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Hospital Readmission Reduction: How Important are Follow Up Calls? (Hint: Very)
Hospital Readmission Reduction: How Important are Follow Up Calls? (Hint: Very)
Hospital Readmission Reduction: How Important are Follow Up Calls? (Hint: Very)
Hospital Readmission Reduction: How Important are Follow Up Calls? (Hint: Very)
Hospital Readmission Reduction: How Important are Follow Up Calls? (Hint: Very)
Hospital Readmission Reduction: How Important are Follow Up Calls? (Hint: Very)
Hospital Readmission Reduction: How Important are Follow Up Calls? (Hint: Very)
Hospital Readmission Reduction: How Important are Follow Up Calls? (Hint: Very)
Hospital Readmission Reduction: How Important are Follow Up Calls? (Hint: Very)
Hospital Readmission Reduction: How Important are Follow Up Calls? (Hint: Very)
Hospital Readmission Reduction: How Important are Follow Up Calls? (Hint: Very)
Hospital Readmission Reduction: How Important are Follow Up Calls? (Hint: Very)
Hospital Readmission Reduction: How Important are Follow Up Calls? (Hint: Very)
Hospital Readmission Reduction: How Important are Follow Up Calls? (Hint: Very)
Hospital Readmission Reduction: How Important are Follow Up Calls? (Hint: Very)
Hospital Readmission Reduction: How Important are Follow Up Calls? (Hint: Very)
Hospital Readmission Reduction: How Important are Follow Up Calls? (Hint: Very)
Hospital Readmission Reduction: How Important are Follow Up Calls? (Hint: Very)
Hospital Readmission Reduction: How Important are Follow Up Calls? (Hint: Very)
Hospital Readmission Reduction: How Important are Follow Up Calls? (Hint: Very)
Hospital Readmission Reduction: How Important are Follow Up Calls? (Hint: Very)
Hospital Readmission Reduction: How Important are Follow Up Calls? (Hint: Very)
Hospital Readmission Reduction: How Important are Follow Up Calls? (Hint: Very)
Hospital Readmission Reduction: How Important are Follow Up Calls? (Hint: Very)
Hospital Readmission Reduction: How Important are Follow Up Calls? (Hint: Very)
Hospital Readmission Reduction: How Important are Follow Up Calls? (Hint: Very)
Hospital Readmission Reduction: How Important are Follow Up Calls? (Hint: Very)
Hospital Readmission Reduction: How Important are Follow Up Calls? (Hint: Very)
Hospital Readmission Reduction: How Important are Follow Up Calls? (Hint: Very)
Hospital Readmission Reduction: How Important are Follow Up Calls? (Hint: Very)
Hospital Readmission Reduction: How Important are Follow Up Calls? (Hint: Very)
Hospital Readmission Reduction: How Important are Follow Up Calls? (Hint: Very)
Hospital Readmission Reduction: How Important are Follow Up Calls? (Hint: Very)
Hospital Readmission Reduction: How Important are Follow Up Calls? (Hint: Very)
Hospital Readmission Reduction: How Important are Follow Up Calls? (Hint: Very)
Hospital Readmission Reduction: How Important are Follow Up Calls? (Hint: Very)
Hospital Readmission Reduction: How Important are Follow Up Calls? (Hint: Very)
Hospital Readmission Reduction: How Important are Follow Up Calls? (Hint: Very)
Hospital Readmission Reduction: How Important are Follow Up Calls? (Hint: Very)
Hospital Readmission Reduction: How Important are Follow Up Calls? (Hint: Very)
Hospital Readmission Reduction: How Important are Follow Up Calls? (Hint: Very)
Hospital Readmission Reduction: How Important are Follow Up Calls? (Hint: Very)
Hospital Readmission Reduction: How Important are Follow Up Calls? (Hint: Very)
Hospital Readmission Reduction: How Important are Follow Up Calls? (Hint: Very)
Hospital Readmission Reduction: How Important are Follow Up Calls? (Hint: Very)
Hospital Readmission Reduction: How Important are Follow Up Calls? (Hint: Very)
Hospital Readmission Reduction: How Important are Follow Up Calls? (Hint: Very)
Hospital Readmission Reduction: How Important are Follow Up Calls? (Hint: Very)
Hospital Readmission Reduction: How Important are Follow Up Calls? (Hint: Very)
Hospital Readmission Reduction: How Important are Follow Up Calls? (Hint: Very)
Hospital Readmission Reduction: How Important are Follow Up Calls? (Hint: Very)
Hospital Readmission Reduction: How Important are Follow Up Calls? (Hint: Very)
Hospital Readmission Reduction: How Important are Follow Up Calls? (Hint: Very)
Hospital Readmission Reduction: How Important are Follow Up Calls? (Hint: Very)
Hospital Readmission Reduction: How Important are Follow Up Calls? (Hint: Very)
Hospital Readmission Reduction: How Important are Follow Up Calls? (Hint: Very)
Hospital Readmission Reduction: How Important are Follow Up Calls? (Hint: Very)
Hospital Readmission Reduction: How Important are Follow Up Calls? (Hint: Very)
Hospital Readmission Reduction: How Important are Follow Up Calls? (Hint: Very)
Hospital Readmission Reduction: How Important are Follow Up Calls? (Hint: Very)
Hospital Readmission Reduction: How Important are Follow Up Calls? (Hint: Very)
Hospital Readmission Reduction: How Important are Follow Up Calls? (Hint: Very)
Hospital Readmission Reduction: How Important are Follow Up Calls? (Hint: Very)
Hospital Readmission Reduction: How Important are Follow Up Calls? (Hint: Very)
Hospital Readmission Reduction: How Important are Follow Up Calls? (Hint: Very)
Hospital Readmission Reduction: How Important are Follow Up Calls? (Hint: Very)
Hospital Readmission Reduction: How Important are Follow Up Calls? (Hint: Very)
Hospital Readmission Reduction: How Important are Follow Up Calls? (Hint: Very)
Hospital Readmission Reduction: How Important are Follow Up Calls? (Hint: Very)
Hospital Readmission Reduction: How Important are Follow Up Calls? (Hint: Very)
Hospital Readmission Reduction: How Important are Follow Up Calls? (Hint: Very)
Hospital Readmission Reduction: How Important are Follow Up Calls? (Hint: Very)
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Hospital Readmission Reduction: How Important are Follow Up Calls? (Hint: Very)

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Starting in 2012, the Centers for Medicare and Medicaid Services (CMS) will begin withholding payments for potentially avoidable readmissions. This presentation reviews these new regulations, what …

Starting in 2012, the Centers for Medicare and Medicaid Services (CMS) will begin withholding payments for potentially avoidable readmissions. This presentation reviews these new regulations, what causes excessive readmissions, and how hospitals can positively impact patient health by reaching out 24-72 hours after discharge.

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  • 1. time Why it’s to focus on  hospital readmissions Bridging the gap between hospital and home
  • 2. Approx.  $2 trillion is spent on healthcarein the U.S. each year.   SOURCE: Fazzi R, Agoglia R, Mazza G, Glading-DiLorenzo J. The Briggs National QualityImprovement/Hospitalization Reduction Study. Caring: National Association for HomeCare magazine. 2006; 25(2):70.  
  • 3. Flickr: Daquella manera   1/3 hospitalizations. is spent on SOURCE: Fazzi R, Agoglia R, Mazza G, Glading-DiLorenzo J. The Briggs National QualityImprovement/Hospitalization Reduction Study. Caring: National Association for HomeCare magazine. 2006; 25(2):70.  
  • 4. 20% readmissions.   of those hospitalizations are SOURCE: Fazzi R, Agoglia R, Mazza G, Glading-DiLorenzo J. The Briggs National QualityImprovement/Hospitalization Reduction Study. Caring: National Association for HomeCare magazine. 2006; 25(2):70.  
  • 5. Hospital Readmission (Definition)A hospitalization that occurs within a specified time frame after discharge from the first or index admission. SOURCE: American Journal of Medical Quality. Redefining Hospital Readmissions to Better Reflect Clinical Course of Care for Heart Failure Patients.
  • 6. “ I think readmissions are abellwether of whether we are really doing the kind of support, education,outreach, and coordination that really can keep people as healthy as they possibly can [be].”   Dr. Donald Berwick, Administrator of the Centers for Medicare and Medicaid Services
  • 7. Leaving the hospital   stressful. can be  
  • 8. Patients may be tired.
  • 9. Patients may be tired. …uncertain about their discharge instructions.  
  • 10. Patients may be tired. …nervous about transitioning home.   …uncertain about their discharge instructions.  
  • 11. Patients may be tired. …nervous about transitioning home.   …uncertain about their discharge instructions.   …concerned their condition could worsen.  
  • 12. Patients may be tired. …nervous about transitioning home.   …uncertain about their discharge instructions.   …concerned their condition could worsen.  …unhappy with theirhospital experience.  
  • 13. …at risk of readmission.  
  • 14. This is especially truewith Medicare patients.  
  • 15.  18-20% of Medicare patients are re-hospitalized within 30 days of discharge.  SOURCE: Jencks S, et al. Rehospitalizations among patients in the Medicare fee-for-service program.New England Journal of Medicine 2009.
  • 16. 33% readmit within 90 days.SOURCE: Jencks S, et al. Rehospitalizations among patients in the Medicare fee-for-service program.New England Journal of Medicine 2009.
  • 17. However, many of thesereadmissions are potentiallyavoidable.      
  • 18. “ Readmissions are not primarily about people beingre-hospitalized because of mistakesmade in the hospital. [Readmissions] are about making transitions effectively.” Stephen Jencks, M.D., a former senior clinical adviser to CMS.
  • 19. Avoidable Readmission (Definition)A potentially preventable re-hospitalization… that in many cases may be prevented with proven standards of care. SOURCE: MedPAC (June 2007) Report to the Congress: Promoting Greater Efficiency in Medicare
  • 20. Avoidable  readmissions are all   too common.
  • 21. In fact, 13% of Medicare re-hospitalizations arepotentially avoidable.SOURCE: Hackbarth G, Reischauer R, Miller M. Report to Congress: Medicare Payment Policy. Washington, DC: Medicare Payment Advisory Committee; March 2007.
  • 22. That’s a cost of about   $12 billion! ($7,000 per person) SOURCE: Recreated from Table 5-2 within: MedPAC (June 2007) Report to the Congress: Promoting Greater Efficiency in Medicare. P 107, from 3M analysis of 2005 Medicare discharge claims.
  • 23. What causes potentially avoidable these readmissions?
  • 24. Reason #1Patientsdon’t follow homecare instructions.
  • 25. Which can cause serious  complications with their at home recovery.
  • 26. Especially when dealing with  medications.
  • 27.  In fact, of 2/3Medicare readmissionsare due to medicationnon-compliance.   SOURCE: Jencks S, et al. Rehospitalizations among patients in the Medicare fee-for-service program.New England Journal of Medicine 2009.
  • 28. Reason #2 There isn’t   adequate follow up or monitoring.
  • 29. Many patients aren’t seen byphysicians promptly after discharge.
  • 30. In fact, 50% of Medicare patients hadno interaction with a physician between discharge and readmission.   SOURCE: Jencks S, et al. Rehospitalizations among patients in the Medicare fee-for-service program.New England Journal of Medicine 2009.
  • 31. With no  one to help them   schedule   and keep those  appointments
  • 32. …a significant  gap in care occurs.
  • 33. …a significant   gap in care occurs. And patient  health deteriorates.
  • 34. Reason #3Hospitals   and Physicians  aren’t good at sharingpatient care plans.
  • 35. Quite often,   physiciansaren’t kept in the loop about   discharge plans.
  • 36. In fact, one review found that   only 3%-20% of hospitals communicate with the primary care physician.SOURCE: Kripalani S, LeFevre F, Phillips CO, Williams MV, Basaviah P, Baker DW. Deficits incommunication and information transfer between hospital-based and primary carephysicians: implications for patient safety and continuity of care. JAMA. Feb 282007; 297(8):831-841.
  • 37. And only 12%-34% of primary care physicians have access to discharge summaries during the first post discharge visit.SOURCE: Kripalani S, LeFevre F, Phillips CO, Williams MV, Basaviah P, Baker DW. Deficits incommunication and information transfer between hospital-based and primary carephysicians: implications for patient safety and continuity of care. JAMA. Feb 282007; 297(8):831-841.
  • 38. But change is on the horizon.
  • 39. Medicare andThe Center forMedicaid Services (CMS) is beginning to hold   hospitals accountable.
  • 40. Starting October 2012, CMS will begin withholding payments for excessive readmissions.
  • 41. Focusing first on: 1.  Congestive Heart Failure (CHF) 2.  Acute Myocardial Infarction (AMI) 3.  Pneumonia
  • 42. then adding others in 2014 . 4.  Chronic Obstructive Lung Disease 5.  Coronary Bypass Grafting 6.  Percutaneous Coronary Interventions 7.  Vascular Procedures
  • 43. CMS penalties are based on amaximum percentage of total inpatient operating payments.
  • 44. increase Which will   over the next   three years.2012 = 1% 2013 = 2% 2014 = 3%
  • 45. Their goal is toincentivizehospitals to improve patient health by extending care servicesbeyond the hospital setting – thereby reducing costs.
  • 46. “ The incentives wereputting into place have created a whole new way to think about hospital care.”   Jonathan Blum, deputy administrator of the federal Centers for Medicare Medicaid Services, or CMS.
  • 47. And it’s  not just about the   numbers.  
  • 48. Patient Experience will play a key role in measuringthe effectiveness of a hospital’s inpatient and discharge planning.
  • 49. In fact, higher have beenHCAHPS associated with a lower 30-day risk of hospital readmission for: Congestive Heart Failure (CHF) Acute Myocardial Infarction (AMI) PneumoniaSOURCE: The American Journal of Managed Care: Relationship Between Patient Satisfaction With Inpatient Care and Hospital Readmission Within 30 Days
  • 50. To avoid CMS penalties,it will be critical for hospitals   to support patients using aftercare services.
  • 51. Aftercare (Definition)The subsequent care or maintenance of a patient after a stay in the hospital. SOURCE: New Oxford American Dictionary
  • 52. Hospitals need tostart thinking of themselves as care managers.
  • 53. And take a  leading role in managing patient care  after discharge.
  • 54. In other words…
  • 55. Set clear  expectations on what will happen.
  • 56. Set clear   expectations on what will happen. contact  Stay in   with the patient after discharge.  
  • 57. Set clear   expectations on what will happen. contact  Stay in   with the patient after discharge.   Keep physicians   in-the-loop.
  • 58. Set clear   expectations on what will happen. contact  Stay in   with the patient after discharge.   Keep physicians   in-the-loop. Provide   24x7 accessto decision support services.
  • 59. “While timely follow-up is critical, that alone isn’t enough to prevent readmissions. To beeffective, you need a care team that can connect,evaluate, and escalate patients to appropriate care and/or administrative resources.”   Jeff Forbes, President, SironaHealth
  • 60. Post Discharge Follow-up (Definition) Outbound calling programs that rapidly assess apatients current health status, schedule follow-up care, and gather feedback on their hospital experience. SOURCE: SironaHealth
  • 61. To be successful,  post discharge calling programs must…  
  • 62. Follow up  24-72 hours after discharge
  • 63. Review patient discharge   instructions
  • 64. Provide  decision support and   health coaching
  • 65. Schedule Follow Up Facilitate Find a Doctor appropriatenext steps Escalate to Urgent or Emergency Care Guide to Other Hospital Services
  • 66. Make it easy to   reconnect   with a   clinician* *in case they develop symptoms after initial call.
  • 67. Keep all  members informedof the care team  
  • 68. feedback   Use  to improve the discharge     experience
  • 69. “ smooth If we are able to the transitions [afterdischarge], those people would stay home where they want to be and costs would fall because [the patients] are not deteriorating. We have a tremendous possibility there.”   Dr. Donald Berwick, Administrator of the Centers for Medicare and Medicaid Services
  • 70. We Agree.
  • 71. Post DischargeFollow Up ServicesKeep patients healthy, reduce readmissions, improve experiencesLearn more!www.SironaHealth.com/post-discharge
  • 72. About SironaHealthHealthcare needs have evolved.Most contact centers havent.Thats why were here.We are a multi-channel health contact center that offers healthcare companies a unified way tocoordinate patient care across telephone, web, email, and mobile channels. SironaHealth programshelp your patients make the appropriate healthcare choices —whether it be choosing the properphysician or knowing when they should seek emergency care.Connect with us online!blog.sironahealth.comfacebook.com/sironahealth  twitter.com/sironahealthlinkedin.com/company/sironahealth-in

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