1. To understand different payment methodologies a. Coding, documentation, and groupers in reformed payment models b. Value based payments and quality measurement in new payment models c. Population based payments such as global budgets
2. To review the development of severity DRGs and risk adjusted methodologies, such as Hierarchical Condition Categories (HCCs). a. Data reporting trends for hospitals for each methodology b. Focus on completeness of coding/data quality/integrity
3. To discuss groups using severity DRGs to produce public reporting such as Health grades, Physician Compare, US News & World Report
4. To review severity DRG trends by hospital product line from coding review recommendations (using data set of 1,000s of audited records)
5. To provide examples of clinical documentation improvement strategies for appropriate case mix/data reporting. a. Technology impact b. Compliant practices
6. To suggest strategies for hospitals managing their Medicaid data under varying methodologies.
7. Summary/Close: What payment reforms are on the horizon? What is the timing? How will they affect CDI/data quality opportunities?
After this session, you will be able to:
1. Identify current users of severity DRG data for public reporting of quality, reimbursement and patient satisfaction benchmarks
2. Understand current and proposed healthcare payment methodologies and implications for hospitals
3. Assess your hospital’s position relative to success factors for appropriate reimbursement using severity DRGs and contributing factors
May 6, 2019
CEU: 1.0 – Clinical Data Management
Dr. Patrick Redmon
Dr. Redmon comes to BRG with over twenty-five years of experience in healthcare economics, working with healthcare clients as well as in government and academics. His work has focused on payment and rate-setting methodologies, payment reform, clinical analytics for providers, as well as population health improvement initiatives for government and health systems. He has worked with health systems, academic medical centers, community hospitals and trade associations in assessing and developing payment methodologies in a variety of settings.
Most recently, Dr. Redmon served as the Executive Director for Maryland’s Health Services Cost Review Commission where he led the organization in the development and implementation of a variety of payment methodologies for episodes of care and population based reimbursement. He worked with State leaders and system stakeholders to modernize the State’s Medicare waiver and develop the State’s proposed demonstration model submitted to the Center for Medicare and Medicaid Innovation. As Deputy Director for Research and Methodology at the Commission, he was responsible for the implementation of APR-DRGs in the all-payer rate-setting system along with methodologies for recognizing indirect medical education, disproportionate share, and uncompensated care in hospital payments.
He has also served as an Associate Professor in Xavier University’s Health Services Administration Graduate Program and as a Senior Economist at the Government Accountability Office in Washington, DC. He holds a Ph.D. in Economics from Michigan State University.
Heather Lawrence, MS, RHIA, CCS
Ms. Lawrence currently serves as a Director at Horizon Consulting Services and is a project manager for several inpatient auditing programs at acute care facilities. Ms. Lawrence has over 20 years of Health Information Management experience including 18 years providing coding and auditing services and is an expert in severity-DRG logic. She has designed and implemented coder education sessions, as well as clinical documentation improvement programs. Ms. Lawrence has been an adjunct instructor at the Community College of Baltimore County (CCBC), teaching courses in introductory and advanced inpatient coding. Ms. Lawrence has designed and provided ICD-10-CM/PCS training sessions for MDHIMA including the AHIMA award winning ICD-10 “Body System Series”. Ms Lawrence earned a Master of Science in Healthcare Administration from the University of Maryland and a Bachelor of Science in Health Information Management from the University of Pittsburgh.