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Dana McHugh
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July 22, 2016

Reducing Antipsychotic Usage in Long Term Care Facilities
By Ken Brummel-Smith, MD
FAHA H&S Medical Director


For a number of years, experts in geriatric medicine and psychiatry have been questioning the use of antipsychotic medication in persons with dementia. Symptoms that look like those seen in non-demented psychotic patients are commonly seen in persons with dementia – hallucinations, delusions, resistance to care, irritability, and many others. It seems natural that antipsychotic drugs would be used for these symptoms. However, as the problem was more closely studied, it became apparent that not only were these drugs often ineffective, they actually increased the harm experienced by patients with dementia. Over-sedation, parkinsonian movements, and falls are common. More concerning, these drugs increase the death rate of people on them. At first, we thought this may be due to using older drugs, like thorazine or haloperidol. But then studies showed the newer drugs had the same effects. For this reason, the American Geriatrics Society released this “Choosing Wisely” recommendation: “Do not use antipsychotics as first choice to treat behavioral and psychological symptoms of dementia.”  READ MORE

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June 3, 2016

Why Everyone Should Care About Managed Care

According to the latest data, about one in five Floridians is 65 or over, and nearly one out of two of them are choosing Medicare Advantage plans. That number has been rising for some time.


Since the transition of Florida’s Medicaid program to managed care, LeadingAge Florida’s Medicaid provider members have been acutely aware of the impact of that change, and the need to stay informed about the ways it is altering long-term care system.

Increasingly, though, managed care is no longer just a Medicaid issue for aging services providers.



Why Everyone Should Care About Managed Care Workshop

Join us for an important workshop to help aging services providers understand the potential impacts of these changes, to deliver the latest critical information about the plans and the nuances of their processes, and to help prepare for what may well be the next major shift in the aging services environment.

Since the transition of Florida’s Medicaid program to managed care, LeadingAge Florida’s Medicaid provider members have been acutely aware of the impact of that change, and the need to stay informed about the ways it is altering long-term care system.

Increasingly, though, managed care is no longer just a Medicaid issue for aging services providers.

According to the latest data, about one in five Floridians is 65 or over, and nearly one out of two of them are choosing Medicare Advantage plans. That number has been rising for some time.

 

This workshop will be held in three locations throughout the year:

 

Wednesday, September 28
10:00 am – 2:00 pm
John Knox Village of Florida
651 SW Sixth St
Pompano Beach, FL

Cancellation Date: Sept. 23

Register Now

      
 

Wednesday, November 30
10:00 am – 2:00 pm
Moosehaven, Inc.
1701 Park Ave
Orange Park, FL

Cancellation Date: Nov. 25

Register Now


Speakers: Janice Baron, Senior Vice President Network, United Healthcare;
Kili Chivers, Executive Vice President for Payor Solutions, PointRight;
Janine Savage, RN, RAC-CT,CHC, Vice President of Client Experiences, PointRight;
Dana McHugh, Executive Director, FAHA H&S

Registration Fee: LeadingAge Florida Members is $125 and Prospective Members is $225. Lunch is included with your registration. FREE for FAHA H&S Members. Contact Dana McHugh to register if your a FAHA H&S Member.

There are Two Ways to Register:
1. To register online and pay with credit card, please click on the Register above on the date and location to would like to attend.
2. To pay by check, click here for the registration form. Fill out the form and mail to LeadingAge Florida - 1812 Riggins Rd, Tallahassee, FL 32308

Cancellations/Refunds/Substitutions:
There is a $50 administrative fee for each cancellation or refund. All cancellations must be in writing. Substitutions will be accepted at no additional fee. Due to costs incurred related to the workshop, no refunds will be issued after date posted below. All cancellations and substitution requests must be sent to info@LeadingAgeFlorida.org or faxed to (850) 671-3790.

ADA/Dietary Needs/Questions:
If you require assistance to participate in this event, including special meal requests, please contact Elizabeth Lane at elane@LeadingAgeFlorida.org or (850) 671-3700.


 

Why Bundled Payments?

During the holiday shopping season many of us are looking for a good deal on products and services.  One way to accomplish the good deal is by purchasing several accompanying products or services wrapped into one lower negotiated package price. This is a simple example of what CMS is hoping to accomplish with the Bundled Payment initiative. 

Why Bundled Payments?  According to CMS, Medicare’s traditional fee-for-service can result in fragmented care with minimal coordination across providers and health care settings. CMS believes this approach rewards quantity of services versus quality of care.   Their research suggests bundled payments can align incentives for hospitals, post-acute care, physicians, and other practitioners – allowing them to work together closely across all specialties and settings.   

The CMS bundled payments initiative known as Bundled Payment for Care Improvement (BPCI) is made up of four broadly defined models of care.  These models, described in the table below, link payments for multiple services received by Medicare beneficiaries within an episode of care as defined by clusters of DRG’s such as:  total joint; CHF, etc. 

 

Model 1

Model 2

Model 3

Model 4

Episode

All acute patients, all DRGs

Selected DRGs, hospital plus post-acute period

Selected DRGs, post-acute period only

Selected DRGs, hospital plus readmissions

Services included in the bundle

All Part A services paid as part of the MS-DRG payment

All non-hospice Part A and B services during the initial inpatient stay, post-acute period and readmissions

All non-hospice Part A and B services during the post-acute period and readmissions

All non-hospice Part A and B services (including the hospital and physician) during initial inpatient stay and readmissions

Payment

Retrospective

Retrospective

Retrospective

Prospective

 

Florida is represented with 22 Participant Awardees in Models 2, 3, and 4 with the most participation in Model 2.  

How is it implemented?  The first set of Awardees for Models 2, 3, and 4 began in January 2013 and the Model 1 Awardees began in April 2013. The initiative includes two phases for Models 2, 3, and 4. Phase 1, is referred to as the “preparation” period, which the participants prepare for the implementation and financial risk of the initiative. Those approved by CMS and agree to assume financial risk will be allowed to enter Phase 2 of the initiative.  Phase 2 is considered the “risk-bearing” period. By October 2013, some Awardees entered into Phase 2. Please see footnotes for further detail on those participating Awardee hospitals and the number of episodes awarded in Phase 2.

Relationships matter in all things and this is especially true with your local hospital or physician Bundled Payment Awardee. As explained in the footnotes portion of this article, “any reduction in payments beyond the target price is paid to the participant and may be shared among their provider partners.” Please consider meeting with your local Awardee (hospital or physician) to understand their participation and your potential partnership in the bundled payment initiative.   

For further information or questions, please contact Dana McHugh at dmchugh@leadingageflorida.org or (850) 702-0308.  Additional information can also be found at the CMS Innovation Center: https://innovation.cms.gov

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Keeping up with the various types of health care reform initiatives in your region is critical.  We have prepared the following detailed information on the bundled payment models and which entities have been selected in the State of Florida.

BPCI Model 1: Retrospective Acute Care Hospital Stay Only

In Model 1, the episode of care is defined as the inpatient stay in the acute care hospital.   Medicare pays the hospital a discounted amount based on the payment rates established under the Inpatient Prospective Payment System used in the original Medicare program.   Medicare continues to pay physicians separately for their services under the Medicare Physician Fee Schedule.

                No Florida hospitals awarded this Model 1 effective July 1, 2015

BPCI Model 2:  Retrospective Acute & Post Acute Care Episode (678 awardees nationally)

In Model 2, the episode of care includes a Medicare beneficiary’s inpatient stay in the acute care hospital, post-acute care and all related services during the episode of care, which ends either 30, 60, or 90 days after hospital discharge. Awardees select up to 48 different clinical episodes to test in the model.

Under this payment model, Medicare continues to make fee-for-service (FFS) payments to providers and suppliers furnishing services to beneficiaries in Model 2 episodes. The total expenditures for a beneficiary’s episode is later reconciled against a bundled payment amount (the target price) determined by CMS.  his target price is set based on historical fee-for-service payments for the participant’s Medicare beneficiaries in the episode including a discount.  A payment or recoupment amount is then made by Medicare reflecting the aggregate performance compared to the target price. Any reduction in expenditures beyond the target price is paid to the participant and may be shared among their provider partners.   Any expenditure paid above the target price is to be repaid to Medicare by the participant.

The information below represents the Florida BPCI Model 2 Awardees as of October 1, 2015 which are actively testing BPCI in Phase 2 at one or more episode-initiating sites:

Model 2 Awardees

Phase 2

Number of Episodes

Location

Aventura Hospital and Medical Center

22

Aventura

Flagler Hospital

3

St. Augustine

Florida Health Sciences Center dba Tampa General Hospital

1

Tampa

Halifax Hospital Medical Center

1

Daytona Beach

JFK Medical Center

22

Atlantis

Jupiter Medical Center

4

Jupiter

Lakeland Regional Medical Center, Inc

1

Lakeland

Lakewood Ranch Medical Center

1

Lakewood Ranch

Manatee Memorial Hospital LP

5

Bradenton

Memorial Hospital Jacksonville

19

Jacksonville

North Brevard County Hospital District dba Parrish Medical Center

3

Titusville

Orlando Health

5

Orlando

Physicians of Central Florida PA

1

Mount Dora

St Vincent’s Healthcare

5

Jacksonville

Wellington Regional Medical Center

37

Wellington

West Palm Beach Physician Group

35

Sunrise

Westside Regional Medical Center

18

Plantation

 

BPCI Model 3:  Retrospective Post Acute Care Only (1,353 awardees nationally)

In Model 3, the Episode of Care is triggered by a Medicare beneficiary’s acute care hospital stay and begins at initiation of post-acute care services with a participating skilled nursing facility, inpatient rehabilitation facility, long-term care hospital or home health agency.  The post-acute care services included in the episode of care must begin within 30 days of discharge from the inpatient stay and end 30, 60, or 90 days after the initiation of the episode of care. Participants can select up to 48 different clinical condition episodes to test in the model.

Under this model, Medicare continues to make fee-for-service (FFS) payments to providers and suppliers furnishing services to beneficiaries in Model 3 episodes. The total expenditures for a beneficiary’s episode is later reconciled against a bundled payment amount (the target price) determined by CMS. A payment or recoupment amount is then made by Medicare reflecting the aggregate performance compared to the target price.  

The information below represents Florida BPCI Model 3 Awardees as of October 2015 which are actively testing BPCI in Phase 2 at one or more episode-initiating sites:

Model 3 Awardees

Phase 2 Number of Episodes

Location

Brooks Health System

27

Jacksonville

Chatsworth at Wellington Green, LLC

15

Palm Beach Gardens

Jupiter Medical Center Pavilion

4

Jupiter

Westchester Gardens

1

Clearwater

 

BPCI Model 4:  Prospective Acute Care Hospital Stay Only  (10 participants nationally)

 

Model 4, CMS makes a single, prospectively determined bundled payment to the hospital that  encompasses all services furnished by the hospital, physicians, and other practitioners during the Episode of Care, which lasts the entire inpatient stay. Physicians and other practitioners submit “no-pay” claims to Medicare and are paid by the hospital out of the bundled payment. Related readmissions for 30 days after hospital discharge are included in the bundled payment amount. Participants can select up to 48 different clinical condition episodes to test in the model.

 

The information below represents FLORIDA BPCI Model 4 Awardees as of October 2015 which are actively testing BPCI in Phase 2 at one or more episode-initiating sites:

 

Model 4 Awardees

Phase 2 Number of Episodes

Location

Florida Hospital

2

Orlando

 

For more information on any of the specific bundled payment awardees, please go to the following website:  https://innovation.cms.gov

 
       
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