Debbie Linnes

Debbie is a Partner and Chief Operating Officer for DCCS. She has a broad background of CEO, COO, Operations leadership in systems (CHW, SCLHS, CHI) and free standing health systems across the country. She brings experience in moving organizations forward to Consulting and Interim senior leadership and operating positions and has a strong strategic and clinical background with outstanding physician relations skills. She rejuvenates underperforming organizations and programs, raising performance and profitability and develops leadership and workplace cultures that lead to high levels performance and employee satisfaction. Core skills include: Vision/Strategic Planning, Operations Improvement, Physician Practice Operations, Leadership Development, Clinical Quality/Patient Safety, Service Excellence, Service Line Development, Population Management, Mergers/Acquisitions, Physician Alignment, Ambulatory and Physician Services, Workplace Culture Development

The two-midnight rule for observation status went into effect two years ago, along with great confusion. On Jan. 1, the Outpatient Prospective Payment System (OPPS) final rule for the 2016 fiscal year went into effect, meaning that shorter stays could qualify for inpatient reimbursement based on physician judgment, not just time. Unfortunately, this has only created greater confusion, and a national rise in observation status usage.

Results

  • Providers, confused about the criteria, often err on the side of observation status for patients
  • Observation patients are not being managed differently from inpatients, with timely assessment and interventions necessary being applied for both
  • Patients receiving observation services are responsible for up to 20 percent of their bill if they don’t have secondary insurance, and the time they spend in the facility does not count toward the minimum three-day inpatient stay mandated by the Centers for Medicare & Medicaid Services (CMS) for skilled nursing facility (SNF) care
  • Higher observation rates yield significant financial impacts for hospitals

Essential Drivers for Improvement

  • Standardization of the hospitalist care:
    • Consistent, committed staffing – locums staffing is a key issue driving inappropriate observation status use
    • Quality
    • Improved timely care management for observation patients
  • Clinical documentation
  • Effective observation determination
  • Leadership and performance of each hospitalist group
  • Improved coordination between the ED and hospitalist services in admission and observation care management
  • Improved case management systems, staffing, and oversight
  • Enhanced CDI program performance supporting improved physician documentation
  • Structured systems for observation care placement and management
  • Key dashboards and metrics for managing inpatient and observation care
  • Availability of weekend diagnostic testing and specialty support

Determining the appropriate patient status initially, managing patients effectively, and avoiding conversions represent significant quality and financial opportunities for patients, providers, and facilities.

About the Author

Debbie Linnes is a partner and chief operating officer for DCCS. She has a broad background of service as a CEO, COO, and operations leader in accredited (CHW, SCLHS, CHI) and freestanding health systems across the country. She brings experience in moving organizations forward to consulting and interim senior leadership and operating positions and has a strong strategic and clinical background with outstanding physician relations skills. She rejuvenates underperforming organizations and programs, raising performance and profitability, and develops leadership and workplace cultures that lead to high levels of performance and employee satisfaction.

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Tuesday, 24 May 2016 17:20

Are You Swimming Fast Enough?

d linnesNew Centers for Medicare & Medicaid Services (CMS) hospital data went public this week – so how are you comparing to your competition?

The new performance data for hospitals, including timely and effective care measure data and Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) data, was released on May 4. As the reimbursement associated with value-based purchasing (VBP) is based on a competitive bell curve, we advise hospitals to be focused on the movement of the database and also the movement of their competitive markets.

As this data is updated quarterly, hospitals need to know how they are positioned in real time related to the performance of their identified competitors. Hospitals need to review the quarterly updates from the Hospital Compare database, identifying where the bell curve has moved, updating financial forecasting, and seizing upon strategic opportunities.

We advise hospitals to recalculate their forecast assumptions and use their most current data to provide the most accurate forecast of their organization’s performance and opportunities. Also, be sure that your organization’s performance is matching that of the pace of your competitors in order to maximize your financial performance and market growth.

Make sure your pay-for performance reports include:

  • A competitive analysis of providers’ performance in your market;
  • A financial forecast and performance comparative to the CMS database for VBP; readmissions, and hospital-acquired conditions (HACs); and
  • The most recent emergency department performance comparative

About the Author

Debbie is a partner and chief operating officer for DCCS. She has a broad background of CEO, COO, and operations leadership in systems (CHW, SCLHS, CHI) and freestanding health systems across the country. She brings experience in moving organizations forward to consulting and interim senior leadership and operating positions and has a strong strategic and clinical background with outstanding physician relations skills. She rejuvenates underperforming organizations and programs, raising performance and profitability, and develops leadership and workplace cultures that lead to high levels of performance and employee satisfaction. Her core skills include  vision/strategic planning, operations improvement, physician practice operations, leadership development, clinical quality/patient safety, service excellence, service line development, population management, mergers/acquisitions, physician alignment, ambulatory and physician services, and workplace culture development.

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Tuesday, 26 January 2016 03:01

New Data Shining Spotlight on Care Quality

On Dec. 10, 2015, the Centers for Medicare & Medicaid Services (CMS) updated and released the following:

New performance data for hospitals on the Hospital Compare website, including timely and effective care measure data from the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS):

https://www.medicare.gov/hospitalcompare/search.html

The data identified 758 hospitals that will see their Medicare payments reduced by 1 percent for ranking in the bottom quartile nationally:

https://www.medicare.gov/hospitalcompare/HAC-reduction-program.html

Hospital Compare is targeted to provide the public more aggregate data on the various quality measures reported to CMS. It does not provide the implications of performance, nor the pace of improvement to the CMS database, which is what drives the reimbursement and penalty distribution curve.

The Value-Based Purchasing (VBP) Program is a self-funded program. If an organization’s pace of change is not exceeding that of the data base, organizations still making improvements can be surprised to find that they are on the wrong side of the improvement curve at the end of the year and paying penalties (rather than seeing a financial upside). Quarterly forecasting of the CMS database movement is critical.

Organizations need tools that provide:

  • The ability to review hospital performance by domain and measure and assess the financial implications of that performance;
  • The ability to forecast financial performance related to quality activities;
  • Focus for quality and safety initiatives in areas most strategically important to their pay-for-performance financial impacts; and
  • Forecasting of the pace of change of the CMS database quarterly to ensure that the organization’s pace of improvement exceeds that of the database (to be on the right side of the bell curve).

About the Author

Debbie is a partner and chief operating officer for DCCS. She has a broad background of CEO, COO, and operations leadership in systems (CHW, SCLHS, CHI) and freestanding health systems across the country. She brings experience in moving organizations forward to consulting and interim senior leadership and operating positions and has a strong strategic and clinical background with outstanding physician relations skills. She rejuvenates underperforming organizations and programs, raising performance and profitability, and develops leadership and workplace cultures that lead to high levels of performance and employee satisfaction.

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Tuesday, 27 October 2015 22:33

The Push for VBP is Alive and Well

According to a July announcement from the Centers for Medicare & Medicaid Services (CMS), Medicare will transition into a bundled payment model for hip and knee replacements going forward. As the most common inpatient surgery for Medicare beneficiaries, in 2013 a total of 400,000 inpatient primary hip and knee procedures cost $7 billion – for hospitalization alone.

The Facts:

  • CMS plans to require hospitals in 75 different areas to test out bundled payments for hip and knee surgeries. The proposed rule is an attempt to push certain kinds of hospitals that haven't signed up for the voluntary bundling program to participate. (See the CMS announcement summary)
  • The new requirement will involve more than 800 hospitals with a variety of utilization patterns, local market profiles, and access to capital, according to the agency. Markets will vary in size from New York and Los Angeles to smaller ones like Flint, Mich. (See who is targeted).]
  • The program would begin Jan. 1, 2016 and run for five years. Hospitals would continue to be paid on a fee-for-service basis and at the end of the year would receive additional payments or be required to repay Medicare for a portion of episode costs, depending on performance. Hospitals would not assume risk until year two. 

This proposal sends a strong message that CMS is not going to tolerate holdouts when it comes to the shift to value-based reimbursement. 

Where are the Impacts?

  • Some hospitals that haven't invested in IT infrastructure and care coordination models may find themselves unable to meet the quality requirements of the program. 
  • The CMS demonstration project results to date show that more than half of the cost of providing care for joint replacements occurred post-surgery, with the bulk of that cost occurring in either the acute inpatient rehabilitation units or the sub-acute rehabilitation units of skilled nursing facilities (SNFs). 
  • Post-acute providers will see a significant hit to inpatient rehab and SNF utilization as providers search for lower cost alternatives such as home health services.
  • Hospitals are likely going to cut out their one- and two-star SNFs to mitigate the risk of penalties during the post-discharge period.

The 90-day comment period for CCJR closed Sept. 8. CMS now will review feedback and deliver the final framework of the proposal. However, it is likely that CCJR will begin as scheduled in January 2016. Over the fourth quarter of 2015, hospitals must define new levels of business relationships across their provider networks that encompass both risk and potential gain-sharing initiatives, and develop innovative ways to maximize quality while minimizing cost.

Next Steps:

  • Assess your preparedness. 
  • Evaluate your post-acute care services and coordination.
  • Engage the additional resources you need to be positioned for Jan 1, 2016.

This work is the beginning as more bundles will be following. Get positioned now.

About the Author

Debbie Linnes is a partner and chief operating officer for DCCS. She has a broad background of CEO, COO, and operations leadership in systems (CHW, SCLHS, CHI) and freestanding health systems across the country. She brings experience in moving organizations forward to consulting and interim senior leadership and operating positions and has a strong strategic and clinical background with outstanding physician relations skills. She rejuvenates underperforming organizations and programs, raising performance and profitability, and develops leadership and workplace cultures that lead to high levels of performance and employee satisfaction. Her core skills include  vision/strategic planning, operations improvement, physician practice operations, leadership development, clinical quality/patient safety, service excellence, service line development, population management, mergers/acquisitions, physician alignment, ambulatory and physician services, and workplace culture development.

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Wednesday, 09 September 2015 22:41

Big Movements in Readmission Penalties

So, how did you score?

Medicare recently identified 2,225 hospitals that will have payments reduced for a year, starting on Oct. 1, as a result of having too many readmissions. While the overall number of penalized hospitals stayed about the same this year, with Medicare penalizing two-thirds of eligible hospitals, there have been considerable shifts among facilities.  

Here Are the Facts

  • A total of 1,371 hospitals are receiving a lower fine than last year. Nationwide, the average hospital fine will be slightly smaller.
  • Medicare is increasing penalties for 1,074 hospitals over last year. 
  • Hospitals that treated large numbers of low-income patients were more likely to be penalized than those treating the fewest impoverished people.
  • The readmissions program offers only penalties, not rewards.

Addressing Planned Readmissions

Some of the changes in the penalties may be due to refinements Medicare made in the way it calculates readmissions. This time, it excluded from its analyses cases for which doctors had planned for a second admission.

Key Examples

  • A lung cancer patient, for instance, might be admitted for pneumonia and then return for previously planned chemotherapy. 
  • A doctor might unblock a heart attack patient’s arteries and have him come back for a heart pump or previously planned transplant. 

Medicare estimates that re-hospitalizations are planned in 12 percent of heart attack return cases, 6 percent of heart failure return cases and 4 percent of pneumonia return cases.

How Do You Compare? 

Data for individual hospitals are available as a printable PDF file or a downloadable CSV spreadsheet.

Not Making Progress? Call a Timeout

If you are not making progress, it's important to step back, take a focused look at your data, identify the resources and support needed to drive progress, and ensure that you have the bandwidth to be successful. 

About the Author

Debbie is a partner and chief operating officer for DCCS. She has a broad background of CEO, COO, and operations leadership in systems (CHW, SCLHS, CHI) and freestanding health networks across the country. She brings experience in moving organizations forward to consulting and interim senior leadership and operating positions and has a strong strategic and clinical background, with outstanding physician relations skills. She rejuvenates underperforming organizations and programs, raising performance and profitability, and develops leadership and workplace cultures that lead to high levels of performance and employee satisfaction.

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Are you looking at your updated Centers for Medicare & Medicaid Services (CMS) data?

Your patients are.

Are you looking at your updated CMS quality data?

Your patients are.

CMS recently released quality data on healthcare organizations to the public, with the biggest changes including updates on patient experience data that were not included in the last refresh.  

Click to see how you compare.

CMS also introduced star ratings of HCAHPS scores on Hospital Compare to make it easier for consumers to understand the data. Now the public can use a star rating system, making the process of selecting a provider much like buying a refrigerator or a car.

Nationally, Medicare awarded the top rating of five stars to 251 hospitals, or about 7 percent of all the hospitals Medicare judged. Many of these are small specialty hospitals that focus on elective procedures such as spine, heart, or knee surgeries. They have traditionally received more positive patient reviews than have general hospitals delivering a broader range of services.

Click to see how you compare:

CMS Released 2016 IPPS Proposed Rule

Many hospitals will see increases in their Medicare reimbursements next year, as CMS also recently released its proposed rule for the 2016 fiscal year for the Medicare Inpatient Prospective Payment System. New measures, including care coordination, will also be in play.
LEARN MORE>>>

We are advising our clients to:

1. Know where you stand: update your comparative data.  
As everyone is driving improvements, your performance can no longer be just focused on your historical improvement.

2. Don't lag behind: the pace of change in increasing. 
With reimbursement based upon a distribution curve, ensuring that you are driving improvements at the same pace or faster pace than your competitors will determine your reimbursement.  

3. Focus your team.
Reprioritize those areas weighted highest, where improvement initiatives can have the most beneficial impact on outcomes and results 

4. Do you have the resources to meet the timelines? 
Identify the resources needed to achieve results in the time periods defined by CMS. Use external resources to insure meeting targets.

Remember, time is of the essence:

  • Traditional quality improvement initiatives often require longer timelines that will not meet the timetables set by CMS.
  • Outside bandwidth and expertise can provide focused solutions that will drive rapid results.

Keeping your team focused, resourced, and moving forward is the name of the game.

About the Author

Debbie is a partner and chief operating officer for DCCS. She has a broad background of CEO, COO, and operations leadership in systems (CHW, SCLHS, CHI) and freestanding health systems across the country. She brings experience in moving organizations forward to consulting and interim senior leadership and operating positions, and she has a strong strategic and clinical background with outstanding physician relations skills. She rejuvenates underperforming organizations and programs, raising performance and profitability, and develops leadership and workplace cultures that lead to high levels of performance and employee satisfaction. Core skills include Vision/Strategic Planning, Operations Improvement, Physician Practice Operations, Leadership Development, Clinical Quality/Patient Safety, Service Excellence, Service Line Development, Population Management, Mergers/Acquisitions, Physician Alignment, Ambulatory and Physician Services, and Workplace Culture Development.

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