UPDATE Weekly

On November 12, 2015, the Centers for Medicare & Medicaid Services (CMS) finalized regulations regarding the Comprehensive Care for Joint Replacement (CJR) Model (formerly using the acronym CCJR). This final rule implements a new Medicare Part A and B payment model under section 1115A of the Social Security Act, called the Comprehensive Care for Joint Replacement (CJR) Model. In this model, acute care hospitals in certain selected Metropolitan Statistical Areas (MSAs), including Asheville, Charlotte, Durham and Greenville, will receive retrospective bundled payments for episodes of care for lower extremity joint replacement or reattachment of a lower extremity (collectively referred to as LEJR). All related care within 90 days of hospital discharge from the LEJR procedure will be included in the episode of care.

The CJR model holds participant hospitals financially accountable for the quality and cost of a CJR episode of care and incentivizes increased coordination of care among hospitals, physicians, and post-acute care providers. The episode of care begins with an admission to a participant hospital of a beneficiary who is ultimately discharged under MS-DRG 469 (Major joint replacement or reattachment of lower extremity with major complications or comorbidities) or 470 (Major joint replacement or reattachment of lower extremity without major complications or comorbidities) and ends 90 days post-discharge. The episode includes all related items and services paid under Medicare Part A and Part B for all Medicare fee-for-service beneficiaries, with the exception of certain exclusions.

Every year during the approximate five performance years of this model, CJR hospitals will receive separate episode target prices for MS-DRGs 469 and 470, reflecting the differences in spending for episodes initiated by each MS-DRG. CMS will also use a simple risk stratification methodology to set different target prices for patients with hip fractures within each MS-DRG. All providers and suppliers are paid under the usual payment system rules and procedures of the Medicare program for episode services throughout the year. At the end of a model performance year, actual spending for the episode (total expenditures for related services under Medicare Parts A and B) is compared to the Medicare target episode price for the responsible hospital. Depending on the participant hospital’s quality and episode spending performance, the hospital may receive an additional payment from Medicare or be required to repay Medicare for a portion of the episode spending.

Unlike past payment reform models, this is mandatory for hospitals in the 67 included MSAs, as well as any providers accepting patients discharged from these hospitals following certain joint replacement procedures. This program becomes effective on April 1, 2016. CMS has delayed implementation by three months from its original implementation date in order to allow the impacted hospitals (and other involved providers) additional time to prepare.

A Provider and Technical Fact Sheet may be found at https://innovation.cms.gov/Files/fact-sheet/cjr-providerfs-finalrule.pdf. The CJR Web site, with additional information, can be accessed by clicking here.

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The Centers for Medicare & Medicaid Services (CMS) has announced that effective January 1, 2016, the Medicare Part A SNF daily coinsurance will be $161.00. This is an increase of $3.50 over the current coinsurance of $157.50. This increase is for traditional Medicare only, any changes in Medicare Advantage coinsurance amounts will be announced by the individual plans.

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Adam Sholar has been named General Counsel and Director of Government Affairs for the North Carolina Health Care Facilities Association. Prior to joining NCHCFA, he served as Legislative Counsel and Director of Government Affairs for the North Carolina Department of Health and Human Services. In that role he provided legal and policy advice to the Secretary and represented DHHS before the North Carolina General Assembly. Sholar is also a former Senior Law Clerk to Justice Paul M. Newby of the North Carolina Supreme Court. He is an alumnus of Wake Forest University and Campbell University School of Law. He began his work for NCHCFA on November 1st, 2015.

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The Quality Award program has three progressive step levels. This seminar will cover the first level, Bronze – Commitment to Quality. Bronze Award applicants begin their quality journey by developing an organizational profile including vision and mission statements, an awareness of their environment and customers’ expectations, and a demonstration of their ability to improve a process.

This session includes a full day of training and consultation on how to complete the AHCA/NCAL Bronze Quality Award Application led by the Administrator of the Quality Award Program and a trained Quality Award Examiner and award recipient. This training will decipher the criteria, answer questions, clarify concepts, and guide participants through the process of writing an organizational quality award application. Using interactive technology, participants will leave the workshop with their applications complete or with few areas to fill in.

It is never too early to begin thinking about and planning your quality award application. This is an opportunity for you and your team to begin your quality journey by working together through the writing process. Get your application ready early and have plenty of time to fine tune it before the deadline.

For the complete brochure and registration information, click here.

SPACE IS LIMITED TO 22 REGISTRATIONS!

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The NCHCFA Annual Convention and Trade Show, The Art of Caring, will be held February 21-24, 2016 at the Sheraton Greensboro Hotel at Four Seasons/Joseph S. Koury Convention Center in Greensboro, NC! Call the Sheraton at (800) 242-6556 to make your room reservation. Identify that you are with “NC Health Care Facilities Association 2016” to receive the group discounted rate. Brochures outlining specific program information will be available in December.

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Palmetto GBA will host the Jurisdiction M Part A Ask the Contractor Teleconference (ACT) on Thursday, November 19th, 2015, from 2:00 PM – 3:00 PM ET. This call is intended for Part A providers billing for services rendered in Virginia, West Virginia, North Carolina and South Carolina. The ACT call is designed to open the communication channels between Palmetto GBA and the Jurisdiction M Part A provider community. For this call, Palmetto GBA’s Provider Outreach and Education team will partner with their appeals department to discuss current trends.

To participate on the call, dial (877) 789-3907 and reference confirmation code 38818531.

An Encore digital recording of this conference will be available for replay two hours after the call’s completion. To access the recording, dial (855) 859-2056 and the Conference ID number shown above. The encore recording will be available until November 26th, 2015.

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There is only one week left to submit your Intent to Apply (ITA) for a 2016 Quality Award! Though not mandatory, submitting the intent to apply by 8pm EST November 19th has a number of associated benefits:

• The overall application fee is reduced; and
• Applicants will receive regular emails from Quality Award staff with deadline reminders, tips on applying for the award, and links to exclusive educational webinars.

Applicants who submit an ITA receive a discount off their overall application fee – a $200 savings for Bronze applicants; a $400 savings for Silver; and $550 savings for Gold. The complete awards fee schedule is available.

The AHCA/NCAL National Quality Award Program sets high standards for quality based on the Baldrige Performance Excellence criteria and encourages member providers to commit, achieve and excel in quality performance.

Have questions? Contact the Quality Award staff at qualityaward@ahca.org.

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With the November 2015 update of the downloadable Exclusions files, the Office of Inspector General (OIG) will begin a three-month transition toward offering this data in a new file format. The current downloadable files are offered in DBF format and contained within self-extracting/compressed files (EXE and ZIP). OIG will now offer raw data in comma-separated value (CSV) format, which is currently contained in a TXT file. All fields and data within the files remain the same. The new CSV format will be replacing the previous formats.

To ease the transition over the next three months, OIG will continue offering the previous file formats along with the new format. The DBF, EXE, and ZIP files will be eliminated in February 2016. While the DBF files are still available OIG strongly recommends downloading the CSV-formatted file and testing it in your software environment. Please report any issues to the following e-mail address which has been set up specifically to receive feedback about your experience: leie.update@oig.hhs.gov. Please look to the Exclusions Web site for updates and additional information as adjustments are made based on feedback received.

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The book presents specific care strategies for all stages of dementia and emphasizes relatively simple interventions that nurses can incorporate into their care plans to prevent problems or address them before they escalate. The guide distinguishes between dementia and conditions that mimic dementia, discusses issues related to specific care settings, presents person-centered strategies for families and care partners, and covers the assessment and management of pain, safety concerns, communication strategies, and ethical and legal issues. It additionally provides numerous resources that nurses can offer to caregivers. Fast Facts for Dementia Care will serve as a daily companion for all clinical nurses who work with older patients in any setting, including the emergency room, medical-surgical unit, medical office, and community mental health settings.

Key Features:

• Easy to use and carry in all patient settings
• Provides communication techniques for different stages of dementia
• Describes numerous interventions for addressing issues such as pain, safety, behaviours, and ADLs
• Includes the “Fast Facts in a Nutshell” feature for quick reference
• Illustrates content with case vignettes

To order, visit http://www.AHCApublications.org or call (800) 321-0343.

Product #8293
AHCA MEMBERS $30.00

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This DVD, Mobility and Safe Movement of the Elderly, Improving Your Skills to Prevent Injuries and Reduce Falls, by Teepa Snow, MS, OTR/L., FOTA, Dementia Care & Training Specialist, was developed in conjunction with Wake Allied Health Education Center, Durham Technical Community College and the University of North Carolina School of Medicine, Office of Information Systems. The content is formatted in separate segments in order to customize the delivery of content to your learning objective. Handouts developed by Teepa accompany each video and may be reproduced. To order, e-mail your request to Donna Snyder at donnas@nchcfa.org. The price is $35.00 (tax and shipping included).

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Report Finds Alzheimer’s May Possibly Bankrupt States, Medicaid If Precautions Aren’t Taken

http://www.providermagazine.com/news/Pages/2015/1115/Report-Finds-Alzheimer%E2%80%99s-May-Possibly-Bankrupt-States,-Medicaid-If-Precautions-Aren%E2%80%99t-Taken.aspx

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You would not guess by looking at them, but running turkeys can reach speeds up to 25 mph.

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