Hospital Readmissions New Rules

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GrandCare Systems\' 7-7-11 Aging/Tech bi-weekly webinar. John Boden from Elder Issues presented on Hospital Readmissions and the new Medicare Rules!

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Hospital Readmissions New Rules

  1. 1. ElderIssues, LLC <br /> <br /> <br /> <br />Building Bridges<br />Between companies providing products and services for eldercare and the elders and families who need them. <br />
  2. 2. John Boden<br />Prior to starting ElderIssues in 2001, John was the founder of Personal Care Managers, Inc. (PCM), a professional geriatric care management company begun in 1988. That company helped elders and their families navigate every area of eldercare. <br />He also developed www.LifeLedger.com which is a cloud based system that guides families through the entire caregiving process. <br />John is a nationally recognized expert in elder care issues and geriatric care management. He has served as President of the Florida Guardianship Association and has been an active member in the National Association of Professional Geriatric Care Managers and the National Guardianship Association. <br />He has a master level Certificate in Gerontology from FAU and was their first graduate and served as a U.S. Marine helicopter pilot in Vietnam, successfully completing more than 750 combat missions. You can read about those experiences in his book Klondike Playboy www.klondikeplayboy.com.<br />He is married to his wife Patricia who founded PCM with him, and has five children, eight grandchildren, and two great grandchildren, who give him pride, joy and happiness.<br />
  3. 3. New Hospital Readmission Rules<br />The Real Story<br />
  4. 4. March 2010 Patient Protection and Affordable Care Act (PPACA)New Medicare Rules For<br />Readmissions<br />Can Cause Big $ Penalties for Hospitals<br />
  5. 5. It Is a Big Problem<br />One In Five <br />Medicare beneficiaries who leave a hospital are back in less than 30 days!<br />Yes!<br />One In Five <br />
  6. 6. When Will It Happen?<br />Collection of Statistics October 1, 2011<br />Penalties Assessed in 2013<br /> For Readmissionsat the rate of: 1.15% if within 30 days<br /> 1.77% if within 15 days<br /> 2.38% if within 7 days<br />The total maximum penalty will be capped at: <br /> 2013 1%<br /> 2014 2%<br /> 2015 3%<br />and then increase after that<br />on<br />Total Annual Medicare Billings<br />
  7. 7. Who Will Be Penalized? <br />Those hospitals that rank in the lowest<br /> 25th percentile based on patients readmitted with the following 3 diagnoses: <br />Heart Failure (HF) <br />Acute Myocardial Infarction (AMI)<br />Pneumonia<br />This list will grow to include:<br />Chronic Obstructive Pulmonary Disease (COPD)<br />Coronary Bypass Grafting <br />Percutaneous Coronary Interventions <br />Vascular Procedures.<br />
  8. 8. How Will It Be calculated?<br />The ratings will be based on complicated formulas against “expected” rates of readmissions.<br />It will NOT<br />mean that that if patient Jones is readmitted the hospital will not be paid.<br />A common misconception<br />
  9. 9. How Will This Help Us?<br />Readmissions will no longer be a rarely mentioned source of increased revenue for the hospital.<br />Hospitals will now have skin in the game and want to have discharges stay discharged.<br />SNFs, ALFs and Home Health companies will have to demonstrate their ability to keep those discharged into their care, safe and healthy.<br />
  10. 10. Technology To the Rescue<br />“We need reimbursement before we buy” as an objection will be reduced.<br />New “Face to Face” Plan of Care rules and declining reimbursements will increase the need for the efficiencies that technology will provide.<br />Transitions from Medicare to private-pay will be an opportunity to ask families to keep their system and turn the agencies into dealers.<br />
  11. 11. Care Transitions<br />“Discharge” rapidly changing to “Transition”<br />Why:<br />What may be the most startling fact about readmissions is that most are NOT clearly related to a single medical error but are much more often caused by systemic issues in the discharge planning process and post-discharge follow-up. <br />
  12. 12. Examples<br />The correct order for discharge medications is made, and the prescriptions delivered to the patient, but there is no verification about whether the patient can arrange to get them, can afford them, or information about the medications already at home that may interact with the medications in the discharge order.<br />The discharge is made for an elderly patient but no one had determined that the family caregiver, who is struggling to assist her mother from a thousand miles away has not been informed of any care plan changes or been made aware of the symptoms that should be watched for as they could indicate a pending onset of a major problem.<br />
  13. 13. Tips for Selling toHome Health Agencies<br />Ask what they see as challenges with the new readmission and Face-to-Face rules now in effect.<br />Ask what changes they are making to meet changes.<br />Ask how they plan to transition patients from their Medicare side to their private-pay side.<br />Build a plan specifically for them showing how your technology can improve their results and increase their revenue.<br />
  14. 14. How To Make A Deal<br />When you want someone to do something for you (like buy your product or service) don’t waste your time trying to figure out how to make them buy. Instead, look for something that they need and then figure out how you can give it to them. That’s the true art of the deal. <br />

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