REVENUE CYCLE INSIGHTS PATIENT ACCE S S PASSPORT eCARE™ NEXT AND THE AFFORDABLE CARE ACT Maximizing Reimbursements For Acute Care Hospitals Executive Summary The Affordable Care Act (ACA) authorizes several new Medicare reimbursement programs that start going into affect in October 2012. Four programs directly affect acute care hospitals: 1. Hospital Value-Based Purchasing (VBP) Program, 2. Hospital Readmission Reduction Program, 3. Bundled Payments for Care Improvement Initiative and 4. Medicare Shared Savings Program. The Passport eCare™ NEXT suite of solutions helps hospitals maximize reimbursement under these new programs in a variety of ways, as outlined in this white paper. 1 Hospital Value-Based Purchasing (VBP) Program Congress authorized the Hospital Inpatient Value-Based Purchasing (VBP) program in Section 3001(a) of the Affordable Care Act. The program uses the hospital quality data reporting infrastructure developed for the Hospital Inpatient Quality Reporting (IQR) Program, which was authorized by Section 501(b) of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003. The Hospital VBP program is part of the Centers for Medicare & Medicaid Services’ (CMS’) longstanding effort to link Medicare’s payment system to improve healthcare quality, including the quality of care provided in the inpatient hospital setting. Starting in October 2012, hospitals will be paid for inpatient acute care services based on the quality of care, not just quantity of the services they provide. Most acute care hospitals serving Medicare patients are eligible to participate in Hospital VBP. Participation is optional, but most will likely participate to receive the payment. The VBP payments are funded by reducing the base operation Diagnosis-Related Group (DRG) payments. The reductions will be 1.0% in FY 2013, 1.25% in FY 2014, 1.5% in FY2015, 1.75% in FY2016 and 2.0% in FY2017 and beyond. These payments create a pool for funding performance-based payments. These reductions apply to all eligible hospitals, whether they participate or not. The program doesn’t affect DSH adjustments, IME adjustments or outlier adjustments. These adjustments are included in the overall baseline for determining the base DRG payment amount. Hospitals that score well will receive back more than the 1.0% they contribute to the payment pool. For FY 2013, the total VBP payment pool for the approximately 3,000 eligible acute care hospitals was $917M. The actual 1% deductions and matching payments will be implemented in January 2013 to avoid end-of-year adjustments for hospitals with ﬁscal year reporting. Based on the recently published IPPS ﬁnal rule for FY2013, the proposed payment mechanism is that the quality factor would be applied to each diagnosis reimbursement automatically on a claim by claim basis. Hospital VBP score is based on data collected through the Hospital Inpatient Quality Reporting (IQR) Program. This program establishes clinical quality outcomes, benchmarks and reporting mechanisms. Prior to Hospital VBR, the program was used by hospitals to avoid a 2.0% reduction in their annual market basket update amount as outlined in the MMS 2005 Act. CMS is adopting 12 of 45 quality measures of the Hospital IQR Program for Hospital VBP. Measures were removed primarily due to being “topped out”, meaning there was not a sufficient spread between high and low performers to differentiate quality. These measures will continue to be reported through the existing CMS’ funded QualityNet website. These measures as a group constitute the Clinical Process of Care portion of the score, which is 70% of the total quality score. The Hospital IQR measures today use a combination of claims-based data and clinical outcomes reporting. The claims-based measures include Patient Safety Indicators, Inpatient Quality Indicators, Hospital Acquired Conditions Indicators, Mortality Measures and Readmission Measures. The rest are based on hospital-reported clinical outcomes reporting. The remaining 30% of the overall quality score is the Patient Experience of Care portion, which is based on the existing Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) consumer survey. Providers can either use their absolute score relative to the national average or they can use their improvement over the previous year. This represents 80% of the Patient Experience score. Their improvement on their lowest HCAHPS score is also factored into the overall patient experience score, representing the remaining 20% of the total. 2 Medicare patients can access both the clinical quality outcomes and the patient satisfaction outcomes through the HHS website. The 12 Clinical Quality Measures The table below outlines the 12 quality achievement thresholds and benchmarks for the FY 2013 Hospital VBP Measures. NQI Measure Identiﬁer Measure Title Brief Explanation AMI-7a Percent of Heart Attack Patients Given Fibrinolytic Medication Within 30 Minutes Of Arrival Blood clots can cause heart attacks. Doctors may give this medicine, or perform a procedure to open the blockage, and in some cases, may do both. AMI-8a Percent of Heart Attack Patients Given PCI Within 90 Minutes Of Arrival The procedures called Percutaneous Coronary Interventions (PCI) are among those that are the most effective for opening blocked blood vessels that cause heart attacks. Doctors may perform PCI, or give medicine to open the blockage, and in some cases, may do both. HF-1 Percent of Heart Failure Patients Given Discharge Instructions The staff at the hospital should provide you with information to help you manage your heart failure symptoms when you are discharged. PN-3b Percent of Pneumonia Patients Whose Initial Emergency Room Blood Culture Was Performed Prior To The Administration Of The First Hospital Dose Of Antibiotics A blood culture tells what kind of medicine will work best to treat your pneumonia. PN-6 Initial Antibiotic Selection for CAP Antibiotics are medicines that treat infection, and in Immunocompetent Patient each one is different. Hospitals should choose the antibiotics that best treat the infection type for each pneumonia patient. SCIP-Inf-1 Prophylactic Antibiotic Received Within One Hour Prior to Surgical Incision Getting an antibiotic within one hour before surgery reduces the risk of wound infections. This measure shows how often hospital staff make sure surgery patients get antibiotics at the right time. 3 NQI Measure Identiﬁer Measure Title Brief Explanation SCIP-Inf-2 Prophylactic Antibiotic Selection for Surgical Patients Some antibiotics work better than others to prevent wound infections for certain types of surgery. This measure shows how often hospital staff make sure patients get the right kind of preventive antibiotic medication for their surgery. SCIP-Inf-3 Prophylactic Antibiotics Discontinued Within 24 Hours After Surgery End Time Taking preventive antibiotics for more than 24 hours after routine surgery is usually not necessary. This measure shows how often hospitals stopped giving antibiotics to surgery patients when they were no longer needed to prevent surgical infection. SCIP-Inf-4 Cardiac Surgery Patients with Controlled 6AM Postoperative Serum Glucose All heart surgery patients get their blood sugar checked after surgery. Any patient who has high blood sugar after heart surgery has a greater chance of getting an infection. This measure tells how often the blood sugar of heart surgery patients was kept under good control in the days right after their surgery. SCIP-Card-2 Surgery Patients on a Beta Blocker Prior to Arrival That Received a Beta Blocker During the Perioperative Period Many people who have heart problems or are at risk for heart problems take drugs called beta blockers to reduce the risk of future heart problems. This measure shows whether surgery patients who were already taking beta blockers before coming to the hospital were given beta blockers during the time period just before and after their surgery. SCIP-VTE-1 Surgery Patients with Recommended Venous Thromboembolism Prophylaxis Ordered Certain types of surgery can increase patients’ risk of having blood clots after surgery. For these types of surgery, this measure tells how often treatment to help prevent blood clots was ordered by the doctor. SCIP-VTE-2 Surgery Patients Who Received Appropriate Venous Thromboembolism Prophylaxis Within 24 Hours Prior to Surgery to 24 Hours After Surgery This measure tells how often patients having certain types of surgery received treatment to prevent blood clots in the period from 24 hours before surgery to 24 hours after surgery. Legend: AMI = Acute Myocardial Infarction, HF = Heart Failure, PN = Pneumonia, SCIP = Surgical Care Improvement Project, Inf = Healthcare-associated infections, Card = Cardiology, VTE = Venous Thromboembolism Prophylaxis 4 The 8 Patient Satisfaction Measures References The table below outlines the Patient Experience of Care dimensions of the HCAHPS scores that are used for FY 2013 Hospital VBP measures. CMS website on Hospital VBP http://www.cms.gov/Hospital-Value-BasedPurchasing/ Measure Description CMS Hospital VBP FAQ (outlines the 13 Hospital IQR rules and formula on page 17 and the HCAHPS questions and formula on page 22) http://www.cms.gov/Medicare/QualityInitiatives-Patient-Assessment-Instruments/ hospital-value-based-purchasing/Downloads/FY2013-Program-Frequently-Asked-Questions-aboutHospital-VBP-3-9-12.pdf 1. Communication with Nurses 2. Communication with Doctors 3. Responsiveness of Hospital Staff 4. Pain Management 5. Communication About Medicines 6. Cleanliness and Quietness of Hospital Environment 7. The IPPS Rule that outlines Hospital VBP formula and pool collection mechanisms (page 791) http://www.cms.gov/Medicare/Medicare-Fee-forService-Payment/AcuteInpatientPPS/FY-2013-IPPSProposed-Rule-Home-Page.html Discharge Information 8. Overall Rating of Hospital QualityNet website (includes overview of the claims-based and self-reported quality measures) www.qualitynet.org Passport eCare NEXT™ Suite and Hospital VBP Program HCAHPS Site (includes approved survey vendors) http://www.hcahpsonline.org/home.aspx PatientRisk™ is able to identify patients that are admitting for AMI, Heart Failure, Pneumonia and Inpatient Surgery and ﬂag them at time of registration. This is the quality alert in PatientRisk. Since it's a ﬁrst-class alert in Passport eCare NEXT, it can be used to group accounts into a work queue, prioritize cases in a work queue and be measured for closure. HCAHPS Quality Rule http://www.hcahpsonline.org/qaguidelines.aspx Public Quality Data Access http://www.hospitalcompare.hhs.gov This alert allows for the creation of work queues speciﬁc to Case Management. Unlike today, when case management is primarily reacting post-service, with PatientRisk quality alert case managers can engage early in the care cycle and intervene if quality protocols are violated. PatientDischarge™ communicates discharge instructions in Passport eCare NEXT, PatientKiosk™ and PatientSimple™. Having discharge instructions communicated at admission as well as available post-service through the patient portal should increase hospital scores on the discharge Information question of the patient satisfaction survey. 5 Hospital Readmission Reduction Program Section 3025 of the 2010 Affordable Care Act establishes a Hospital Readmissions Reduction Program where hospital Medicare Inpatient Prospective Payment System (IPPS) payments would be reduced for excess readmissions beginning on or after October 2012. The program deﬁnes readmissions based on the National Quality Forum (NQF)-endorsed 30-day Risk-Standardized Readmission measures for acute myocardial infarction (AMI), heart failure, and pneumonia. The payments are adjusted based on the difference between the hospital's readmission performance and the national averages for the same procedures. The hospitals performance is adjusted for factors that are clinically relevant including patient demographic characteristics, co-morbidities and patient frailty. The performance is based on discharge data for the previous three years and a minimum of 25 cases. For FY2013, the 3 year period is from July 1, 2008 to June 30, 2011. For FY2013, Readmissions adjustments are capped at a 1% reduction. The reduction is based on the sum of the total DRG payments by service category multiplied by the excess readmission ratio for that category. In FY2013, 307 hospitals will be receiving the full 1% penalty and 2,214 hospitals will receive some level of penalty. weighted and then combined into an overall score. The characteristics and weights are the same measures that CMS uses to assess population risk in determining a facility’s target readmission rate. This alert allows for the creation of work queues speciﬁc to Case Management. Unlike today, when case management is primarily reacting post-service, with PatientRisk Quality alert case managers can engage early in the care cycle and intervene if quality protocols are violated. References Fiscal Year 2013 IPPS Final Rule http://cms.gov/Medicare/Medicare-Fee-for-ServicePayment/AcuteInpatientPPS/FY-2013-IPPS-FinalRule-Home-Page.html QualityNet overview of the Hospital Readmissions Reduction Program http://www.qualitynet.org/dcs/ContentServer?c=Pa ge&pagename=QnetPublic%2FPage%2FQnetTier2&c id=1228772412458 CMS Overview of the Hospital Readmission Reduction Program http://cms.gov/Medicare/Medicare-Fee-for-ServicePayment/AcuteInpatientPPS/ReadmissionsReduction-Program.html/ Affected Hospital Stats http://www.npr.org/blogs/ health/2012/10/03/162220243/admit-it-medicareerrs-in-crackdown-on-hospital-quality PatientRisk™ and Hospital Readmission Reduction Program PatientRisk is able to identify patients that are admitting for AMI, Heart Failure, Pneumonia and ﬂag them at time of registration. This is the quality alert in PatientRisk. Since it's a ﬁrst-class alert in Passport eCare NEXT, it can be used to group accounts into a work queue, prioritize cases in a work queue and be measured for closure. In addition, PatientRisk is also able to identify patients with a higher likelihood of readmission, based on demographic characteristics and other clinically relevant factors. These elements are 6 Bundled Payments for Care Improvement Initiative Centers for Medicare and Medicaid Services (CMS) is working in partnership with providers to develop four different models for bundling payments through the Bundled Payments for Care Improvement Initiative. The Bundled Payments for Care Improvement initiative is not the National Pilot Program on Payment Bundling but will likely inform how CMS implements the this program in early 2013. The Acute Care Episode (ACE) demonstration is another initiative that’s very similar to the model 4 of the Bundled Payments initiative and will also likely inﬂuence CMS’s National Pilot Program implementation. The differences in the programs are outlined in the Bundled Payments FAQ. price will be a 2% to 3% discount from an amount based on the historical fee-for-service payments for the episode. In Model 4, CMS makes a prospectively determined bundled payment to the hospital that would encompass all services furnished during the inpatient stay by the hospital, physicians and other practitioners. Physicians and other practitioners would submit “no pay” claims to Medicare and would be paid out of the bundled payment. CMS invited providers to participate in the program on August 23, 2011. Completed applications for Model 1 were due on October 21, 2011. Model 2-4 Letters of Intent (LOI) were due on November 4, 2011. Completed applications for Models 2-4 were due by June 28, 2012. Three of the models involve a retrospective bundled payment arrangement, with a target payment amount for a deﬁned episode of care. In these models, CMS and providers set a target payment for a deﬁned episode of care. Providers would propose the target price which would be set by applying a discount to total costs for a similar episode of care as determined by historical data. Payment would be made under the original fee-for-service (FFS) system, at a negotiated discount in the 2%-3% range. At the end of the episode, total payments are compared to the target price. Providers will share in the savings. Model 1, episode of care is the inpatient stay in the acute care hospital. Payments are discounts of established Inpatient Prospective Payment System (IPPS). Physicians are paid separately under the Medicare Physician Fee Schedule. Model 2, episode of care is the inpatient stay and post-acute care and it ends 30 or 90 days after discharge. Model 3 is just the post acute care and ends at least 30 days after discharge. The bundle for both models includes physician services, postacute care provider, related readmissions, clinical laboratory services, durable equipment, prosthetics, orthotics and supplies, and Part B drugs. Target 7 MODEL Feature MODEL 1 MODEL 2 Inpatient Stay Only Inpatient Stay plus Post-discharge Services Eligible Awardees • Physician group practices • Acute care hospitals paid under the IPPS • Health systems • Physician-hospital organizations • Conveners of participating health care providers • Physician group practices • Acute care hospitals paid under the IPPS • Health systems • Physician-hospital organizations • Post-acute providers • Conveners of participating health care providers MODEL 3 Post-discharge Services Only • Physician group practices • Acute care hospitals paid under the IPPS • Health systems • Long-term care hospitals • Inpatient rehabilitation facilities • Skilled nursing facilities • Home health agency • Physician-hospital organizations • Conveners of participating health care providers MODEL 4 Inpatient Stay Only • Physician group practices • Acute care hospitals paid under the IPPS • Health systems • Physician-hospital organizations • Conveners of participating health care providers Payment of Bundle Discounted IPPS and Target Price payment; no separate target price Retrospective comparison of target price and actual FFS payments Retrospective comparison of target price and actual FFS payments Prospectively set payment Clinical Conditions All MS-DRGs Targeted Applicants to propose based on MS-DRG for inpatient hospital stay Applicants to propose based on MS-DRG for inpatient hospital stay Applicants to propose based on MS-DRG for inpatient hospital stay Types of Services Included in Bundle Inpatient hospital services • Inpatient hospital • Post-acute care and physician services services • Related readmissions • Related post• Other services acute care deﬁned in the services bundle • Related readmissions • Other services deﬁned in the bundle • Inpatient hospital and physician services • Related readmissions 8 MODEL Feature MODEL 1 MODEL 2 Inpatient Stay Only Inpatient Stay plus Post-discharge Services Expected Discount To be proposed Provided to by applicant; Medicare CMS requires minimum discounts increasing from 0% in ﬁrst 6 mos. to 2% in Year 3 Payment from CMS to Providers • Acute care hospital: IPPS payment less pre-determined discount • Physician: Traditional fee schedule payment (not included in episode) MODEL 3 Post-discharge Services Only MODEL 4 Inpatient Stay Only To be proposed by applicant; CMS requires minimum discount of 3% for 30-89 days postdischarge episode; 2% for 90 days or longer episode To be proposed by applicant To be proposed by applicant; subject to minimum discount of 3%; larger discount for MS-DRGs in ACE Demonstration Traditional fee-forservice payment to all providers and suppliers, subject to reconciliation with predetermined target price Traditional fee-forservice payment to all providers and suppliers, subject to reconciliation with predetermined target price Prospectively established bundled payment to admitting hospital; hospitals distribute payments from bundled payment PatientDischarge™ and Bundled Payments for Care Initiative PatientDischarge allows patients to select and schedule follow-up visits with qualiﬁed post acute care providers, based on previous patient feedback. The list of providers can be dynamically determined based on the patient demographics, insurance information and order data. Hospitals can then focus customers to post-acute care providers where the bundled payment percentages have already been negotiated and common payment mechanisms established. By pulling post-acute care scheduling into the registration workﬂow, providers ensure that the patient course of care will reconcile with the established bundled payment arrangements with chosen post-acute care providers. References CMS website on Bundled Payments for Care Improvement http://innovations.cms.gov/initiatives/bundledpayments/index.html CMS Bundled Payments for Care Improvement Fact Sheet http://innovations.cms.gov/Files/fact-sheet/ Bundled-Payment-Fact-Sheet.pdf CMS Bundled Payments FAQ http://innovations.cms.gov/Files/x/ BundledPaymentsFAQ.pdf CMS Bundled Payments Application Guidance http://innovations.cms.gov/Files/x/ BundledPaymentsAppGuidance.pdf 9 Passport eCare™ NEXT and the Medicare Shared Savings Program Under the Patient Protection and Affordable Care Act (ACA), Centers for Medicare and Medicaid Services (CMS) created the Medicare Shared Saving Program to incent care providers to better coordinate care for Medicare patients through Accountable Care Organizations (ACOs). The Shared Savings Program rewards ACOs that lower their growth in health care costs while meeting performance standards on quality of care. Participation in the program is voluntary. To participate, ACOs must make a three-year commitment, have at least 5,000 Medicare Fee for Service patients and not be participating in other shared savings programs. Participating ACOs will continue to be paid under the Medicare Fee for Service rules. However, CMS will also develop a benchmark for each ACO against which performance is measured to determine shared savings or losses. The benchmark is an estimate of what the total Medicare Fee for Service Parts A and B would have been in the absence of the ACO, even if all those services were not provided by providers in the ACO. The benchmark is updated every year. CMS is implementing a one-sided model (shared savings) and a two-sided model (shared savings and losses). Sharing percentage is greater in the two-sided model (60% vs 50%). If an ACO meets quality standards and achieves savings that meets or exceed a Minimum Savings Rate (MSR), the ACO will share in savings based on the quality score of the ACO. And, conversely, if an ACO falls below the Minimum Loss Rate (MLR), the ACO will share in losses in the two-sided model. Shared Savings Program is one of three Medicare ACO programs, also including Advanced Payment Initiative and the Pioneer ACO Model. All three models use the same quality performance assessment, quality measures, modes of data collection and timing of data submission and reporting. This model is derived by the Physician Quality Reporting System (PQRS). For participants who quality for PQRS reporting incentives, they will be able to submit one set of reports through the ACO Group Practice Reporting Option (GPRO) web interfaces, available for download at QualityNet website. For the quality performance standards, ACOs are measured against 33 existing nationally recognized quality measures. These quality measures are the same as those used by other CMS quality programs such as the Physician Quality Reporting System (PQRS) and the Electronic Health Record (EHR) Incentive Programs. The 33 measures are reported through a combination of claims data (4 measures) administrative data, ACO GPRO Web Interface (22 measures) and patient experience surveys (7 measures). The claims based measures are all calculated using professional (Medicare Part B) claims. For the patient experience care measures, CMS will administer and pay for the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey for the ﬁrst two years of the Shared Savings Program (2012 and 2013) and the ﬁrst year of the Pioneer ACO initiative (2012). After that, the ACOs will select and pay for a CMS-certiﬁed vendor to administer the patient survey. In the ﬁrst year, payments will be based on savings and submitting quality data. After the ﬁrst year, ACOs will report and also perform on selected quality measures. CMS will publish national benchmarks for ACO quality measures after the ﬁrst year. Minimum attainment level will be set at the 30th percentile, maxing out at the 90th percentile. PatientRisk™ Identiﬁes ACO Members PatientRisk includes an ACO ﬂag, which identiﬁes patients who are enrolled in an ACO plan. For the Medicare ACO programs, CMS simply sends a spreadsheet of patients originally enrolled, and then patients who have opted out of the program. Passport is able to store this member data in a database and then ﬂag the registration when the 10 patient present for services. This ﬂag enables unique downstream workﬂows, including a special ACO discharge work ﬂow in Passport’s PatientDischarge solution. PatientRisk also ﬂags patients who will affect the quality measures used in the ACO reimbursement calculation. Both of these ﬂags are ﬁrst-class alerts in Passport eCare NEXT and can be used to group accounts into a work queue, prioritize cases and be measured for closure in a quality scorecard. PatientDischarge™ and Medicare Shared Savings Program Patient Discharge allows patients to select and schedule follow-up visits with qualiﬁed post acute care providers, based on previous patient feedback. The list of providers can be dynamically determined based on the patient demographics, insurance information and order data. Hospitals can then focus customers to post-acute care providers where revenue sharing arrangements have already been negotiated and common payment mechanisms established. http://www.cms.gov/Medicare/Medicare-Feefor-Service-Payment/sharedsavingsprogram/ Downloads/MSSP-ACOs-List.pdf QualityNet Site (Under Physican Offices) www.qualitynet.org CAHPS Website http://www.cahps.ahrq.gov/ Press Ganey CGCAHPS Page http://www.pressganey.com/ourSolutions/ medicalPracticeSolutions/satisfactionSuite/ cgcahpsInsights.aspx Physician Comparison Website http://www.medicare.gov/ﬁnd-a-doctor/providersearch.aspx?AspxAutoDetectCookieSupport=1 By pulling post-acute care scheduling into the registration workﬂow, providers ensure that the patient course of care will reconcile with the established bundled payment arrangements with chosen post-acute care providers. References CMS website on Medicare Shared Savings Program http://www.cms.gov/Hospital-Value-BasedPurchasing/ ACO Quality Measures Overview (p4 table of the 33 measures and data submission method) https://www.cms.gov/Medicare/Medicare-Feefor-Service-Payment/sharedsavingsprogram/ Downloads/ACO_QualityMeasures.pdf ACO Payment Methodology http://www.cms.gov/Medicare/Medicare-Feefor-Service-Payment/sharedsavingsprogram/ Downloads/ACO_Methodology_Factsheet_ ICN907405.pdf ACO Shared Savings Program Pilots 11 Patient Access Changes Due to ACA The ACA represents a major change in Medicare reimbursement methodologies. In the same way the high deductible plans and health savings accounts required patient access to create estimates, triage for charity and collect patient-owed portions up-front, ACA will affect similar changes in order to optimize quality scores and readmission rates. Speciﬁcally, two changes are pretty obvious: discharge planning will start at registration and case management will likely engage much earlier in the revenue cycle. We'll go into the mechanics of these two changes in some detail. Discharge Planning Starts at Registration Communication of discharge instructions, selection of post-acute care provider and scheduling of postacute care follow-up are all likely to be tacked on to the existing registration process. The rational is that registration is more systematic, measured and actively managed than discharge. And, patients are already receiving other key pieces of information at registration, including consent forms, estimates, receipts and medical necessity notices. Patients are also able to make these decisions more easily before service, before they go through the emotional distress of a major medical event and are under pain medication. Lastly, registration has all the key pieces of information to do the discharge planning step, the order, the coverage and the patient demographics. So, folding discharge planning into the registration workﬂow and systematically measuring it like other registration activities makes good sense for those hospitals who are now managing post-acute care. managers can ensure that protocols are followed and properly documented and that patients are discharged to best practices, protecting a hospital from having a readmission count against their rate. So, in the same way that patient access systems can identify patients with coverage issues and assess the likelihood for charity enrollment, they will now be identifying clinically risky patients and routing them to case management for proactive supervision through the care cycle. This beneﬁt of involving case management is even more apparent for facilities that have implemented pre-service clearance. In these facilities, case management can engage at the time of scheduling or soon thereafter, ensuring that the patient is receiving the right course of care at the right service location within the health system and that pre-service communication is clear and concise. By adding the pre-service care piece to the postacute care communication and referral, the entire course of care can be carefully managed for those patient encounters driving the quality scores and readmission rates. In both of these workﬂow changes, the key admissions initially will be those in ANI, heart attack, pneumonia, inpatient surgeries and those patients enrolled in ACOs. By having two workﬂows in place, hospitals can focus the process change on the speciﬁc patient population that requires the additional steps in discharge planning and case management, ensuring the change is minimized and focused on the high-leverage encounters. Case Management is Engaging Earlier in the Revenue Cycle Case management is the obvious group to manage and document the high-risk admissions that are now driving a hospital's quality score and readmission rate. But, to do so, case management will need to engage early in the care cycle, as the patient is being scheduled and registered. By engaging earlier, case 12 Conclusion Medicare reimbursement change is here, starting with the Value-based Purchasing Program and Readmission Risk program in October 2012 and expanding soon to the Bundled Payments for Improvement of Care and Medicare Shared Savings programs. The Passport eCare NEXT suite of products expand Passport’s best-of-breed patient access suite to address these changes. PatientRisk allows clinically risky patient encounters to be identiﬁed early in the revenue cycle, enabling case managers to engage early in the care cycle ensuring compliance and optimal ﬂow through the system. PatientDischarge communicates discharge instructions and schedules post-acute care follow-up for patients, helping to reduce readmission rates while coordinating care with post-acute providers in a shared payment model. Combined, these products allow discharge planning to start at registration and allow case managers to engage earlier in the revenue cycle, the two key process changes needed to maximize Medicare reimbursement in the post-ACA environment. 13 ABOUT PASSPORT HEALTH COMMUNICATIONS INC. Passport Health Communications Inc. creates software and solutions to enable hospitals and health care providers to improve business operations and secure payment for their services. Founded in 1996 and headquartered in Franklin, Tenn., the organization is among the nation’s fastest-growing Software-as-aService companies. Passport’s eCare® brand of revenue cycle management solutions are available across multiple platforms and are delivered to one in three U.S. hospitals and more than 8,600 other health care facilities in all 50 states. 720 Cool Springs Blvd., Suite 200, Franklin, TN 37067 | 888-661-5657 | www.passporthealth.com