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How to survive cms's most recent 3% hospital readmissions penalties increase

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Hospital readmissions rates are now at 3 percent, which means that health systems are feeling the financial burden of decreased payments from Medicare. They also need to track two more 30-day readmission rates. While there aren’t any new penalty measures planned for 2016, coronary artery bypass grafts will be added as yet another measure to track in 2017. By using three strategies to reduce readmission rates, health systems will experience better outcomes and decreased penalties. The three strategies include the following: (1) implementing a data warehouse that provides a single source of truth; (2) engaging a multidisciplinary team to lead the improvement efforts; (3) installing a sophisticated analytics platform.

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How to survive cms's most recent 3% hospital readmissions penalties increase

  1. 1. How to Survive CMS’s Most Recent 3% Hospital Readmissions Penalties Increase — Bobbi Brown VP of Financial Engagement
  2. 2. © 2014 Health Catalyst www.healthcatalyst.com CMS Readmissions Penalty On October 1, 2014, the final payment and policy changes for hospital readmissions from CMS went live. Just weeks into the change, thousands of hospitals across the United States are feeling the financial pressures of the increased penalty. Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
  3. 3. © 2014 Health Catalyst www.healthcatalyst.com CMS Readmissions Penalty Providers have already seen a decrease in payments from Medicare for health systems with high readmissions rates. CMS applies the penalty to the base operating DRG (diagnosis related group) payment. Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
  4. 4. © 2014 Health Catalyst www.healthcatalyst.com Patient Cohort Tracking Health systems also now must track two more 30-day readmission rates: • COPD • THA/TKA (Knee or Hip Arthroplasty) These rates are in addition to patient cohorts hospitals already track: • Heart attack (AMI) • Heart failure • Pneumonia Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
  5. 5. CMS started the Hospital Readmission Reduction Program in 2012 with the goal to improve healthcare. CMS believed providers with excess readmissions for patients with high-risk conditions, such as heart failure or pneumonia, were providing low quality care. © 2014 Health Catalyst www.healthcatalyst.com Why the Need to Levy Hospital Readmissions Penalties? Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
  6. 6. CMS focused on improving were pneumonia, heart failure, and acute myocardial infarction. The program saw the following reimbursement withholding trends: • FY 2014 – 2% (same conditions) © 2014 Health Catalyst www.healthcatalyst.com Why the Need to Levy Hospital Readmissions Penalties? • FY 2013 – 1% Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
  7. 7. With 2015 in full swing providers are looking at a maximum penalty of 3%. The penalty impacts 75.8% of hospitals across the United States. Note: The U.S. government republished an updated ruling on October 3, 2014. © 2014 Health Catalyst www.healthcatalyst.com Why the Need to Levy Hospital Readmissions Penalties? Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
  8. 8. The results of the program are positive to date. In fact, CMS has estimated that hospital readmissions declined by a total of 150,000 from January 2012 to December 2013, a significant improvement. © 2014 Health Catalyst www.healthcatalyst.com Why the Need to Levy Hospital Readmissions Penalties? Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
  9. 9. © 2014 Health Catalyst www.healthcatalyst.com Public Concerns about Risk Adjustments Despite a public concern regarding risk adjustments for SES (socioeconomic status), CMS isn’t adding any risk adjustments because it already monitors the impact of SES on hospital results. CMS data reveals that patients with low SES are actually capable of performing well on the measures. Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
  10. 10. Future CMS Readmission Penalty Measures © 2014 Health Catalyst www.healthcatalyst.com CMS has no plans to expand the conditions in 2016. However, data suggests the reduction of the readmit rate following coronary artery bypass graft surgery (CABG) is an important target for future quality improvement initiatives. CMS will add CABG to monitored conditions in 2017. Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
  11. 11. No single strategy will reduce readmission rates. Hospitals must embrace multiple strategies and consistently monitor results. Six strategies are discussed in this article: Hospital Strategies Associated with 30-Day Readmission Rates for Patients with Heart Failure. * *July 2013 issue: Cardiovascular Quality and Outcomes © 2014 Health Catalyst www.healthcatalyst.com Reducing Readmission Rates Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
  12. 12. Partnering with 1 community physicians and physician groups © 2014 Health Catalyst www.healthcatalyst.com Reducing Readmission Rates Six Strategies 2 Partnering with local hospitals 3 Having nurses responsible for medication reconciliation 4 Arranging for follow-up visits before discharge 5 Sending discharge summaries to primary care physician 6 Assigning staff to follow-up on test results after discharge Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
  13. 13. How One Large Health System Achieved Reduced Readmissions © 2014 Health Catalyst www.healthcatalyst.com One large health system used four key interventions to lower their 30-day heart failure readmission rates by 29 percent. They were able to achieve these results by using these evidence-based interventions: Medication reconciliation Post-discharge appointments Post-discharge phone calls Teach back interventions Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
  14. 14. How One Large Health System Achieved Reduced Readmissions © 2014 Health Catalyst www.healthcatalyst.com Eight months after implementing the four evidence-based interventions, the health system experienced a: • 29% reduction in 30-day HF readmissions • 14% reduction in 90-day HF readmissions • 120% increase in follow-up appointments • 78% increase in pharmacist medication reconciliation • 87% increase in follow-up phone calls • 84% increase in teach-back interventions Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
  15. 15. 3 Ways to Achieve Significant Heart Failure Readmission Rates © 2014 Health Catalyst www.healthcatalyst.com In order for interventions to be successful, strategies and tools must be in place to collect and analyze the pertinent data. For the health system our example three critical solutions were implemented: A data warehouse to provide a single source of truth Engaged multidisciplinary teams driving improvements Analytics to drill down into each episode of care Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
  16. 16. 3 Ways to Achieve Significant Heart Failure Readmission Rates 1: Data warehouse The Health System chose a late-binding data warehouse to overcome the limitations of a traditional data warehouse. Due to the agile architecture of the late-binding warehouse, the system was able to fully deploy their data warehouse within just a few months. © 2014 Health Catalyst www.healthcatalyst.com Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
  17. 17. 3 Ways to Achieve Significant Heart Failure Readmission Rates 2: Multidisciplinary teams The health system knew they needed to engage physicians and build a culture of trust to drive improved outcomes. They organized a multi-disciplinary team that included physicians, nurses, quality, analytics, IT, informaticists, operations, and finance. © 2014 Health Catalyst www.healthcatalyst.com Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
  18. 18. 3 Ways to Achieve Significant Heart Failure Readmission Rates 3: Analytics drill down Using a sophisticated analytics platform, clinicians had the ability to drill down into each episode of care and assess all aspects of interventions. The analytics platform included an easy-to-use visualization tool that didn’t require complicated queries for clinicians to get the answers they needed. © 2014 Health Catalyst www.healthcatalyst.com Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
  19. 19. Readmission Penalties—Here to Stay © 2014 Health Catalyst www.healthcatalyst.com The U.S. healthcare system is in the midst of a massive transformation to improve patient care and reduce costs. Traditional EDW systems are inadequate to meet data demands needed to reduce readmissions rates. A late binding architecture gives teams the right tools for the job. Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
  20. 20. Readmission Penalties—Here to Stay © 2014 Health Catalyst www.healthcatalyst.com How did your hospital fare when the readmissions penalties increased to three percent? If you’re facing a financial burden, do you have any questions about how a Late-Binding Data Warehouse™ can help you avoid future penalties? Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
  21. 21. © 2014 Health Catalyst www.healthcatalyst.com Link to original article for a more in-depth discussion. How to Survive CMS’s Most Recent 3% Hospital Readmissions Penalties Increase More about this topic The Best Way to Manage a Readmission Reduction Program Bobbi Brown, VP of Financial Engagement 4 Ways to Reduce Penalties Under the HAC Reduction Program Bobbi Brown, VP and Michael Barton, VP Understanding Value-Based Reimbursement and How to Survive It Bobbi Brown, VP Financial Engagement The Key to Transitioning from Fee-for-Service to Value-Based Reimbursement Bobbi Brown, VP and Jared Crapo, VP 6 Steps for Implementing Successful Performance Improvement Initiatives Bobbi Brown, VP and Leslie Falk, VP Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
  22. 22. © 2014 Health Catalyst www.healthcatalyst.com For more information: Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
  23. 23. Other Clinical Quality Improvement Resources Bobbi Brown is Vice President of Financial Engagement for Health Catalyst, a data warehousing and analytics company based in Salt Lake City. Ms. Brown started her healthcare career at Intermountain Healthcare supporting clinical integration efforts before moving to Sutter Health and, later, Kaiser Permanente, where she served as Vice President of Financial Planning and Performance. Ms. Brown holds an MBA from the Thunderbird School of Global Management as well as a BA in Spanish and Education from Misericordia University. She regularly writes and teaches on finance-related healthcare topics. © 2014 Health Catalyst www.healthcatalyst.com Click to read additional information at www.healthcatalyst.com Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.

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