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Valerie Campbell, CHC, CHPCSenior Director, Corporate ComplianceWestchester Medical Center Health Network
Sharon Marino, R.N., BSNSenior Director, Corporate ComplianceWestchester Medical Center Health Network
2016 HCCA Compliance InstituteApril 17, 2016 – Las Vegas, Nevada
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Teamwork“Coming Together Is The Beginning.
Keeping Together is Progress.Working Together Is Success.”
‐ Henry Ford
Teamwork
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Let’s Look Back Federal Sentencing Guidelines
Deficit Reduction Act enacted January 1, 2005
The Patient Protection and Affordable Care Act (PPACA)enacted on March 23, 2010
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Disconnect Between Compliance & Quality
• Communication
• Departments working in silos
• Sharing of information
• Team Building
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Let’s Play Nice in the Sandbox Benefits
‐Increase in patient satisfaction
‐Increase in compliance with billing
‐Better quality outcomes
‐Better documentation to support medical necessity
‐Appropriate payment for services rendered
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OVERLAP of Compliance Program with Quality Components
• Ensure Compliance with all Medicare and Medicaid Quality Initiative Programs
• Ensure the information provided to CMS and the State is accurate and reflects the patient care and status
• Collaboration on investigation and resolution of issue (i.e., Patient Care, Quality of Care, Documentation, CMS Reporting)
• Compliance with CMS Conditions of Participation and Joint Commission as well as State standards
• Staff Education
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First Steps to Consider to Integrate Quality & Compliance
Look at your hospital structure What is your relationship with the Vice President of Quality?
How is compliance viewed in the Quality arena?
Is there buy in at your Senior Management level? Have you had a discussion with your CEO
Program expectation as a whole; How is Quality and Compliance viewed at the CEO level; Is there buy in?
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Westchester Medical Center Health Network
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Westchester Medical Center Maria Fareri Children’s Hospital Behavioral Health Center MidHudson Regional Hospital Bon Secours Community Hospital St. Anthony’s Community Hospital Good Samaritan Hospital
Challenges to Integrating Compliance/Quality into a Multi‐Hospital Integration System
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Working in silos
Viewed as a threat
Obtaining required reports
Establishing a working relationship
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Westchester Medical Center Health Network Integration Steps
Alignment with Quality
Discussion with CEO
Meeting with VP of Quality, CMO and CEO
Determine boundaries, if any
How will data and information be disseminated
Compliance Officer Role
Presentation at Executive Compliance Committee
Senior Management Team11
Integration Process
Become member of Quality Committee
Data transformed to Compliance Dashboard
Data reported to Board Audit & Compliance
Committee
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How do we do this???
CMS Quality Measures
Compliance / Quality
Hospital Inpatient Quality
Reporting
Hospital Acquired Conditions (HACS)
Hospital Valued Based Purchasing
Hospital Readmission Reduction Program
Outpatient Quality
Reporting
IRF Reporting
IPF Reporting
Meaningful Use
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Inpatient Quality Reporting (IQR)
Outpatient Quality Reporting (HOQR)
CMS Timeline
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Value‐Based Purchasing (VBP)
Hospital Readmission Reduction Program
Meaningful Use
HACs
20132012 2014 2015 2016 2017
Psychiatric Unit/Facility Quality Reporting (IPFQR)
IRF Reporting
Linking Quality to Payment
Impact of Quality Measures
Documentation/Coding/DRGs/Billing
Reimbursement
Denials/Medical Necessity
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How is Compliance Involved??
Participation in Quality Meetings Review and Analyze Quality Data Provide Guidance and Oversight of Quality Improvements Annual Risk Assessment/Work Plan Quality Audits Audit Summary Reports to Board Members Senior Management Dashboard
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WMC Quality Program
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WMC Quality Council
Home Health
Acute Care Hospitals
Skilled Nursing and Long Term
Care Facilities
Children’s Hospital
Behavioral Health Hospital
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Data Review• Midas Reports
• Pepper Reports (Program for Evaluating Payment Patterns Electronic Report)
• Quality Dashboard
• Readmissions
• Never Events
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Compliance Risk Assessment & Work Plan
Review Industry Standards
Analyze and Review Quality Data
Interviews with Key Staff
Conduct Risk Assessment
Develop Work Plan
Board Approval
Communicate to Senior Management
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Quality Audits
• HACS ‐ CAUTI (Catheter‐Associated Urinary Tract Infections)
• Core Measures
• Medical Necessity
• Discharge Planning
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Audit Process Communication with Management Opening Meeting with applicable staff to discuss Audit Data/Medical Record review Follow‐up meeting with Management to share findings Draft Audit Report Management Corrective Action Plan Final Audit Report to Senior Management Hospital Board and Audit Committee
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Dashboard Compliance and Quality interface on Dashboard for:
Senior Management review
Audit & Compliance Committee of the Board
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Program
Component
Audit Name Audit Stage Responsible
VP
Senior
Mgmt.
Action Items Date Due Status
QUALITY
Audits:
Work Plan
Corporate Compliance Program Dashboard –Westchester Medical Center
Discharge Planning
Field Work V.P. SVP Chart Review 5/31/16
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Progressing appropriately Experiencing delays StoppedStatus:
Audit Summary Report
Discharge Planning
VP Case Mgt./Sr. VP
Field Work
Progressing Data Collection
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Questions
Valerie Campbell, CHC, CHPCSenior Director, Corporate Compliance
845‐431‐[email protected]
Sharon Marino, R.N., BSNSenior Director, Corporate Compliance
914‐493‐[email protected]