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MS Medicaid DRGUpdate for July 1, 2017June 12, 2017June 14, 2017June 16, 2017Payment Method DevelopmentGovernment Healthcare SolutionsMSI17025
Topics1. Overview2. Year 6 updates3. Analytical dataset Overview and utilization of inpatient care4. Simulation overview and impacts5. Looking to the future"This Report was produced using proprietary computer software created, owned and licensed by the 3M Company. All copyrights in and to the 3M [APR ] Software, andto the 3M [APR DRG] classification system(s) (including the selection, coordination and arrangement of all codes) are owned by 3M. All rights reserved."June 2017Mississippi Medicaid DRG Training2
OverviewJune 2017Mississippi Medicaid DRG Training3
OverviewHistory of the DRG ProjectTimeline: 2005: Assessment of options 2005-2006: Consultation and policy design 2008: Evaluation published in Health Affairs 2009: Unanimously recommended by Legislative PEER Committee 2012: Legislature directs DOM to implement DRG paymentYear 1: October 2012-September 2013, APR-DRG V.29Year 2: October 2013-June 2014 (nine months), APR-DRG V.30Year 3: July 2014-June 2015, APR-DRG V.31Year 4: July 2015-June 2016, APR-DRG V.32. ICD-10 implemented Oct. 1, 2015Year 5: July 2016-June 2017, APR-DRG V.33Year 6: July 2017-June 2018, APR-DRG V.34June 2017Mississippi Medicaid DRG Training4
OverviewHistory (Cont.) DRG payment is used for all Mississippi Medicaid inpatient acute care stays Presently, Medicaid covers hospital inpatient services for Medicaid beneficiaries through fee-for-service and managed care December 1, 2015 managed care was expanded to include coverage of hospital inpatient services for beneficiaries enrolledin MississippiCAN, the managed care program DRG payment applies to all inpatient care in all acute care hospitals, including general hospitals, Long-term acute care,freestanding psychiatric hospitals, freestanding rehabilitation hospitals and critical access hospitals DRGs were implemented on October 1, 2012. Benefits of a DRG payment method include but are not limited to thefollowing: Value purchasing Quality Rewards efficiency Reduces administrative burden Encourages access Increases transparencyJune 2017Mississippi Medicaid DRG Training5
OverviewHow States Pay for Inpatient Care June 2017Mississippi Medicaid DRG TrainingA majority of states, and theDistrict of Columbia, use orwill use APR-DRGs for FFSMedicaidAll the largest states haveimplemented APR-DRGsAPR-DRGs account for overhalf of the FFS inpatientMedicaid dollars6
OverviewKey Resources Division of Medicaid’s website at:https://medicaid.ms.gov/providers/finance FAQ Quick tips DRG calculator Grouper settings document Training presentationJune 2017Mississippi Medicaid DRG Training7
OverviewKey ResourcesJune 2017Mississippi Medicaid DRG Training8
Year 6 UpdatesJune 2017Mississippi Medicaid DRG Training9
Year 6 UpdatesThe Headlines, DRG Rate Year 6 Effective July 1, 2017 the standard yearly updates will include: APR-DRG grouper version change from version 33 to 34 Hospital Acquired Conditions (HAC) version change form version 33 to 34 APR-DRG relative weight version change from version 33 HSRV to 34 HSRV CCRsJune 2017 Cost report year end 2015 for in-state hospitals 08/22/16 Final Rule for out-of-state hospitals CCRs will be updated on 10/01/2017 utilizing 2016 cost reports and the FY-18 Final RuleMississippi Medicaid DRG Training10
Year 6 UpdatesThe Headlines, DRG Rate Year 6 (Cont.)Effective July 1, 2017 policy updates will include: Low-side outlier payment policy implementation Charge-cap payment policy implementation Neonate policy adjustor changes from 1.45 to 1.40 Policy adjustors will be applied based on the DRG and Medicaid Care Category (MCC) assignments The estimated annual aggregate expenditures of the Division of Medicaid relative to APR-DRG years 1,2,3,4, and 5;calculated on a Federal Fiscal Year basis, are expected to be a decrease of 802,000 in state funds and 2.4 million infederal funds for FY-17 and 3.1 million in state funds and 9.6 million in federal funds for FY-18 The reduction in expenditures could change depending on increases or decreases in utilizationJune 2017Mississippi Medicaid DRG Training11
Year 6 UpdatesUpdate to V.34 APR-DRG V.34 APR-DRG: 3 deleted DRGs; 7 new DRGs Changes to the description of 20 DRGs 318 Base DRGs each with 4 levels of severity 1,272 APR-DRGs Two Error DRGs (955 and 956) 1,274 APR-DRG in aggregate Clinical logic changes Adjustments to the HSRV weightsV.34 DRG Code UpdatesDeleted173 Other Vascular ProceduresReplacements181 Lower extremity vascular procedures182 Other peripheral vascular procedures460 Renal Failure469 Acute kidney injury470 Chronic kidney disease693 Chemotherapy695 Chemotherapy for acute leukemia696 Other chemotherapyNew322 Shoulder & elbow joint replacementNote:1. Three DRG codes are deleted and each replaced with two new DRG codes. There isone new stand-alone DRG. Measured casemix changes using Year 4 stays (1/1/2016through 6/30/2016), comparing V.32 and V.34 Overall measured casemix decreased from 0.77 to 0.76 Changes in casemix by MCC were variedV.34 HAC upgrade will include up to five HACs identifiedand used, minor impactJune 2017Mississippi Medicaid DRG Training12
Year 6 UpdatesLow-Side Outlier A Low-side outlier payment reduction policy will be implemented for low cost non-psychiatric cases where the gainto the hospital (APR-DRG base payment minus estimated hospital cost) exceeds the low-side outlier threshold of( 50,000) In such situations, the APR-DRG base payment will be reduced by the amount the gain exceeds the low-side outlierthreshold, times the low-side outlier marginal cost percentage of 50% Medical education payments will be excluded from the calculation of the Low-side Outlier payment reductionCharges 400,000CCR0.40Cost 160,000DRGBasePrice 6,415DRGDRG Rel. PreliminaryWtPMT46.7654 300,000GrossGain/LossAmountDoes theGainGainNet Gain/Thresh Marginal ExceedReductionoldCost % Threshold Amt 140,000 50,0000.50 YFinal DRGAllowed 45,000.00 255,000.00(DRG Base Pmt. – Cost Gross Gain) 300,000 – 160,000 140,000(Gross Gain – Outlier Threshold Net Gain) 140,000 – 50,000 90,000(DRG Base Payment – (Net Gain * Marginal Cost Percentage)) Final DRG Allowed( 300,000 – ( 90,000 * .5)) ( 300,000 - 45,000) 255,000June 2017Mississippi Medicaid DRG Training13
Year 6 UpdatesCharge Cap If the allowed amount exceeds charges, payment is reduced to charges Charges 50,000 DRG Allowed 73,000 DRG final Allowed 50,000Charges 50,000June 2017CCR0.40Cost 21,000DRGBasePriceGrossDRGGain/DRGPreliminary LossRel. Wt PMTAmount 6,415 11.6913Mississippi Medicaid DRG Training 75,000 54,000Final DRGNet Gain/ AllowedGainMarginal Cost Reduction Before ChgThreshold %amtCap 50,0000.50 2,000.00 73,000.00Final DRGAllowed withCharge Cap 50,00014
Year 6 UpdatesNeonate Policy Adjustor at 1.40 V.34 biggestchange in clinicallogic in recentyears Note increase inneonate casemixJune 2017Mississippi Medicaid DRG Training15
Year 6 UpdatesNeonate Policy Adjustor at 1.40 BaselineNeonatepayment 45.1million SimulatedNeonatepayment 44.9million Payment willdepend uponactual utilizationand casemix Figures excludesupplementalpaymentsData represents a six month period, Jan 1 – June 30 2016.June 2017Mississippi Medicaid DRG Training16
Year 6 UpdatesPolicy Adjustors Effective July 1, 2017, all policy adjustors will be applied based on the DRG and Medicaid Care Category (MCC)assignments See slide 16 for payments by Medicaid Care Category impactsAPR-DRG Range580-625630-639863Medicaid CareCategoryNeonateSeverity of PolicyIllnessAdjustor Age Range1- 41.40 Less than 365 days626 and 640Normal Newborn1-41.50 Less than 365 days540-566Obstetric1-41.50 No restriction001-003, 006,440Pediatric Transplant1-41.50 Less than 21 years of age001-003, 006,440Adult Transplant1-41.50 Greater than or equal to 21 years of age740 - 776Pediatric Mental Health1-42.00 Less than 21 years of age740 - 776Adult Mental Health1-41.60 Greater than or equal to 21 years of age860Rehab1-42.00 No restrictionJune 2017Mississippi Medicaid DRG Training17
Year 6 UpdatesMS Policy HistoryPolicy DecisionsItemYear 1Year 2Year 3Year 4Year 5Year 6Jul. 1, 2016 to Jun. 30,2017Jul. 1, 2017 to Jun. 30,2018Calendar periodOct. 1, 2012 to Sep. 30, 2013Oct.1 2013 to Jun. 30, 2014Jul. 1, 2015 to Jun. 30,Jul. 1, 2014 to Jun. 30, 2015 2016Budget targetBudget neutral (on a volumeadjusted basis) with the simulationperiod since Oct. 1, 2010 - Mar.31, 2011, not including medicaleducation.Budget neutral (on a volumeadjusted basis) with the periodOct. 1 2010 - March. 31, 2011,not including medicaleducation.Budget neutral (on a volumeadjusted basis) with theperiod Oct. 1 2012 - Sep. 30,2013, not including medicaleducation.Budget neutral with theperiod Jul. 1 2013 - Jun.30, 2014, not includingmedical education.Budget neutral with theperiod Jul. 1 2014 - Jun.30, 2015, not includingmedical education.The baseline was setusing a six month periodfrom January 1, 2016 toJune 30, 2016, notincluding medicaleducationDocumentation and coding adj.3.5%3.5%2.0%0%0%0%DRG base price 6,223 6,022 6,415 6,415 6,415 6,415APR-DRG versionV.29V.30V.31V.32V.33V.33 to V.34APR-DRG relative weightsV.29 traditional weightsV.30 HSRV weightsV.31 HSRV weightsV.32 HSRV weightsV.33 HSRV weightsV.34 HSRV weightsAverage casemix0.730.700.720.720.720.76Policy adjustor—pediatric MH2.082.082.002.002.002.00Policy adjustor—adult MH1.751.751.751.601.601.60Policy adjustor—obstetric1.401.401.401.501.501.50Policy adjustor—normal newborn 1.401.401.401.501.501.50Policy adjustor—neonate1.401.401.401.451.451.40Policy adjustor—rehab2.112.112.002.002.002.00Policy y adjustor—otherNoneNoneNoneNoneNoneNoneCost outlier poolTarget 5%Target 5%Target 5%Target 5%Target 5%6.7%Cost outlier threshold 30,000 32,800 35,175 50,000 50,000 50,000June 2017Mississippi Medicaid DRG Training18
Year 6 UpdatesMS Policy History (Cont.)Policy DecisionsItemYear 1Year 2Year 3Year 4Year 5Year 6Low cost, outlier reduction thresholdN/AN/AN/AN/AN/A 50,000Marginal cost percentage60%60%60%50%50%50%Low cost, marginal cost percentageN/AN/AN/AN/AN/A50%Day outlier threshold19 days19 days19 days19 days19 days19 daysDay outlier per diem payment 450 450 450 450 450 450Interim claim per diem amount 450 850 850 850 850 850Cost-to-charge ratiosLatest availableLatest availableActual for LDOS 1 yearActual for LDOS 1 yearActual for LDOS 2 years Actual for LDOS 2 yearsCharge levels used for simulationActualAdjusted for expectedcharge inflation of 9.37%Adjusted for expectedcharge inflation of 8.62%Adjusted for expected charge Adjusted for expect charge Adjusted for expect chargeinflation of 8.18%inflation of 5.05%inflation of 5.33% annually02, 05, 07, 63, 65, 66, 82, 85, 02, 05, 07, 63, 65, 66, 82,91, 93, 9485, 91, 93, 9402, 05, 07, 63, 65, 66, 82,85, 91, 93, 94Under age 21Under age 21Under age 21Transfer adj discharge values02, 05, 07, 65, 6602, 05, 07, 63, 65, 6602, 05, 07, 63, 65, 66, 82,85, 91, 93, 94Pediatric age cutoffUnder age 21Under age 21Under age 21Pricing logicNo changeNo changeNo changeNo changeNo changeCharge Cap/Low sideoutlierAllowed chg source logicNo changeNo changeNo changeNo changeNo changeLow side outlierMedicaid Care Category definitionsNo changeNo changeNo changeNo changeNo changeRedefinedMedical education add-on paymentsUpdated list, reflectingmarket basket increaseUpdated list, reflectingmarket basket increaseUpdated list, reflectingmarket basket increaseUpdated list, reflectingmarket basket increaseUpdated list, reflectingmarket basket increasePer diem treatment authorization threshold 19 days19 days19 days19 days19 days19 daysNo changeComplication of care settingchanged to “exclude onlynon-POA CoC codes”.No changeNo changeOther aspects of payment methodJune 2017No changeMississippi Medicaid DRG TrainingNo change19
Analytical Dataset- Overview and Utilization of Inpatient CareJune 2017Mississippi Medicaid DRG Training20
OverviewAnalytical DatasetYear 4SFY 2016Analytical Dataset Analytical dataset consists of a six-month period; 1/1/2016 – 6/30/2016 paid through 1/23/2017 DRG version 32 ICD-10-CM/PCS codes only Total stays 48,260; total allowed before medical education add-on and TPL deductions is 296,400,164Year 5SFY 2017Baseline Dataset Year 4 utilization paired with year 5 policy DRG version 33, ICD-10-CM/PCS only Total stays 48,260; total allowed before medical education add-on and TPL deductions is 305,857,459 (3%increase)June 2017Mississippi Medicaid DRG Training21
OverviewAnalytical DatasetYear 6SFY 2018(Con’t)Simulation Dataset DRG version 34, ICD-10-CM/PCS Year 4 utilization with year 6 policy; Low-side outlier adjustment; lower-of; neonate policy adjustor reduced to 1.40 Total stays 48,260; total allowed before medical education add-on and TPL deductions is 299,538,847 (2% decrease)June 2017Mississippi Medicaid DRG Training22
OverviewComposition of the Analytical Dataset DRG version 32 Year 4 stays with a last date of service between 1/1/2016 and 6/30/2016 paid through 1/23/2017 48,260 stays Fee-for-service total 9,634 Managed care total 38,626 ICD-10-CM/PCS codes only Multiply by 2.137 to annualize DRG payment refers to the allowed amount before TPL, cost sharing and supplemental payments Payment will depend upon utilization and casemix Medical education payments are excludedJune 2017Mississippi Medicaid DRG Training23
Utilization of Inpatient CareFFS vs CCOFunding StreamFFSStaysDaysChargesV. 32Casemix ALOSAllowed9,63470,145 519,862,174 95,044,9561.217.28United18,55278,925 437,963,400 94,159,3490.654.25Magnolia20,07486,322 471,635,739 107,195,8590.684.30Totals48,260235,392 1,429,461,313 296,400,1640.774.88CCO Subtotal38,626165,247 909,599,139 201,355,2080.664.28Relative to DatasetTotalAs Percentage of Dataset TotalFunding 6%32% 1.561.49United38%34%31%32% 0.840.87Magnolia42%37%33%36% 0.880.88100%100%100%100% 1.001.0080%70%64%68% 0.860.88TotalsCCO Subtotal FFS represented 20% of stays;30% of days and 32% of allowed FFS patients were much sicker(casemix 1.21), on average, CCO patients (casemix .66)Notes:1. Payment excludes hundreds of millions in supplementary payments to hospitals.Data represents a six month period, Jan 1 – June 30 2016.June 2017Mississippi Medicaid DRG Training24
Utilization of Inpatient CareFY 2016 Utilization by MCC Obstetrics,newborns, andpediatricsaccounted for 64%of stays and 42%of total payments Normal newbornsrepresented 21% ofstays and 4% ofpayments Neonatesrepresented 3% ofstays and 15 % ofpaymentsJune 2017Mississippi Medicaid DRG Training25
Utilization of Inpatient CareHow Claims Paid in FY 2016June 2017Mississippi Medicaid DRG Training26
Simulation Overview and ImpactsJune 2017Mississippi Medicaid DRG Training27
Simulation Overview and ImpactsSimulation Overview Analysis and simulation done using 48,260 stays from the period January-JuneDRG Update: Simulation Results2016 ActualBaselineSimulationYear 4Year 5Year 6 Multiply by 2.137 to annualizeStays48,26048,26048,260Base price 6,415 6,415 6,415 Simulation is not a forecast, since it does not reflect forecasts of eligibility and utilizationPayment 296.4M 305.9M 299.5MAnnualized 633.4M 653.6M 640.1MDRG payment method changes charge cap, low-side cost outlier, decreaseChange3.2%-2.1%6.3%6.7%Outlier %5.6%neonate policy adjustor to 1.40Notes: Medical education payments are excluded1. Payment excludes hundreds of millions insupplemental payments to hospitals.2. Analysis and simulation are based on FFS andCCO paid stays for the period January-June 2016.June 2017Mississippi Medicaid DRG Training28
Simulation Overview and ImpactsCasemix by MCC V.34 biggestchange in clinicallogic since V.20;nevertheless, notlarge Note increase inneonate weightsJune 2017Mississippi Medicaid DRG Training29
Simulation Overview and ImpactsTotal Payments by MCC DRG paymentrefers to theallowedamount beforeTPL, costsharing andsupplementalpaymentsData represents a six month period, Jan 1 – June 30 2016.June 2017Mississippi Medicaid DRG Training30
Simulation Overview and ImpactsOutlier Payments by MCC Total outlier payment 20.1 million Mostly to miscellaneous adult and miscellaneouspediatric categoriesJune 2017Mississippi Medicaid DRG Training31
Simulation Overview and ImpactsPeer Group Impacts, CasemixJune 2017Mississippi Medicaid DRG Training32
Simulation Overview and ImpactsPeer Group Impact, PaymentsData represents a six month period, Jan 1 – June 30 2016.June 2017Mississippi Medicaid DRG Training33
Simulation Overview and ImpactsPeer Group Impact, Payment Per StayJune 2017Mississippi Medicaid DRG Training34
Simulation Overview and ImpactsPeer Group Impact, Outlier PercentageData is for a six month period, Jan 1 – June 30 2016.June 2017Mississippi Medicaid DRG Training35
Simulation Results by Peer GroupUnder 50 BedsAnalyticalDatasetStaysBaselineCasemix AllowedDays V33BaselineMarion General Hospital427 1,6780.73 2,563,876South Sunflower County Hospital2756830.41S E Lackey Memorial Hospital127384Claiborne County Hospital57Kings Daughters HospitalSimulationChange in PaymentCasemix AllowedV34SimChange in PctChange inPaymentChange PaymentChange in PaymentXDecrease 10%XDecrease 10%0.71 2,499,685- 64,190-3%X 902,3280.41 863,772- 38,557-4%XXIncrease 10%0.44 342,2990.43 337,654- 4,645-1%XXIncrease 10%1810.60 219,4700.59 212,503- 6,968-3%X551850.57 195,0600.54 184,329- 10,731-6%XWebster General Hospital511350.66 208,0430.64 199,594- 8,450-4%XSharkey Issaquena CommunityHospital481230.49 149,8840.48 128,597- 21,288-14%Hardy Wilson Memorial Hospital341290.60 131,0180.57 124,586- 6,432-5%XNoxubee General Critical Access Hos291140.58 108,7010.56 106,044- 2,656-2%XBeacham Memorial Hospital291250.66 122,3900.63 109,815- 12,575Field Health System27980.79 126,2690.75 119,617- 6,652-5%XLawrence County Hospital24850.43 77,0010.42 75,037- 1,964-3%XNorth Sunflower Medical Center23650.68 98,7350.63 91,308- 7,428-8%XWalthall Co General Hospital22660.55 77,0560.52 73,200- 3,856-5%XTishomingo Health Services Inc21620.72 89,8000.72 87,410- 2,390-3%XScott Regional Medical Center20590.53 66,7590.51 64,016- 2,743-4%XStone County Hospital Inc20540.54 63,7680.52 61,446- 2,322-4%XYalobusha Gen Hosp Nursing Home17510.54 59,3570.52 54,777- 4,579-8%XTyler Holmes Memorial Hospital15530.54 51,4970.54 52,046 5491%Quitman County Hospital LLC15270.57 54,4540.57 53,812- 642-1%June 2017Mississippi Medicaid DRG Training XPayment excludessupplementalpayments-10% XXXData represents a six monthperiod, Jan 1 – June 30 2016.36
Simulation Results by Peer GroupUnder 50 Beds (Con’t)AnalyticalDatasetChange in PaymentBaselineCasemix AllowedDays V33BaselineStaysSimulationChange in PaymentCasemix AllowedV34SimChange in PctChange inPayment Change PaymentXDecrease 10%XDecrease 10%Alliance Healthcare System13460.51 44,4640.51 43,581- 883-2%XXIncrease 10%Baptist Medical Center Leake13470.50 41,3890.49 40,274- 1,116-3%XXIncrease 10%Whitfield Med Surgical Hosp121020.74 53,7720.72 50,886- 2,886-5%XHolmes County Hospital And Clinics12320.63 48,1850.61 47,130- 1,055-2%XH C Watkins Memorial Hospital11400.53 35,1470.52 34,962- 186-1%XSimpson General Hospital10280.57 35,6240.54 32,564- 3,060-9%XPioneer Comm Hospital Of Aberdeen10350.80 48,5170.75 45,472- 3,045-6%XLaird Hospital Inc10320.66 41,4490.65 40,724- 725-2%XCalhoun Health Services8230.52 26,4310.51 26,217- 215-1%XJohn C Stennis Memorial Hospital7220.78 28,3340.76 24,861- 3,473-12% XFranklin County Memorial Hospital5170.66 21,2190.57 18,376- 2,843-13% XJefferson County Hosp5170.59 18,9810.58 14,842- 4,140-22% XJefferson Davis General Hospital5210.65 20,7170.58 18,522- 2,194-11% XPontotoc Health Services Inc250.85 7,4240.83 7,406- 180%XTallahatchie General Hospital290.71 9,1720.77 9,921 7508%XChoctaw Regional Medical Center260.53 6,7380.52 6,683- 55-1% Payment excludessupplementalpaymentsXData represents a six month period, Jan 1 – June 30 2016.June 2017Mississippi Medicaid DRG Training37
Simulation Results by Peer Group51 to 100 x AllowedV33BaselineCasemixChange in PctV34Allowed Sim Payment ChangeDaysChange in PaymentChange in PaymentChange inPaymentXDecrease 10%Och Regional Medical Center6441,6480.38 2,039,0840.38 2,012,407- 26,677-1%XXDecrease 10%Merit Health Gilmore Hospital5651,7660.45 2,088,4950.44 2,064,404- 24,091-1%XXIncrease 10%Merit Health Madison3661,0320.47 1,486,3000.46 1,487,866 1,5660%XIncrease 10%Clay County Medical Center2737990.41 931,7320.40 904,408- 27,324-3%XMethodist Healthcare Olive Branch2306110.49 871,1320.47 846,377- 24,755-3%XGeorge County Hospital2205980.37 673,2500.36 663,148- 10,102-2%XNeshoba County General Hospitalnur1945230.46 560,7030.45 539,992- 20,711-4%XWayne General Hospital1716500.56 713,1140.55 641,359- 71,755-10%Highland Community Hospital1513710.47 555,4860.47 559,764 4,2781%Magee General Hospital1043350.45 344,8220.44 334,399- 10,423-3%XNorth Oak Regional Medical Center391250.62 157,5950.60 151,622- 5,973-4%XBaptist Medical Center Attala12280.67 46,7840.61 42,295- 4,489-10%XTippah County Health Services11350.66 39,1610.62 37,500- 1,661-4%XCovington County Hospital11240.69 37,1630.70 36,776- 387-1%XWinston Medical Center10300.55 34,5040.52 32,782- 1,722-5%XTrace Regional Hospital5140.56 17,9810.51 16,357- 1,623-9%XSelect Specialty Hospital Jackson1211.75 11,2231.91 12,272 1,0499%XX PaymentexcludessupplementalpaymentsData represents a six month period, Jan 1 – June 30 2016.June 2017Mississippi Medicaid DRG Training38
Simulation Results by Peer Group101 to 200 BedsAnalyticalDatasetBaselineSimulationChange inPaymentStaysCasemix AllowedV33BaselineCasemi Allowedx V34SimChange in PctChange inPayment Change PaymentDaysChange in Payment1,6525,3950.60 7,450,3380.58 7,258,695 - 191,643-3%XMerit Health Biloxi9653,8280.52 4,323,4110.51 4,234,840- 88,571-2%XBaptist Memorial Hosp union County9002,0630.33 2,564,0810.33 2,535,656- 28,425-1%XMagnolia Regional Health Center8892,8870.56 3,813,3710.55 3,685,567 - 127,804-3%XMerit Health Northwest Mississippi8392,7930.59 3,760,9530.57 3,639,573 - 121,380-3%XAlliance Health Center7816,4570.50 4,500,0850.48 4,295,859 - 204,226-5%XMerit Health River Oaks7683,0120.57 3,772,5540.60 3,873,742 101,1883%SW MS Regional Medical Center7231,9800.54 2,925,7400.53 2,829,211- 96,530-3%XMerit Health Batesville5282,2640.47 2,250,1310.45 2,140,674 - 109,457-5%XKings Daughters Medical Center5211,2380.51 2,101,0610.50 2,040,344- 60,717-3%XBolivar Medical Center5191,5510.46 1,865,2250.45 1,821,082- 44,144-2%XGarden Park Medical Center4491,2770.56 1,824,6660.54 1,775,738- 48,928-3%XUniversity Of MS Medical Center Gre2597730.52 1,008,5320.51 988,845- 19,687-2%XHancock Medical Center2196930.55 1,195,9740.54 1,181,957- 14,017-1%XMerit Health Women's Hospital1896260.410.42 735,596 5,0781%MS Methodist Rehab Center1241,7581.32 2,007,8881.41 2,138,199 130,3116%Rankin Medical Center703551.24 569,8521.16 553,552- 16,300-3%Anderson Regional Medical Center So652630.61 379,7530.59 385,298 5,5451%Bapt Mem Hosp Boonevile401440.69 173,7730.67 167,394- 6,378-4%Baptist Memorial Hospital DesotoJune 2017Mississippi Medicaid DRG Training 730,518X XDecrease 10%XDecrease 10%XIncrease 10%XIncrease 10%PaymentexcludessupplementalpaymentsXXXXData represents six monthperiod, Jan 1 – June 30 2016.39
Simulation Results by Peer GroupOver 200 BedsAnalytical Dataset BaselineStaysDaysSimulationCasemix AllowedV33BaselineChange in PaymentCasemixChange in PctChange inV34Allowed Sim PaymentChange PaymentUniversity Of Miss Med Center6,00343,1311.41 68,452,0631.40 66,900,452 - 1,551,611-2%XForrest General Hospital3,04313,6430.81 19,084,0240.79 18,428,067- 655,957-3%XNorth Mississippi Medical Center2,28313,0510.91 16,263,2920.93 16,261,342- 1,9500%St Dominic Jackson Memorial Hospital2,1809,7440.74 12,824,1200.70 12,180,611- 643,510-5%XMemorial Hospital At Gulfport1,8329,6120.81 13,076,5800.79 12,834,312- 242,267-2%XSinging River Health System1,7976,6540.71 9,586,4840.69 9,394,011- 192,473-2%XMississippi Baptist Medical Center1,3477,2670.89 9,061,9560.91 9,038,797- 23,1590%XMerit Health Central1,3036,7930.73 8,230,1320.73 8,341,990 111,8581%XRiver Region Health System1,2686,0990.55 5,739,4670.54 5,622,843- 116,623-2%XSouth Central Reg Med Ctr1,1913,6610.53 4,764,7890.52 4,568,994- 195,795-4%XAnderson Regional Medical Center1,1784,0880.60 5,430,5990.59 5,299,967- 130,632-2%XDelta Regional Medical Center1,1014,7830.73 5,918,6500.75 5,746,187- 172,463-3%XMerit Health Wesley1,0363,0870.50 4,325,6900.50 4,292,251- 33,439-1%XGreenwood Leflore Hospital9913,4010.65 4,544,0700.64 4,441,067- 103,003-2%XRush Foundation Hospital8022,7900.67 4,107,8080.66 3,934,258- 173,551-4%XBaptist Memorial Hospital North MS7922,4830.57 3,344,2150.56 3,263,828- 80,387-2%XBMH Golden Triangle6352,2390.70 3,343,7780.68 3,196,397- 147,381-4%XMerit Health Natchez6121,9270.47 2,215,7910.46 2,164,903- 50,888-2%XChange in PaymentX XDecrease 10%XDecrease 10%XIncrease 10%XIncrease 10%PaymentexcludessupplementalpaymentsAll data represents a six month period, Jan 1 – June 30 2016.June 2017Mississippi Medicaid DRG Training40
Simulation Results by Peer GroupFreestanding M HAnalytical DatasetStaysBrentwood Behavioral HealthcareParkwood Behavioral Hlth SystemDiamond Grove CenterLongleaf HospitalLakeside Behavioral Hlth SysOak Circle CenterLiberty Healthcare Systems LLC81243237092403715BaselineSimulationChange in PaymentCasemix AllowedCasemix AllowedChange in PctChange inDaysV33BaselineV34SimPayment Change Payment8,6920.49 5,124,5360.46 4,816,524 - 308,011-6%X3,6260.50 2,775,4340.48 2,629,860 - 145,574-5%X3,4880.54 2,549,3880.51 2,407,021 - 142,367-6%X9440.45 540,9750.41 497,761 - 43,214-8%X5180.50 265,2180.48 254,323 - 10,895-4%X1,6090.49 660,6650.44 636,501 - 24,164-4%X1130.33 63,6740.33 62,593- 1,080-2%XChange in Payment XDecrease 10%XDecrease 10%XIncrease 10%XIncrease 10%Payment excludessupplementalpaymentsData represents a six month period, Jan 1 – June 30 2016.June 2017Mississippi Medicaid DRG Training41
Simulation Results by Peer GroupOut of State (Top 20 only)Analytical Dataset BaselineStaysSimulationCasemix AllowedV33BaselineDaysChange in PaymentCasemixChange inV34Allowed Sim PaymentChange in PaymentPctChange inChange PaymentMethodist Hospitals Of Memphis7766,5641.48 9,313,3121.47 9,258,036- 55,276-1%USA Children's Women's Hospital2232,2131.31 2,308,0561.42 2,407,945 99,8894%Baptist Memorial Hospital1521,3771.88 1,974,7501.80 1,901,041- 73,710-4%Regional One Health1482,1652.39 3,453,1072.64 3,690,745 237,6387%XOchsner Foundation Hospital1341,4442.01 2,109,7502.03 2,109,844 950%XUSA Medical Center949691.97 1,170,5091.87 1,023,535- 146,974Ochsner Medical Center Northshore753720.87 409,4070.86 404,117- 5,290-1%XSt Jude Children's Research Hospital733181.23 609,2311.16 579,864- 29,367-5%XSlidell Memorial Hospital712330.49 286,9940.50 297,106 10,1124%XSaint Francis Hospital625580.97 556,4650.97 555,546- 9190%XChildren's Hospital535511.88 1,053,9151.78 1,066,868 12,9531%XTulane University Hospital355802.22 1,870,0292.02 1,913,526 43,4972%XChildren's Hospital Of Alabama211402.53 350,0242.29 320,092- 29,932-9%XProvidence Hospital211341.08 146,9021.02 138,467- 8,435-6%XUniversity Of Alabama Hospital171572.13 243,3282.10 242,283- 1,0440%Delta Medical Center161670.74 112,9070.70 105,661- 7,247-6%Our Lady Of The Lake Regnl Med Ctr14961.17 111,5851.16 111,271- 3140%DCH Regional Medical Center8190.54 28,8700.52 27,872- 998-3%XMobile Infirmary Medical Center7391.62 65,1421.58 63,444- 1,697-3%XJune2017Jackson5311.46 37,6801.72 38,856 1,1763%Madison County General HospXXXXDecrease 10%XDecrease 10%XIncrease 10%XIncrease 10%-13% XXXXXData represents a six monthperiod, Jan 1 – June 30 2016.42
Looking to the FutureJune 2017Mississippi Medicaid DRG Training43
Looking to the Future1.CCR updates on 10/1/20172. Post implementation monitoring and review3. Monitor legislation4. DOM implements APR-DRG V.35 mapper on 10/1/2017June 2017Mississippi Medicaid DRG Training44
For Further InformationDarrell BullocksDebra StipcichKaren Thomas, CPMSenior ConsultantPayment Method omPMD Client ExecutivePayment Method DOM Accounting Director, Hospital ProgramOffice of ReimbursementMississippi Division of th thanks to:DOM: Michael Daschbach, Shatara Bogan, Evelyn Sampson, Sharon Jones,Keith Heartsill, Margaret King, Zeddie ParkerConduent: Steve Bonesteel, Bud Davies, Lisa Nelson, Kevin QuinnJune 2017Mississippi Medicaid DRG Training45
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2005-2006: Consultation and policy design 2008: Evaluation published in Health Affairs 2009: Unanimously recommended by Legislative PEER Committee 2012: Legislature directs DOM to implement DRG payment Year 1: October 2012-September 2013, APR -DRG V.29 Year 2: October 2013-June 2014 (nine months), APR-DRG V.30 Year 3:
