Data Analytics

2018 AHCA/NCAL Annual Convention

DA-5 - Next-Generation Analytics: Positioning for Success in 2020

Tuesday, October 9
2:30 PM - 4:00 PM
CE: NAB: 1.5 | Nurses 1.5

Fee-for-service (FFS) performance has historically been defined by an SNF’s Medicare per diem rate and average length of stay. As unbridled FFS disappears from the post-acute care reimbursement landscape, value-based incentive payment systems necessitate more sophisticated measures of SNF performance. Health systems and insurance companies demand quantifiable, measurable, and comparable outcomes data, unbiased by the qualitative nature of concurrent patient conditions. Accordingly, SNF episodic revenue (or cost to the payer), rehospitalization rates, and functional improvement cannot be taken at face value. Dynamic variables must be case-mixed and demographically adjusted to calculate accurate measures of quality. If they don’t identify and neutralize bias, SNFs risk unbalancing the care/payment equation associated with risk-based payment models that continue to gain traction with insurance companies and care management concerns. The Minimum Data Set (MDS) has been the go-to source for comparative quality and predictive analytics intelligence. However, the MDS was not designed to serve in this capacity; it lacks the important cost elements that are readily available on the UB-04. This program will include case studies that demonstrate how to aggregate, interpret, and report intelligence beyond the MDS. The presenters (a registered nurse with 30-plus years of SNF experience and a risk management expert) will introduce the next-generation analytics required to reconcile care delivery to new payment models. They will explain how to distill key dependent qualitative variables that drive cost. In short, the session is designed to connect the human condition to business intelligence, and in doing so empower providers to balance the care/payment equation for years to come.

Learning Objectives:

Vincent Fedele, MBA

Partner & Director of Analytics
Zimmet Healthcare Services Group, LLC

Vincent Fedele is Partner and Director of Analytics at Zimmet Healthcare Services Group, LLC. He is charged with leading the consulting firm's nascent "Risk Management" department. Vincent also serves as Chief Operating Officer at CORE Analytics, an innovative data intelligence software company focused on utilizing current claims data for reimbursement accuracy, comparative market insights and expense modeling. Vincent’s expertise is merging publicly available data with facility-specific, accretive outcomes to develop (and manage) a provider’s “Risk Profile.” This proprietary measure serves to mitigate the provider-exposure endemic to shared savings initiatives and episodic payment models. His “fee-for-service” roots enable Vincent to reconcile the conflicting incentives in a world where volume and value run parallel, to find the resonant balance best suited to the culture and vision of our unique provider clients. Mr. Fedele lectures extensively on diverse topics associated with SNF reimbursement, risk and compliance. He is a graduate of Boston University and earned his MBA from Rutgers University.


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Sheryl B. Rosenfield, RN, BC

Partner, Director of Clinical Operations
Zimmet Healthcare Services Group

Sheryl Rosenfield, RN, Director of Clinical Services
Sheryl joined Zimmet Healthcare in 1996, and has been the partner in charge of the firm’s growing clinical consulting team for nearly 20 years.
As a Board Certified Registered Nurse, Sheryl has devoted her career to serving the post-acute care community, remaining at the forefront of regulatory and payment changes for over 40 years. She is an active participant, speaker and member of many national organizations, including the AHCA/Health Care Compliance Association’s Post-Acute Care Services Care Committee. In this capacity, Sheryl works with representatives nationwide on matters impacting medical review and payment concerns.
Ms. Rosenfield has been a trainer of the MDS since 1990 and is among the nation’s leading resident-assessment experts. She is a founding member of AANAC, a national organization serving over 15,000 professionals associated with the assessment and care processes in skilled nursing facilities.
Sheryl has longstanding relationships with many State and Federal agencies, having worked with the Centers for Medicare & Medicaid Services (CMS) and various Medicaid agencies on multiple projects. She was appointed to the Technical Expert Panel established to evaluate the impact of the Medicare Prospective Payment System on provider operations and finances. She was a member of the clinical standards and training team for the Federal DAVE project and a Data Monitor for the Federal STRIVE initiative. She also served as an MDS 2.0/3.0 Manual reviewer, and remains highly engaged in improving the resident assessment process and empowering post-acute nurse managers.


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DA-5 - Next-Generation Analytics: Positioning for Success in 2020

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