Hospital Readmission Roullette

1,255
-1

Published on

Readmissions are a heightened focus under the Affordable Care Act. Initiatives are in place to reduce hospital admission through improving transition in care. During this course the speaker will discuss CMS quality initiatives, care transition, projects and barriers. This presentation reviews the key elements to tackling Avoidable Readmissions.

1. Learn to summarize the CMS quality initiative for healthcare reform related to hospital readmissions

2. Learn to identify underlying causes and barriers related to readmissions

3. Learn to state current CMS research projects and pilot programs

4. Learn to identify hospital and SNF strategies for collaboration

Published in: Health & Medicine
0 Comments
1 Like
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total Views
1,255
On Slideshare
0
From Embeds
0
Number of Embeds
0
Actions
Shares
0
Downloads
28
Comments
0
Likes
1
Embeds 0
No embeds

No notes for slide

Hospital Readmission Roullette

  1. 1. Hospital Readmission Roulette HARMONY UNIVERSITY The Provider Unit of Harmony Healthcare International, Inc. (HHI) Presented by: Diane Buckley, BSN,RN RAC-CT Director of Quality & Performance Improvement
  2. 2. Hospital Readmission Roulette
  3. 3. Harmony Healthcare International, Inc. 3 Speaker Bio Director of Quality and Performance Improvement for Harmony Healthcare International, Inc. Over 25 years in the healthcare industry Nurse Manager Director of Admissions Director Case Management Manager of Quality & Risk Management Training and development of training modules for Critical Care Home Care LTCH Acute Care Long-Term Care and Case Management Copyright © 2013 All Rights Reserved
  4. 4. Harmony Healthcare International, Inc. 4 Hospital Readmission Roulette Disclosure: The planners and presenters of this educational activity have no relationship with commercial entities or conflicts of interest to disclose: Planners: Elisa Bovee, MS, OTR/L Diane Buckley, BSN, RN, RAC-CT Beckie Dow, RN, RAC-MT Keri Hart, MS CCC, SLP, RAC-CT, Kristen Mastrangelo, OTR/L, MBA, MHA Christine Twombly, RNC, RAC-MT, LHRM Presenter: Diane Buckley, BSN, RN, RAC-CT Copyright © 2013 All Rights Reserved
  5. 5. Harmony Healthcare International, Inc. Hospital Readmission Roulette Disclosure Speaker: Diane Buckley, BSN, RN, RAC-CT The speaker has no relevant financial relationships to disclose The speaker has no relevant nonfinancial relationships to disclose Copyright © 2013 All Rights Reserved 5
  6. 6. Harmony Healthcare International, Inc. Hospital Readmission Roulette Criteria for Successful Completion Complete Sign-in and Sign-Out on Attendance Form Attendance for entire session Completion and submission of speaker evaluation form Copyright © 2013 All Rights Reserved 6
  7. 7. Hospital Readmission Roulette Objectives: The learner will be able to summarize the CMS quality initiative for healthcare reform related to hospital readmissions The learner will be able to identify underlying causes and barriers related to readmissions The learner will be able to state current CMS research projects and pilot programs The learner will be able to identify hospital and SNF strategies for collaboration Copyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 7
  8. 8. Hospital Readmission Roulette Reducing Re-hospitalizations among Medicare beneficiaries has become a high priority for policymakers and the Center for Medicare & Medicaid Services (CMS) Copyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 8
  9. 9. Hospital Readmission Roulette Hospital Readmissions are seen as an important indicator of care quality and account for billions of dollars in annual Medicare spending (MedPac, 2007) Copyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 9
  10. 10. Harmony Healthcare International, Inc. 10Copyright © 2013 All Rights Reserved Hospital Readmission Roulette Hospitalizations and Rehospitalizations are symptomatic of multi process defect in the health care system due to lack of: Timely or equitable access to care Effective handoffs and coordination of care Safe care Patient centered and appropriate end of life care
  11. 11. Harmony Healthcare International, Inc. 11Copyright © 2013 All Rights Reserved Hospital Readmission Roulette Five most common Medical condition for Readmission: Heart Failure Pneumonia COPD Psychoses GI problems
  12. 12. Harmony Healthcare International, Inc. 12Copyright © 2013 All Rights Reserved Hospital Readmission Roulette Five most common surgical procedures: Cardiac stent placement Major hip or knee surgery Vascular surgery Major bowel surgery Other hip or femur surgery
  13. 13. Hospitalization of Nursing Home Residents Common Expensive Often Traumatic to resident and family Tense with many complications Delirium Polypharmacy Falls Incontinence and catheter use Hospital acquired infections Immobility, De-conditioning, and Pressure Ulcers Copyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 13 Reducing Potentially Avoidable Hospitalization
  14. 14. Reducing Potentially Avoidable Hospitalization Some Hospitalizations of NH Residents are Avoidable As many as 45% of admissions of nursing home residents to acute hospitals may be inappropriate (Salibaet al, J AmerGeriatrSoc 48:154-163, 2000) In 2004 in NY, Medicare spent close to $200 million on hospitalization of long-stay NH residents for “ambulatory care sensitive diagnosis” Grabowski et al, Health Affairs 26: 1753-1761, 2007 Copyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 14
  15. 15. Harmony Healthcare International, Inc. 15Copyright © 2013 All Rights Reserved Why do Re-admissions happen?
  16. 16. Harmony Healthcare International, Inc. 16Copyright © 2013 All Rights Reserved Why do Re-admissions happen? Discharge from Hospital is critical and requires adequate planning and preparations to avoid Medication errors Poor discharge planning Inadequate arrangements Poor communication Adverse events
  17. 17. Why do Re-admissions happen? Medication Errors: The patient is discharged without prescriptions for the proper mix and doses of medication, or lacks instructions for taking them, or new prescriptions may interfere with existing medications. Poor Discharge Planning: There is little or no effort to plan follow up care, including scheduling necessary doctor’s appointments. Copyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 17
  18. 18. Why do Re-admissions happen? In half of all Medicare 30-day readmissions, patients had not seen their regular medical doctor or any health provider following discharge. Inadequate arrangements: Family members and other caregivers lack information or are unable to care for the patient after discharge. Copyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 18
  19. 19. Why do Re-admissions happen? Poor Communication: Providers delay providing discharge instructions, or fail to provide them at all. Lack of discharge summaries to community physicians and post-acute care providers. Too many cases of community providers that have no reports, test results, or other history when seeing the patient at first post discharge visit. Patients may not have received information on how to have a successful recovery. such as alerting them about symptoms that may need medical attention in an outpatient setting. Copyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 19
  20. 20. Harmony Healthcare International, Inc. 20Copyright © 2013 All Rights Reserved Hospital Readmission Roulette Research Recommendations: Interventions at time of Discharge Reliable & prompt follow-up care by primary care physicians Aggressive Management of chronicle illness
  21. 21. Hospital Readmission Roulette Some Readmission to the hospital are planned Other are avoidable and the result of Poor quality of care/ uncoordinated care Variation in readmission rates by hospitals and geographical regions Readmissions rates can be reduced with application of evidenced based guidelines and enhanced care coordination Copyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 21
  22. 22. Harmony Healthcare International, Inc. 22 Medicare readmission rates for Skilled Nursing Facilities to hospitals increased 30% from 2000 to 2006 Copyright © 2013 All Rights Reserved Hospital Readmission Roulette
  23. 23. Hospital Readmission Roulette 1 in 4 patients admitted to a SNF are re-admitted to the hospital within 30 days at a cost of $4.3 billion Copyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 23
  24. 24. Hospital Readmission Roulette ~ 10% - 25% of long stay NH residents are admitted to an acute hospital over a 5-month period Copyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 24
  25. 25. Harmony Healthcare International, Inc. 25Copyright © 2013 All Rights Reserved Hospital Readmission Roulette June 2007 & 2008 Medicare Payment Advisory Commission (MedPAC) Report to Congress highlighted avoidable Rehospitalizations as an area of high cost and low quality Prompted leaders of healthcare systems across the country to focus on avoidable Rehospitalizations in anticipations of potential changes in the market
  26. 26. 2009 Re-Admissions emerged as a Major Quality Initiative of Healthcare Reform. Reducing Re-hospitalization is an important element of President Obama’s February 2009 proposal for financing Health Care Reform. Copyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 26 Hospital Readmission Roulette
  27. 27. 12 million fee-for-service Medicare beneficiaries were analyzed per New England Journal of Medicine 20% who had been discharged were Re- hospitalized within 30 days ( 1 in 5 discharges) 34% were Re-hospitalized within 90 days 51% within 1 year 13% of the readmissions - $12 billion worth – were “potentially avoidable,” (IPPS rule). Copyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 27 Hospital Readmission Roulette
  28. 28. Harmony Healthcare International, Inc. 28Copyright © 2013 All Rights Reserved Hospital Readmission Roulette 90% Re-hospitalizations within 30 days are unplanned 75% of Readmissions preventable equating to $12 Billion a year to Medicare spending 68.9% of patients discharged with a medical condition, were re-hospitalized or died within one year of discharge 53% re-hospitalization of Discharges after a surgical procedure
  29. 29. Harmony Healthcare International, Inc. 29Copyright © 2013 All Rights Reserved . Hospital Readmission Roulette 50% of re-admissions within 30 days had no bill for a physician visit 70% surgical patients were admitted for a medical condition such as pneumonia and UTI 19% of Medicare discharges are followed by an adverse advent with 30 days: 2/3 Drug Events that are preventable
  30. 30. Payers & Policymakers are targeting Readmissions to reduce healthcare expenditures & improve quality of care and patient outcomes Rehospitalization has become a focus for Medicare, other payers, and quality care organizations do to its Clinical and Financial impact. Copyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 30 Hospital Readmission Roulette
  31. 31. Harmony Healthcare International, Inc. 31Copyright © 2013 All Rights Reserved Hospital Readmission Roulette The Affordable Care Act From a Policy perspective performance variation indicated lack of reliable attention to executing successful transition out of the hospital and into the next care setting Several provisions regarding improving Care Transition, Care Coordination and Reducing readmissions
  32. 32. HEALTHCARE POLICY PRIORITY Affordable Care Act Accountable Care Organizations (ACO) Bundled Payments Strategic Partnership Clinical & Financial Performance Data Copyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 32
  33. 33. Healthcare Policy Priority Besides the penalties, the Obama administration is ramping up other efforts to reduce readmissions. Giving out $500 million to help hospitals and other health- care providers improve the transitions of patients out of hospitals And the administration has approved 154 “Accountable Care Organizations,” which are collaborations of hospitals, doctors and other health- care providers that receive financial incentives for preventing costly episodes such as readmissions Copyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 33
  34. 34. Hospital Readmission Roulette CMS actively working to change payments to hospitals to incentivize readmission reduction Hospitals with high rates of preventable readmission will have payments reduced Copyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 34
  35. 35. Hospital Readmission Roulette CMS has undertaken several initiatives to reduce readmissions among the Medicare fee- for- service (FFS) population Copyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 35
  36. 36. Hospital Readmission Roulette Initiatives: Reporting hospital readmission rates through Hospital Compare Funding hospital level improvements through partnership program Changing Payment Policies through the Hospital Readmission Reduction Program Various Shared Savings Initiatives Copyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 36
  37. 37. Hospital Readmission Reduction Program Hospital Readmission Reduction Program Section 3025 of The Affordable Care Act added section 1886(q) to the Social Security Act establishing the Readmission Reduction Program, which requires CMS to reduce payments to IPPS hospitals with excess readmissions, effective for discharges beginning on October 1, 2012 Copyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 37
  38. 38. Hospital Readmission Reduction Program Hospital Readmission Reduction Program FY 2013 IPPS Final Rule finalized the following policies Which hospitals are subject to the Hospital Readmission Reduction Program The Methodology to calculate the hospital readmission payment adjustment factor What portion of the IPPS payment is used to calculate the readmission payment adjustment amount A process for hospitals to review their readmission information and submit correction to the information before the readmission rates are to be made public Copyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 38
  39. 39. Hospital Readmission Reduction Program Hospital Readmission Reduction Program FY 2014 IPPS Final Rule finalized changes to the methodology to calculate the hospital readmission adjustment factor. Readmission Adjustment Factor: FY 2013, the higher of the Ratio or 0.99 (1% reduction) FY 2014, the higher of the Ratio or 0.98 (2% reduction) Penalties will increase to a maximum of 2 percent for FY 2014 & 3% for FY 2015 CMS considering similar payment reduction based on high readmission rates after joint replacement, stenting, heart bypass and stroke Copyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 39
  40. 40. Hospital Readmission Reduction Program As of October 1, 2012 a substantial number of hospitals began receiving reduced payments from Medicare due to high readmission rates within 30 days of discharge Approximately 2,200 hospitals (2/3 of all hospitals) received a reduction in reimbursement for fiscal year 2013 (ranging up to the maximum 1%) Copyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 40
  41. 41. Hospital Readmission Reduction Program Significant number of hospitals have been working on innovative programs using a wide variety of approaches based on the Hospital Reduction Program Copyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 41
  42. 42. Hospital Readmission Reduction Program Major Points are emerging from current initiatives: The reason for admissions aren't what people generally assume Clear communication during transition is key Hospital and health systems are forming collaborations with nursing homes and home care agencies, including monthly council meetings to look at problem cases together and explore the story behind the story Copyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 42
  43. 43. Hospital Readmission Reduction Program Major Points are emerging from current initiatives (continued): Hospitals are developing innovative services to offer needed support to patients without necessarily admitting them Hospitals and health systems are revamping transfer forms and educational materials to support smooth transitions and consistency between different settings Copyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 43
  44. 44. Hospital Readmission Reduction Program Major Points are emerging from current initiatives (continued): Hospitalists in the post-acute setting play a valuable role in reducing readmissions Hospital and health systems boards need to develop a consistent strategy for post acute care Copyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 44
  45. 45. Hospital Readmission Roulette Hospital Readmission Reduction Program Post Acute Hospitalist Are Practicing In: Skilled Nursing Facilities Post Acute Rehabilitation Post Acute Psychiatric facilities Custodial nursing care Assisted Living Inpatient Hospice facilities Copyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 45
  46. 46. Hospital Readmission Roulette IPC The Hospitalist Company in CA is larger single-specialty group practice with over 1,200 full time Hospitalist nationwide and several hundred part time. 5 years ago accounted for 5% in post acute Today increased to 20% of post acute Copyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 46
  47. 47. Hospital Readmission Roulette Barrier Faced by Hospitalist Major barrier to information flow between settings is a lack of compatibility between electronic records, even if the software is from the same company The standard hospital discharge form is designed as a succinct record of care the patient received while hospitalized, but is not designed as a road map for care the patient needs to receive after discharge Copyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 47
  48. 48. Hospital Readmission Roulette Barrier Faced by Hospitalist (continued) Privacy issues add another layer of complexity. Communication is horrible from hospital to the post acute care setting initiating let to dedicated post acute hospitalist practices. Patient are in the same practice and they meet weekly providing an effective handoff. Copyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 48
  49. 49. Hospital Readmission Roulette Hospital and other organizations have implemented additional strategies: Enhanced patient education Increased post-discharge follow up care Increased coordination with outpatient providers (Bradley et. al., 2012) Copyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 49
  50. 50. Hospital Readmission Roulette Seven Principles key to Reducing Readmissions Seven Principles key to reducing readmissions from SNF with using “SNF-ist” of “Hospitalist” were developed by a Hospitalist Kevin Sundbye, MD from Stormont-Vail Healthcare in Topeka, KS Copyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 50
  51. 51. Hospital Readmission Roulette Seven Principles key to Reducing Readmissions Fax needed medication to the pharmacy the day before discharge so medication are on hand when patient arrives Provide written prescription for pain medication before the patient leaves the hospital Have the doctor at the hospital contact the nursing home doctor who will be responsible for the patient. Copyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 51
  52. 52. Hospital Readmission Roulette Seven Principles key to Reducing Readmissions Continued: Attempt to let the nursing home doctor know ahead of time that the patient is being discharged. Do not allow late-afternoon transfers. If you can’t have the patient at the nursing home by 4 pm, don’t send them. Anybody involved in the transfer process (doctor, nurses, social worker) can and should stop the discharge if they detect a problem Use a checklist to confirm that everything is ready and going to according to plan. (GovernanceInstitute.com; BoardRoom Press Dec 2012) Copyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 52
  53. 53. Hospital Readmission Roulette The Department of Health and Human Services (HHS) has included recommendations from the Medicare Payment Advisory Commission (MedPAC) to have skilled nursing facilities (SNFs) join hospitals in accountability for avoidable 30-day hospital readmissions. As part of the 2014 budget proposal, SNFs with high rates of Medicare rehospitalizations would have payments reduced by 3 percent beginning in 2017 Copyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 53
  54. 54. Hospital Readmission Roulette The MedPAC analysis showed that approximately 14 percent of Medicare patients discharged to SNFs were rehospitalized. To avoid penalties and ensure quality care, this budget proposal challenges SNFs to provide Better care so residents are physically ready for discharge, Provide better family education on subjects such a medication management and Form partnerships with high-quality community services. Copyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 54
  55. 55. Hospital Readmission Roulette Also on the table is MedPAC’s recommendation that bundled payment for post-acute care providers be implemented in 2018, including Long-Term Care Hospitals SNFs Inpatient Rehabilitation Facilities Home Health Providers. Copyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 55
  56. 56. Hospital Readmission Roulette Medicare 9th Scope of Work Began investigating 30-day Re-Admissions. CMS’s Fiscal Intermediaries and state based QIOs began flagging 30-day readmissions to the same facility and for same diagnosis. AMI Heart Failure Pneumonia QIOs contact hospitals and conducted reviews of discharge plans and other documentation to identify patterns of preventable readmissions. Copyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 56
  57. 57. Hospital Readmission Roulette CMS will monitor the success of this project by watching the rates at which patients in these communities return to the hospital. Re- admission rates for hospitals have been tracked by CMS for some time, and will be available to consumers through the Hospital Compare Web site at http://www.hospitalcompare.hhs.gov. Copyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 57
  58. 58. Harmony Healthcare International, Inc. 58Copyright © 2013 All Rights Reserved Hospital Readmission Roulette CMS included a Care Transition in its 9th Statement of work (started in 2008) Quality Improvement Organizations (QIOs) in 14 communities are working to coordinate care and promote seamless transitions across settings Specifically focusing on reducing unnecessary readmissions to the hospital by improved transitions of care and greater coordination among providers
  59. 59. Harmony Healthcare International, Inc. 59Copyright © 2013 All Rights Reserved Hospital Readmission Roulette IHI (Institute for Healthcare Improvement) on May 1, 2009 launch the State Action on Avoidable Rehospitalizations (STAAR) Initiative Grant support from the Commonwealth Fund. Initial phase, Two year Multi state project to reduce avoidable Rehospitalizations focusing on two components
  60. 60. STAAR Initiative One of the First large-scale , multi- stakeholder effort to reduce readmissions and an early leader in encouraging the field to form state-level and local cross-setting partnership to address system issues in transitioning care across settings. Copyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 60
  61. 61. STAAR Initiative Aims to reduce Rehospitalizations by working across organizational boundaries and by engaging: Payers Stakeholders at the State, Regional and National level Patient and families and caregivers at multiple care sites and clinical interfaces Copyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 61
  62. 62. Hospital Readmission Roulette STAAR Initiative IHI partners with STAAR states to provide Strategic guidance Support Technical assistance To hospitals and cross-continuum teams to improve transitions in care and reduce avoidable rehospitalizations Copyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 62
  63. 63. Harmony Healthcare International, Inc. 63Copyright © 2013 All Rights Reserved Hospital Readmission Roulette STAAR Initiative IHI (Institute for Healthcare Improvement) Focusing on Two components: A multi-state learning community to Improve Transition of Care Targeted Technical Assistance to address systemic barriers to reducing avoidable Re- hospitalizations
  64. 64. STAAR Initiative 1. Improve Transition of Care by cultivating a cross-continuum learning collaborative Participants are required to engage partners from across the continuum of care to problem solve and co- design improvements in the day to day work of providers The initiative supports the process improvement work in hospitals and cross continuum teams by creating robust learning community Copyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 64
  65. 65. STAAR Initiative STAAR provides Content reviews Process recommendations Inventory Celebration of Best Practices and suggested measurement strategies Copyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 65
  66. 66. STAAR Initiative 2. Engage State-level leadership to understand and mitigate systemic barriers to change Reducing rehospitalizations in a state or region requires not only front-line process improvement, but also identification and mitigation of barriers to system-wide improvements, policy & payment reforms that will reduce fragmentation and encourage coordination across the continuum of care Copyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 66
  67. 67. STAAR Initiative Reforms are necessary to address the shortcomings of the current volume-based incentives, and to place a premium on the quality of the patient’s experience across the continuum Rehospitalization involves new behaviors, norms, relationships and partnerships to communicate and coordinate care between disciplines, settings and organizations State-level leadership is essential to understand an act on the barriers that front line teams encounter in doing this work Copyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 67
  68. 68. STAAR Initiative STAAR Hospital Teams focus on the implementation of four key recommended process level improvements that require extensive collaboration between the hospitals and their community partners to effectively co-design better processes Copyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 68
  69. 69. STAAR Initiative Perform an Enhanced Assessment of Post- Hospital Needs Provide Effective Teaching and Facilitate Enhanced Learning Provide Real-Time Handover- Communications Ensure Timely Post-Hospital Care Follow- Up Copyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 69
  70. 70. STAAR Initiative Perform an Enhanced Assessment of Post-Hospital Needs Involve family caregivers and community providers as full partners in completing a needs assessment of patients’ home-going needs Reconcile medications upon admission Create a customized discharge plan based on the assessment Copyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 70
  71. 71. STAAR Initiative Provide Effective Teaching and Facilitate Enhanced Learning Customize the patient education materials and processes for patients and caregivers Identify all learners on admission Use Teach Back regularly throughout the hospital stay to assess the patient’s and family caregivers’ understanding of discharge instructions and ability to perform self-care. Copyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 71
  72. 72. STAAR Initiative Provide Real-Time Handover- Communications Reconcile medications at discharge Provide customized, real time critical information to next clinical care provider(s) Give patients and family members a patient-friendly discharge plan For high risk patients, a clinician calls the individual listed as the patient’s emergency contact to discuss the patient’s status and plan of care Copyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 72
  73. 73. STAAR Initiative Ensure Timely Post-Hospital Care Follow-Up Identify each patient’s risk for readmission Prior to discharge, schedule timely follow- up care and initiate clinical and social services based upon the risk assessment Copyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 73
  74. 74. STAAR Initiative Measurements of Outcomes and Process Measures Outcome Measures: Readmissions 30-Day All-cause Readmissions (% of discharges with readmission for any cause with 30 days) Readmission Count (Number of readmissions: Numerator for 30-day all cause readmissions measure) Copyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 74
  75. 75. STAAR Initiative Outcome Measures: Patient Experience HCAHPS Communication Questions: “During the hospital stay, how often did nurses explain things in a way you could understand?” “How often did doctors explain things in a way you could understand?” HCAHPS Discharge Questions: “Did hospital staff talk with you about whether you would have the help you needed when you left the hospital?” “Did you get information in writing about what symptoms or health problems to look out for after you left the hospital?” Copyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 75
  76. 76. STAAR Initiative Outcome Measures: Patient Experience Care Transition Measures: The hospital staff took my preferences and those of my family or caregiver into account in deciding what my healthcare needs would be when I left the hospital. When I left the hospital, I had a good understanding of the things I was responsible for in managing my health. When I left the hospital, I clearly understood the purpose for taking each of my medications Copyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 76
  77. 77. STAAR Initiative Process Measures: Enhanced Admission Assessment for Post- Hospital Needs Percent of admissions where patients and family caregivers are included in assessing post discharge needs Percent of admissions where community providers (e.g., home care providers, primary care providers and burses and staff in skilled nursing facilities) are included in assessing post discharge needs Copyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 77
  78. 78. STAAR Initiative Process Measures (continued): Effective Teaching and Enhanced Learning Percent of observations of nurses teaching patient or other identified learner where Teach Back is used to assess understanding Percent of observations of doctors teaching patient or other identified learner where Teach Back is used to assess understanding Copyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 78
  79. 79. STAAR Initiative Process Measures (continued): Real-time Patient and Family-Centered Handoff Communication Percent of Patients discharged who receive a customized care plan written in patient friendly language at the time of discharge Percent of time critical information is transmitted at the time of discharge to the next site of care (e.g., home health, long term care facility, rehab care, physician office) Copyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 79
  80. 80. STAAR Initiative Process Measures (continued): Post-Hospital Care Follow Up Percent of patients discharged who had a follow- up visit scheduled before being discharged in accordance with their risk assessment Balancing Measure Observation Admits Number of Admission to observation status in the month Copyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 80
  81. 81. STAAR Initiative Five Steps the STAAR initiative found to be effective: Know your data Know your partners-with whom you share patients Form operational alliances to share data and improve transition processes. Form a cross continuum team Perform a review of five recently readmitted patients, and bring to the cross continuum team meeting Identify shared process that span the transition from the hospital to other settings, and work together to improve those processes Copyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 81
  82. 82. Hospital Readmission Roulette The Affordable Care Act created a formal Community Based Care Transition Program (CCTP) The program was to test models in for improving care transition and reduce readmissions for high risk Medicare beneficiaries CCTP is part of the Partnership for Patients (P4P) a nationwide partnership aimed to reduce preventable hospital errors by 40% and reduce hospital readmissions by 20% 47 organizations are enrolled and budgeted to $500 million Copyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 82
  83. 83. Partnership For Patients (P4P) Copyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 83
  84. 84. Partnership For Patients (P4P) Copyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 84
  85. 85. Harmony Healthcare International, Inc. 85Copyright © 2013 All Rights Reserved INTERACT(Interventions to Reduce Acute Care Transfers) Joseph Ouslander, MD, Director of Boca Institute for Quality Aging at Boca Raton Community Hospital, created a program aimed at reducing the number of hospital admission from nursing homes
  86. 86. INTERACT INTERACT was initially designed as “Toolkit” in 2007 Evolved into a full Quality Improvement Program that will assist nursing homes in meeting the federal requirement for QAPI program Copyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 86
  87. 87. INTERACT Designed to improve the early identification, evaluation, management documentation and communication about acute changes in condition of residents in nursing homes The goal is to improve care by reducing the frequency of potentially preventable transfers to the acute care hospital and related complications leading to increase health care expenditure Copyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 87
  88. 88. INTERACT Program includes Evidenced Based and Expert recommended Tools Strategies to implement them Related educational resources The tools are to be integrated into everyday care and be incorporated into your facility’s quality improvement program Copyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 88
  89. 89. INTERACT Tools: Quality Improvement Tools Communication Tools Decision Support Tools Advance Care Planning Tools Copyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 89
  90. 90. INTERACT Implementation Elements Advance Care Planning should begin at the time of or shortly after admission and continued through out the resident stay. The INTERACT Advanced Care Planning Tool aides in developing a person centered care plan Medication Reconciliation Worksheet is designed to help with safe medication orders at the time of admission Copyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 90
  91. 91. INTERACT Implementation Elements (continued) Stop and Watch Tool to be used by CNAs to identify changes in resident and clearly communicate those changes to the licensed staff. The tool also can be used with staff who have direct contact with resident and may observe changes (Rehab, environmental services, dietary) Copyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 91
  92. 92. INTERACT Implementation Elements (continued) Once a nurse is alerted to a change in condition the Care Paths and Change in Condition File Cards can be used as decision support tools to help with the recognition, management and reporting of specific symptoms and signs. Include criteria for notifying primary care clinician Copyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 92
  93. 93. INTERACT Implementation Elements (continued) SBAR Form and Acute Change in Condition Progress Note to enhance the evaluation of and documentation with acute changes and improve the communication utilizing a structure. Transfer Checklist and Transfer Forms used to communicate clearly and succinctly information that is critical for the ED and other hospital staff to care for the resident. Copyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 93
  94. 94. INTERACT Quality Improvement Tools The Hospitalization Rate Tracking Tool Quality Improvement Tool Both tools assist with: Tracking, trending, and benchmarking measures Conducting root cause analysis that identify areas for improvement Copyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 94
  95. 95. INTERACT Four Key Strategies for implementation essential for success Make INTERACT an integral component of QAPI program Integrate the INTERACT program and tools into everyday care Tools are visible and accessible for everyday care Culture Change-change takes time and to be mindful of this Copyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 95
  96. 96. INTERACT Commonwealth Fund Project Results 100 bed Nursing Home the average reduction of 0.69 hospitalizations/1000 resident days equates 25 fewer hospitalizations in a year $125,000 in savings to Medicare Part A (conservative) The Interventions as implemented as part of the project cost $7,700 per a facility The savings could aide the facility infrastructure Copyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 96
  97. 97. Hospital Readmission Roulette Medicare Readmission Rates showed Meaningful decline in 2012 per a publication of the Center for Medicare & Medicaid Services, Office of Information Products & Data Analytics Copyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 97
  98. 98. Hospital Readmission Roulette Descriptive analysis of 30-day, all cause hospital readmission rate patterns from 2007-2012 . Population: Medicare FFS beneficiaries experiencing at least one acute inpatient hospital stay. Copyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 98
  99. 99. Hospital Readmission Roulette Method: Chronic Condition Data Warehouse claims, estimate unadjusted, monthly readmission rates for the nation, within the Dartmouth Hospital Referral Region (HRR), and compare participating and non-participating hospitals in the Partnership for Patients(P4P) program (overall and by number of inpatient beds at each facility) Copyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 99
  100. 100. Hospital Readmission Roulette Results: From 2007-2011 the national 30-day all cause hospital readmission rate averaged 19% 2012 readmission rate averaged 18.4% Copyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 100
  101. 101. Hospital Readmission Roulette Current Readmission Rates Copyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 101
  102. 102. Hospital Readmission Roulette Copyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 102
  103. 103. Hospital Readmission Roulette Copyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 103
  104. 104. Hospital Readmission Roulette Copyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 104
  105. 105. Harmony Healthcare International, Inc. 105Copyright © 2013 All Rights Reserved HEALTHCARE POLICY PRIORITY CMS hopes to lower Hospital readmissions Rate by 20% by 2013 utilizing evidenced based interventions
  106. 106. HEALTHCARE POLICY PRIORITY The Affordable Care Act established the Hospital Readmission Reduction Program (HRRP) which ties payment to Performance on Measures HRRP begins October 1, 2012 Lowers Medicare payment rate for hospitals with greater than expected readmission rates for specific conditions Copyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 106
  107. 107. HEALTHCARE POLICY PRIORITY Conditions beginning FY 2013 Heart Failure Acute Myocardial Infarction Pneumonia These three conditions made up approximately 10% of hospital discharges in 2009 (Avalere analysis of 2009 Medicare 100 Percent Standard Analytic files claims data from CMS.) Copyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 107
  108. 108. HEALTHCARE POLICY PRIORITY Conditions Beginning FY 2015 Chronic Obstructive Pulmonary Disease Coronary Bypass Graft Percutaneous Transluminal Coronary Angioplasty Other Vascular Conditions Copyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 108
  109. 109. HEALTHCARE POLICY PRIORITY Payment reduction is determined by an adjustment factor based on an assessment of excess readmissions Copyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 109
  110. 110. HEALTHCARE POLICY PRIORITY Hospitals with excessive readmission rates will have their Medicare payments reduced by up to 1% in fiscal year 2013 2% in 2014 3% by fiscal year 2015 and beyond Copyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 110
  111. 111. Harmony Healthcare International, Inc. 111Copyright © 2013 All Rights Reserved HEALTHCARE POLICY PRIORITY Hospitals with risk adjusted 30 day readmission performance in the lowest quartile will incur penalties against their total Medicare Payment beginning in fiscal year 2013 (starting October 1, 2012) CMS will evaluate prior year’s readmission data starting October 1, 2011
  112. 112. Harmony Healthcare International, Inc. 112Copyright © 2013 All Rights Reserved HEALTHCARE POLICY PRIORITY Preparing for Payment Penalties: Know your readmission metrics including original discharge disposition and origin of readmission Calculate readmission rates by condition, physician performance and post acute care facility Identify opportunities based on patient demographics and common readmissions Screen and target patients based on risk assessments Compare disease specific outcome measures to national and local competitor rates
  113. 113. Harmony Healthcare International, Inc. 113 Hospital Readmission Roulette Four stages of care that allow effective interventions Preparation for discharge, a process starting on admission making staff aware of home environment Hand-off to the out patient physician Medication reconciliation to make sure new prescriptions are filled and that patients are not falling back on their old medication routines Home visits and/or phone call, daily or weekly for first 30 days Copyright © 2013 All Rights Reserved
  114. 114. Hospital Readmission Roulette American Healthcare Association Goal: Reduce Hospital Re-admissions within 30 days during a SNF stay by 15% by March 2015 Copyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 114
  115. 115. Hospital Readmission Roulette Definition of Readmission 30 Day Readmission Measure Readmission occurs when a patient is discharged from the applicable hospital to a non-acute setting and then is admitted to the same or another acute care hospital within 30 days for any reason Copyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 115
  116. 116. Hospital Readmission Roulette Definition of Readmission 30 Day Readmission Measure Exclusion to Readmission Definition: Transfers and planned readmissions are excluded An exception for AMI for planned readmission for revascularization procedures (CABG PTCA) Copyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 116
  117. 117. Hospital Readmission Roulette 1 in 5 Medicare FFS Beneficiaries are Readmitted to the hospital within 30 days Copyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 117 Hospital Discharge Condition 30-Day Rate for Re- hospitalization AMI 19.8 Heart Failure 24.8 Pneumonia 18.4 Hospital Compare National Readmission Rate: http://www.medicare.gov/Download/DownloaddbInterim.asp. Jan 20, 2012
  118. 118. National Transitions of Care Coalition Medicare Transitional Care Act of 2012 Improve transition of care for high risk Medicare beneficiaries at high risk for readmission as they move from the hospital setting to Home Skilled Nursing facility Next point of care The bill is step in improving patient outcomes and reducing unnecessary health-related expenses Copyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 118
  119. 119. National Transitions of Care Coalition The Medicare Transitional Care Act puts in place an infrastructure to promote care transition interventions that have been proven successful Seven key elements found in evidence- based care interventions Copyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 119
  120. 120. National Transitions of Care Coalition Seven Essential Intervention Categories Medication Management Transition Planning Patient and Family Engagement/Education Information Transfer Follow-Up Care Healthcare provider Engagement Shared Accountability across Providers and Organizations Copyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 120
  121. 121. Harmony Healthcare International, Inc. 121 Nursing Home Value-Based Purchasing Demonstration Project CMS initiative to improve Quality and Efficiency of care to Medicare beneficiaries Financial incentives to nursing homes that meet certain conditions providing high quality of care Demonstration includes three states: Arizona, New York, and Wisconsin Copyright © 2013 All Rights Reserved
  122. 122. Harmony Healthcare International, Inc. 122 Nursing Home Value-Based Purchasing Demonstration Project Quality Performance Based on Four Domains: Staffing Appropriate Hospitalizations Minimum Data Set (MDS) Outcomes Survey Deficiencies CMS will award points based on performance with each measure within the domain Points will summed for an overall quality score Copyright © 2013 All Rights Reserved
  123. 123. Harmony Healthcare International, Inc. 123 Nursing Home Value-Based Purchasing Demonstration Project For each state Nursing home scores in the top 20 % Homes in the top 20% of improvement in their scores Eligible for a share of the State’s savings pool Copyright © 2013 All Rights Reserved
  124. 124. Harmony Healthcare International, Inc. 124 Nursing Home Value-Based Purchasing Demonstration Project Anticipate that potentially avoidable Hospitalizations may be reduced as a result of improvement of quality of care Reduction in hospitalizations and subsequent skilled nursing stays result in Medicare savings The saving will fund the payment awards Copyright © 2013 All Rights Reserved
  125. 125. Hospital Readmission Roulette Clinician and Hospital administrators are eager to find effective approaches to reduce Rehospitalizations. As Payers, Policy makers and Purchasers are eager to develop incentives to improve practice. Copyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 125
  126. 126. Hospital Readmission Roulette Transition in Care A Culture Change Copyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 126
  127. 127. SNF Culture Change WHY A Culture Change? Needed in order to be successful! The Affordable Care Act mandates that each facility have a Quality Assurance and Performance Improvement Program (QAPI) Improving Management of acute changes in condition and reducing unnecessary hospital transfers is one potential focus to meet QAPI requirements Copyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 127
  128. 128. SNF Culture Change Corporate Compliance program in place and supported by the organization Support and buy- in from senior leadership down front line staff QAPI program Make readmission an initiative An organization ready for change Cross the continuum collaboration Copyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 128
  129. 129. SNF Culture Change Know your Data Partner with Hospitals, physician offices, Home care, Hospice, Assisted Living, Acute Rehab Be part of Pilot programs or initiatives Implement INTERACT Train and Educate all employees from top down Copyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 129
  130. 130. SNF Culture Change Copyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 130 Admission Process Receive complete and accurate admission information Manage Admissions times and days Customer Service Establish protocols and procedures Handoff communication Transition meeting scheduled with 72 hours of Admission INTERACT Advanced Care Planning
  131. 131. SNF Culture Change Customer Services: Making a Good Impression Providing pre-admission contact with patient/family Staff and room are ready to receive patient Implement a room readiness checklist A warm home like atmosphere A welcome gift Copyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 131
  132. 132. SNF Culture Change Transition Planning Meeting Scheduled with 72 hours of Admission Interdisciplinary Communication Goal: Ease transition into and out of the facility Length of Stay Individualized to each patients situation and condition Reduce readmissions to the hospital Copyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 132
  133. 133. Hospital Readmission Roulette SNF Culture Change (continued) Education Patient and Family through out care Accountability/Communication Effective Hand Off of Care Medication Management Multidisciplinary approach Discharge planning that starts on admission Copyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 133
  134. 134. Hospital Readmission Roulette SNF Structural Support MD/PA/NP availability-“SNF-ist” or Hospitalist Pharmacy support 24/7 and responsiveness Respiratory Therapist and Respiratory vendor support Training and competency Infusion Therapy RN Support Training and competency 24/7 availability Copyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 134
  135. 135. Harmony Healthcare International, Inc. 135Copyright © 2013 All Rights Reserved Questions & Answers
  136. 136. Harmony Healthcare International, Inc. 136Copyright © 2013 All Rights Reserved Hospital Readmission Roulette
  137. 137. References & Resources Healthcare Leader Action Guide to reduce Avoidable Readmissions, 2010 Health Research & Educational Trust Report on Medicare Compliance, “CMS Targets Readmission Through Payment, Audits; “Coaching” Model Reduces Rates.” Volume 17,Number 24. June 30, 2008 Reducing Hospital-SNF 30-Day Readmission. Case Management Monthly. January 2010. Copyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 137
  138. 138. References & Resources Improving Care Transition and Reducing Hospital Readmission. The Remington Report. January/February, 2010 Care Transitions. Re-hospitalizations Among Patients in the Medicare Fee for Service Program. New England Journal of Medicine, April 2, 2009. Institute For healthcare Improvement: Effective Interventions to reduce Rehospitalizations, March, 2009. Copyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 138
  139. 139. References & Resources Hospital Collaborate with SNFs, Home Care, Hospice, to Reduce Readmission by Elaine Zablocki, National Research Corporation, December 2012 BoardRoom Press Medicare & Medicaid Research Review 2013: Volume 3, Number 2, Medicare Readmission Rates Showed Meaningful Decline 2012, Gerhardt, G., Yemane, A. Hickman, P., Oelschlaeger,A., Rollins, E., Brennan,N. Readmission Reduction Program. CMS. Gov, www.cms.gov/Medicare/Medicare-Fee-for-Service- payment/AcuteinpatientPPS/Readmission-Reduction- Program.html Copyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 139
  140. 140. References & Resources State Action on Avoidable Rehospitalizations. www.ihi.org Copyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 140
  141. 141. Questions/Answers Harmony Healthcare International 1 (800) 530 – 4413 dbuckley@harmony-healthcare.com Harmony Healthcare International, Inc. 141141Copyright © 2013 All Rights Reserved Harmony Healthcare International, Inc.
  142. 142. Harmony Healthcare International Have you Considered a Customized Complimentary HARMONY(HHI) MEDICARE PROGRAM EVALUATION or CASE MIX ANALYSIS for your Facility? Perhaps your facility has potential for additional revenue Assess your facility against key indicators and national norms Email us at for more information RUGS@harmony-healthcare.com Analysis is cost & obligation free Harmony Healthcare International, Inc. 142Copyright © 2013 All Rights Reserved Harmony Healthcare International, Inc.
  1. A particular slide catching your eye?

    Clipping is a handy way to collect important slides you want to go back to later.

×