare, Medicaid, or Children’s Health Insurance Program expenditures while preserving or enhancing the quality of care for beneficiaries.
Participating organizations can be hospitals, skilled nursing centers, inpatient rehabilitation facilities, home health agencies. SVMC and our post-acute partners (Cambridge Health and Rehabilitation Center, Jewish Senior Services, Lord Chamberlain, Ludlowe Center for Health and Rehabilitation, St. Joseph’s Center, Bayada Home Health Care, Roy and Aline Friedman Home Care, Stratford VNA and Visiting Nurse Services of Connecticut) are participating providers.
A facilitator (SVHP) is an entity that serves an administrative and technical assistance function in helping participants redesign care. The facilitator does not have an agreement with CMS, bear financial risk or receive payment from CMS. The facilitator assists with financial arrangements made between the participating organization and the convener.
A Convener (NaviHealth) is an entity that bears the financial risk and receives payment from CMS. The Board voted to partner with NaviHealth as our financial convener and therefore, NaviHealth will assume the risk.
On February 14, 2014, CMS announced an expansion of the program to include new hospitals, health systems and provider practices. These bundles will start on July 1, 2015, and are comprised of four broadly defined models of care, depending upon where the episode of care initiated. Reimbursement will be based upon services provided to beneficiaries for that episode of care.
SVMC is participating in MODEL 2: Retrospective Acute Care Hospital Stay plus Post-Acute Care
The episode of care is initiated at the time of admission to the hospital and includes all related services during the episode. Participants select when the episode of care will end – 30, 60 or 90 days after discharge. Participants select up to 48 episodes of care.
The Model 2 Bundle includes physician services, care by post-acute providers, related re-admissions and related Medicare Part B services. The rate is determined by historical fee-for-service payments minus a discount. Payments to providers are made at the usual fee-for-service rate and then reconciled against the target price. Any savings that is realized is paid to the participant and may be shared among the providers. Any expense that is above the target price is paid back to Medicare by the participant.
To prepare for this and other transition initiatives, The Transitions Leadership Committee was developed with the objective and focus of discussing opportunities to strengthen relationships, improve transitions of care and ensure successful outcomes within the network. This Committee has met over the past year to map out processes to coordinate care across the continuum and to validate the requirements delineated in the SVHP Playbook.
We anticipate the the work that has and is being done will positively overflow to the transitions of all patients between each of the settings and across the clinically integrated network.
ICD-10: The Switch
With less then 3 months remaining for the switch from ICD-9 to ICD-10, CMS has continued to provide resources to make the switch a success.
The transitions is going to change how you do business, but it does not have to be overwhelming. Below are resources to assist you with the transition:
CMS has also made several important changes to the policy to ease the transition.
- During the first year, Medicare will not deny claims based upon specificity of diagnosis codes as long as they are in the appropriate family of codes. Therefore, you will not be penalized because of a coding error.
- An ICD-10 Ombudsman office will be established to assist in problems that arise during the transition.
- If Medicare contractors cannot process claims because of issues with ICD-10, CMS will authorize advanced payments.
Over the next few weeks, CMS will be sending to all Medicare Fee-for-Service providers a letter regarding these changes. There will also be a National Provider Call on August 27th.
For more details, please visit the CMS ICD-10 website.
SIM Advanced Medical Home VAnguard Program Pilot
We are excited to announce that 5 Primary Care Physician practices from SVHP were selected as recipients of the State Innovation Model (SIM) Advanced Medical Home Vanguard Program Pilot. Under the program, these practices will receive technical assistance with the Patient Centered Medical Home application process.
The five practices are:
- Complete Health, LLC (Dr. Freda Boateng)
- Primary Care Physicians of Fairfield (Dr. Neil Smerling)
- Hervey A. Weitzman, MD
- Milford Medicine (Dr. Swati Joshi)
- Prime Health of Southport (Dr. Naeem Sarfraz)
Congratulations to Dr. Eugene Lewis and Fairfield Pathology Consultants, LLC as they have added 2 new physicians to the practice: Dr. Heather Carney and Dr. Olena Dorokhova. Fairfield Pathology Consultants are located at SVMC Laboratory, 3rd floor and can be reached at 203-576-5033.
Please help us welcome new staff!!
Pani Stanton, MS, PT, is our new Care Coordination and Integration Manager for St. Vincent’s Health Partners. She received her Bachelors of Science in Biology and her Masters of Science in Physical Therapy from Sacred Heart University in Fairfield, CT. Prior to joining SVHP, Pani was a Physical Therapist at St. Vincent’s Medical Center for 15 years and has experience in the outpatient private practice arena as well. She holds a license to practice Physical Therapy in Connecticut and New York. Pani is passionate about improving patients’ outcomes and aiding patients in a smooth and speedy transition back to their home setting.
Gayathri Muthukumaran is a Healthcare Business Analyst at St. Vincent’s Health Partners. She received her Masters in Management Information Systems from University of Illinois at Chicago and is a Certified Revenue Cycle Representative from the Healthcare Financial Management Association. She brings experience in data analysis, data quality, designing and implementing Business Intelligence solutions in the Healthcare domain. Gayathri will support SVHP in implementing suitable analytic technologies to meet their business needs.
Please also help us in congratulating Asma Ahmed!
After successfully completing her Graduate Capstone project on the implementation of Risk Manager, Asma received the Gold Medal of Excellence with her MS Healthcare Informatics degree for having the highest CGPA in the batch at Sacred Heart University. She has utilized various healthcare techniques as a volunteer to help redesign and engineer workflows at a home health agency. As a Graduate Assistant, she had the opportunity to work on an inter-disciplinary grant to initiate a Global EHR for the Nursing students at Sacred Heart University to utilize while they visited patients in foreign countries like Jamaica and Guatemala. Asma was also the 2014 Dvora-Brodie Internship Grant recipient, which is conducted annually through the New England chapter of HIMSS. Being part of the team at St. Vincent’s Health Partner, Asma will utilize relative data to support the needs of the organization including data governance, and workflow engineering. Asma will be utilizing clinical applications and IT tool sets to support the progression of the organization as well as internal day to day IT operational support.
Dr. Thomas Raskauskas, President/CEO, (203) 275-0205
Dr. Michael Hunt, Chief Medical Officer/Chief Medical Informatics Officer,
Anthony Brockman, Director of Healthcare Informatics and Technology, (203) 275-0206
Colleen Swedberg, MSN, RN, CNL, Director for Care Coordination and Integration,
Karen O’Driscoll, Director of Professional Relations, (203) 275-0205
Sophia Jackson, RN, Care Coordination Associate, (203) 275-0212
Pani Stanton, MS, PT, Care Coordination and Integration Manager, (203) 896-0216 firstname.lastname@example.org
Kyle Lanning, JD, Information and Integration Manager, (203) 275-0204
Gayathri Muthukumaran, MS, Healthcare Business Intelligence Analyst, (203) 275-0207 email@example.com
Asma Ahmed, Healthcare Informatics Associate, (203) 275-0213
Erika Foster, Integration Associate, (203) 275-0208
Susanne, Salgado, Communications and Operations Associate, (203) 275-0201