The Caretech
Budgetwire Blog |
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Caretech Group's Budgetwire Blog addresses the complex budgetary issues facility executives face. We're interested in hearing your personal experiences and challenges each month.
Steve Katz, Vice President of Business Development at Caretech Group and Lecturer on Health Services Administration at City University of New York's Lehman College hosts Caretech's Budgetwire Blog. Mr Katz has over 25 years industry experience and 12 years experience lecturing future industry leaders. |
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Dear Contact Custom Text 1,
This month's featured article, "Rewards and Risks of Value Based Reimbursement" introduces new reimbursement methods that are expected April 1, 2010. As we've discussed since 2nd Quarter 2009, budget cuts and planned changes are close at hand. How will your facility fare under the new reimbursement model? Find out by taking "Caretech's Value Based (Regional Pricing) Reimbursement Risk Assessment" and we will be in touch with you within a business day to let you know if your risk is low, moderate or severe. Necessity is the mother of invention, as the saying goes, and our measured response will prepare you for the imminent changes ahead.
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 Rewards and Risks of Value Based Reimbursement
by Steve Katz
In pursuit of the goal to reward quality providers, Medicare and now Medicaid are using various criteria to evaluate the outcome of care. They include the MDS for data collection purposes (quality and reimbursement), collecting and evaluating other data (staffing, annual survey) over the internet for efficient data transmission. The foundation is now set to create the methodology to recognize quality in the NY Medicaid reimbursement system.
The NYSDOH Work Group with provider participation is constructing the new reimbursement system that will reward quality providers. Medicaid will have a Quality Add-on that facilities in the top twenty percent (20%) from a quality perspective will receive. The Quality Add-on appears to be based upon a formula that considers RN hours as a percentage of all Nursing Department Hours, key Quality Indicators for long term residents ( % of Residents Who Have/Had a Catheter Inserted and Left in their Bladder,% of Residents with a Urinary Tract Infection,% of Residents Who Lose Too Much Weight, % of Residents Whose Need for Help with Daily Activities Has Increased,% of Residents Whose Ability to Move About In and Around Their Room Decreased) and Survey results. The systems will evolve incorporating the Quality First initiative that the industry implemented as well as resident and family satisfaction. It will also recognize facilities that have a significant improvement in their quality rankings from one year to the next. The source of the funding for the Quality Add-on is the problem; zero sum systems are always a challenge.
This new Medicaid reimbursement system will be implemented on April 1, 2010. This system will be budget neutral; the funding for the Quality Add-on will be a reallocation of existing funds within the nursing home Medicaid system. NYSDOH and the Work Group reviewed data and linear regression analysis to adjust the Direct and Indirect components of the Medicaid rate. As the dust continues to settle the reality is clear. The ceilings will be lowered for both the Direct and Indirect components to create the funding for the Quality Add-on. The process that is adjusting the ceilings is currently referred to as Regional Pricing. However, that label may not remain applicable since NYSDOH is considering combining NY State Regions for reimbursement purposes. As a result, it is clear that nursing homes will receive less in their Direct and Indirect component. If a nursing home is to keep its Medicaid reimbursement whole it must be in the top twenty percent (20%) in quality rankings.
The reductions in the Direct and Indirect components of the Medicaid rate are based upon new ceilings that are built around Regional Pricing. Using linear regression analysis, the NYSDOH Work Group developed a new mechanism to redefine the ceiling for both the Direct and Indirect Components. When implemented, Value Based Reimbursement will create enhanced pressures for nursing homes. Quality is now more of an imperative than ever before, since the penalty will be a reduced Medicaid rate. If a facility is not ranked in the top twenty percent (20%) for quality it will have to work harder to get there and reduce its expense since its Medicaid rate will be lower. This challenge is enormous since the ranks of management are thin and where do you focus limited management resources?
While quality of care is always the primary goal of nursing facilities, there will always be a delicate balancing act between administrative and clinical management. How financial resources are allocated affect clinical outcomes. Saving money with poor supply choices can have devastating domino effects on labor as well as clinical consequences that cost the facility thousands of dollars. Shaving labor dollars related to direct care can lead to a decline in clinical outcome, risking a vicious cycle of dwindling financial resources and declining ability to meet care needs. Streamlining both clinical and business processes with the use of technology, real time financial reporting, and valued added strategic partnerships such as procurement specialists have become vital to LTC facilities in New York State.
While lobbying the legislature to prevent implementation of the new reimbursement methodology might seem to be a reasonable response, reassessments of facility allocation of resources, procedures and processes will bring a surprising level of relief. Over the last fifteen years, Caretech has refined its procurement processes on behalf of its clientele, developed value added technological tools to facilitate greater efficiency and profitability, and provides a sophisticated analytical capability for facility managers. Timely and relevant information are powerful tools.
Caretech developed a Value Based Reimbursement Risk Assessment to help a facility determine the impact of the new ceilings on their existing Medicaid rate. To access this site go to Caretech's Value Based (Regional Pricing) Reimbursement Risk Assessment and follow the simple directions. Caretech can assist you with strategies and programs to reduce your supply expenses and provide you with a means to focus more intently on quality while enhancing your control over supply expense. Now is the time to act and Caretech is prepared to assist you. |
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Fight Back Against H1N1 & MRSA Strain USA600
by Liora Stein & Steve Katz |
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During the first week of November 2009, health advisory headlines sounded two very serious alarms. In the first, President Barak Obama declared a state of emergency in relationship to the H1N1 Virus. With more than 1,000 people succumbing to the swine flu, and a significant delay in delivery of its specialized vaccine, hospitals and the federal government may require the flexibility to create off site emergency rooms or take other emergency measures to protect the populace. While news reports also share that the peak of the flu season was reached in October, it does extend through the winter and that fatalities are greater with the swine variants.
The second headline announced that an evolutionary strain of MRSA, USA600, is five times more deadly than the preceding stains of the virus. Fully 50% of patients diagnosed with the USA600 strain within their bloodstreams died within 30 days of infection. In comparison to a mortality rate of 10% in the two older strains of MRSA, this is a very significant evolution of the virus. Additionally, the strain is much more likely to attack older patients with an average age of 64, versus 52, contracting the disease.
According to MRSAInfection.org, the Dutch have been the most effective in their attack of MRSA in their health facilities by implementing "a rigorous hygiene and segmentation protocol nationwide". Publications of the rates of infection have been effective for focusing healthcare officials in countries outside of the USA. To see a comprehensive plan of attack, please visit www.mrsainfection.org
In an effort to help defray both illness and the expenses related to an increase in hospitalizations for our LTC facility customers - we are offering NeutraFlu 96 and NeutraFlu 24 as preventive measures. SaniGard®, contained within the Caretech kit is the only dry on contact germicide on the market, and the Fogger® is effective against 99.9% of germs.
Prevention is always the crucial component in our facilities. Keeping our residents free from infections is an integral part of our Quality Improvement initiatives. The Department of Health reviews this aspect of our operating procedures and will cite our practices as deficient at the first sign of a sneeze. Infection outbreaks have other negative benefits: our operating expenses are worse than budget, increased overtime may result if staff members are impacted and we may have to temporarily close beds to admissions.
The NeutraFlu products offer facilities another way to reduce the likelihood that infections can have a negative impact on our facilties. In an effort to be proactive, we've requested confirmation that our viral protection kits are also affective against the newly identified MRSA USA600 strain, and will alert you as soon as we have confirmation.
To protect the lives of your residents and to protect your fragile budgets, call Caretech Group today to broaden your Influenza and MRSA Prevention Action Plans today!
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In conclusion, Caretech brings you solutions for economic an clinical challenges. Medical supplies that allow you to maximize your resources, as well as cleaning supplies to protect your patients.
Caretech offers three levels of service to help you better manage supplies and reduce these expenses. We look forward to discussing the full scope of your needs. Please call me directly to discuss the ways in which Caretech can assist you at 914-400-7124.
Sincerely,
Steve Katz
Vice President
Business Development
Caretech Group |
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