Dexur Simulators and Calculators to manage CMS Quality Programs

To help healthcare providers in managing costs and monitoring CMS quality programs, Dexur has developed several simulators and calculators that provide insights and suggest useful scenarios to administer costs and quality outcomes. Dexur provides Simulators for the following quality programs:

  • Value Based Purchasing (VBP)
  • Medicare Spending Per Beneficiary (MSPB)
  • Hospital Readmissions Reduction Programme (HRRP)
  • Hospital Acquired Conditions (HAC)
  • CMS Star Rating

Medicare Spending Per Beneficiary (MSPB)

MSPB is a significant factor in driving VBP payments as it accounts for 25% of overall VBP score. MSPB costs consist of costs incurring three days prior to hospitalization, index hospitalization costs, and 30 days post discharge cost. Minimizing the post index stay costs can reduce the average MSPB cost per episode to a large extent.

Dexur Simulator analyzes how reduction of post index stay costs can improve the VBP Adjustment Factor of hospitals. Post Index stay costs comprise of:

  • Rehospitalizations
  • Discharges to Skilled Nursing Facilities (SNF)
  • Discharges to Home Health Agencies (HHA)
  • Discharges to Home

MSPB Cost Reduction Model

Dexur Simulator is designed to demonstrate the interaction between reduction in post index stay costs and its impact on average MSPB costs and VBP incentives. It assesses the post index stay costs, which are crucial in determining MSPB costs and has identified four main levers. The simulator estimates reduction in each of these levers to reduce overall MSPB cost.

  • Lever 1: Reductions in Rehospitalizations
  • Lever 2: Shift from SNF Discharge to Home
  • Lever 3: Shift from SNF Discharge to Home Health
  • Lever 4: Shift from Home Health to Home

The influence of post index stay costs reduction on VBP score is calculated by determining how reducing rehospitalizations or shifting a fraction of discharges, from one facility to another, could affect the overall MSPB cost. Value outcomes are listed in four levers, with percentage changes ranging from 5% to 100%.

Dexur Hospital Quality Benchmarks Slide1

The cost to be reduced in each lever is determined by identifying the number of episodes affected by different percentage changes. Post index stay costs corresponding to the number of episodes is calculated and adjusted in each scenario. The cost reduction in different levers is dependent on the cost contribution of each post index stay facility to the MSPB costs. A higher reduction than the break-even point can further improve the VBP incentives.

MSPB Cost Reduction Scenario

The Dexur Simulator also provides the unique facility to produce different scenarios for MSPB cost reduction manually. The tool helps to identify scenarios by which hospitals can adopt reduction in rehospitalizations or shifts in discharges by impacting the minimum number of episodes to avoid VBP penalties.

Dexur Hospital Quality Benchmarks Slide1