Improving Quality Reporting in Provider-Based RHCs. Dr. Greg Barabell and Sarah Craig

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1 Imprving Quality Reprting in Prvider-Based RHCs Dr. Greg Barabell and Sarah Craig

2 Webinar Series - Agenda Part 1 Tday s Discussin Glbal theme tday - Why Quality??? SHIP Cmpeting Cntinuatin SCORH SHIP Activities SC RHC Prgrams Health Care Terminlgy Overview Prvider Based RHC Overview Part 2 - Nvember 20 th 3pm EST Quality Imprvement Overview Quality Imprvement Metrics Quality Imprvement Methdlgy

3 Suth Carlina Office f Rural Health Established in (c)3 Nt-Fr-Prfit Crpratin ~45 FTEs Lcated in Lexingtn Cunty

4 SCORH Snapsht Prvider Services Center fr Practice Transfrmatin Rural Hspital and Health System Cnsultatin Revlving Lan Fund Rural Prvider Recruitment and Retentin Rural Veterans Health Initiatives Rural Health Clinic Services Rural Emergency Services Cnsultatin Rural Oral Health Initiatives Quality Payment Prgram Cnsultatin Preferred Partners Cmmunity Initiatives Blueprint fr Health Family Slutins f the Lw Cuntry Healthy Peple Healthy Carlinas Rural Health Netwrk Develpment Rural Health Actin Plan (RHAP) 5 Areas f Fcus 15 recmmendatins 50+ Actin Steps Intended t spur prgress ver the next 3-5 years

5 Histry f SHIP Authrized by the Balance Budget Act f 1997 t help small rural hspitals implement data systems required by the Medicare Prspective Payment System Subsequent SHIP legislative prvisins allwed fr supprt twards valuebased purchasing, ACO develpment, purchasing health infrmatin technlgy, equipment, training t cmply with meaningful use, ICD-10 standards, and payment bundling FY 2019 Cmpeting Cntinuatin supprts eligible hspitals in meeting value-based payment and care gals fr their respective rganizatins, thrugh purchasing f hardware, sftware and training. Als, supprts ACO develpment t participate in shared savings prgrams, t purchase health infrmatin technlgy, equipment and/r training t cmply with quality imprvement activities; such as, advancing patient care infrmatin, prmting interperability and payment bundling.

6 FY 19 Purchasing Menu Value-based Purchasing Investment Activities D. Prvider Based Clinic Quality Measures Educatin E. Alternative Payment Mdel and Merit-Based Incentive Payment training/educatin Accuntable Care Organizatin (ACO) r Shared Savings Investment Activities D. Efficiency r quality imprvement training in supprt f ACO r shared savings related initiatives Payment Bundling (PB) r Prspective Payment System (PPS) Investment Activities ICD 10 training Efficiency r quality imprvement training in supprt f PB r PPS related activities

7 Snapsht f SHIP activities acrss the US

8 Snapsht f SHIP activities acrss the US (by State)

9 SC SHIP Prgram Prspective Payment System (PPS) and Payment Bundling Investment Activities 12 SHIP Hspitals; 5 are CAHs All funds pled int SC SHIP Netwrk FY17 Activities included: ICD-10/DRG Payment Wrkshp Certified Revenue Cycle Analyst Training Charge Descriptin Master Class Evaluatin and Management Audit wrkshp Current Prcedural Terminlgy wrkshp ICD-10 Billing and Cding class

10 SC Rural Health Clinics ~ 90 RHCs; 2/3 are wned by hspitals Rural Health Clinic Services Shannn Chamber, Directr f Prvider Slutins Crdinate, spnsr and prvide educatinal wrkshps Prvide On-site visits, webinars and cnference calls t assist in billing, cding and prgrammatic issues Assist in cnversin t an RHC frm initial applicatin t final apprval frm CMS (855s, mck survey walkthrughs, plicy and prcedure manuals)

11 Center fr Practice Transfrmatin Michele Stanek, Directr f the C4PT Supprts RHCs and ther rural prviders in develping medical hmes and pursuing practice imprvement Currently wrking with 50+ RHCs r ther rural primary care prviders n PCMH develpment, quality measurement r practice imprvement Supprt prvided thrugh: Practice facilitatin (Quality Imprvement Caches) Technical assistance Mnthly webinars Face-t-face meetings Shared learning platfrm Engagement with plicymakers and payers Medical Directr engagement

12 Quality Payment Prgram (QPP) Subcntract frm Alliant (QIO) t be the SURS (Small, Underserved & Rural) QPP cntractr fr Suth Carlina Prvide educatin, supprt and technical assistance t practices with 15 r fewer eligible clinicians 5-year prgram; renewed annually Required engagement with ~2,700 clinicians in Suth Carlina Dcumentatin f all interactins in CMS apprved system.

13 Other SC RHC Prgrams Primary Care Access and Stability Prgram SC Department f Health and Envirnmental Cntrl (DHEC) Best Chance Netwrk/WiseWman SC DHEC Chrnic Disease MOrE Care Cllabrative Meaningful Use and SCHIEx Chse Well Initiative SC Rural Access t Veterans Health Resurces New Mrning Fundatin: Expanding Cntraceptive Care t Uninsured/Underinsured Patients in Rural Health Practices

14 Others are ding it well als! Michigan Center fr Rural Health Rural Health Clinic Quality Netwrk (initiative stated in 2011) T measure and imprve the quality f care in Michigan RHCs Quarterly Meetings Standing Agenda Items: Quality Health Indicatrs (QHI) and Practice Operatins Natinal Database (POND) 75 Clinics are enrlled and reprting Other SORHs

15 Health Care Terminlgy Value-Based Purchasing Linking prvider payments t imprved perfrmance by health care prviders. Health care prviders accuntable fr bth the cst and quality f care they prvide. It attempts t reduce inapprpriate care and t identify and reward the best-perfrming prviders. Shared Savings At Risk Links additinal prvider payment t cst savings achieved thrugh jint partnerships Links additinal prvider payment t cst savings but als penalizes prviders fr csts ver budget at a percentage f the ttal additinal Cst

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17 Prvider Based RHC Created r acquired by a main prvider fr the purpse f furnishing prvider fr the purpse f furnishing health care services f a different health care services f a different type frm thse f the main prvider type frm thse f the main prvider under the name, wnership, and under the name, wnership, and administrative and financial cntrl administrative and financial cntrl f the main prvider. f the main prvider. Includes bth the specific physical Includes bth the specific physical facility and the persnnel and facility and the persnnel and equipment needed t deliver the equipment needed t deliver the services at that facility. services at that facility

18 Prvider Based RHC, Cntinued Requirements fr all prvider-based entities: Operate under the same license as the main prvider, unless: Entity can be licensed separately State requires separate license, r des nt allw the entity t be included under hspital s license Share integrated clinical services

19 Integrated Clinical Services Medical staff has privileges at main prvider Clinical versight is the same as fr all ther clinical departments f main prvider Medical recrds integrated int a unified retrieval system (r crss- reference) f the main prvider.

20 Prvider-Based RHC - Billing RHC Services are submitted n a CMS-UB04 claim frm Rural Health Clinic claims are administered by Medicare Part A but submitted under Part B (Physician Service) benefit, using the structure f Medicare Part A.

21 Prvider-Based RHC Hspital Integratin Frm the system quality imprvement and systems integratin standpint, RHCs play the same rll as nn-rhc service prviders fr verall system success Held t same internal rganizatinal gals and cntribute t imprvement in all private and public insurer cntracted savings prgrams

22 CONTACT US Greg Barabell, MD CPC, FAAP Sarah Craig, MHA Website: scrh.net Address: 107 Saluda Pinte Drive Lexingtn, SC Phne: Text SCRURALHEALTH t t subscribe t ur Rural Fcus newsletter!