Christie tiegland state_veterans_homes_not_your_average_nursing_home


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  • The idea would be to get some type of cool graphic (not represented above!) that shows: It is easy to convert data to information and that has a certain value (saves them money- don’t have to pull charts, accuracy of CMS measure calculation, resident level information)- there are a few vendors that do that well, and EQuIP is certainly one of them. A big challenge is that there is too much information, so drilling into the drivers of the outcome you want to improve (specific QMs, falls, bed sores, etc) must be efficient. With EQuIP’s advanced risk assessment technology, we help you focus on the critical areas and residents. Those that will significantly affect clinical and financial outcomes. With this information in hand, an interdisciplinary team can work to create intervention strategies that are focused and supported with data- an evidence based approach to care. The cycle continues by measuring the results of that intervention to determine desired effect and conducting a new risk assessment. This is a Continuous Quality Improvement System and EQuIP can serve as the major informational support for this system. They will make it happen by transforming the information into action and results. Stress that they will be “more powerful” , “more empowered”, and “better able” to accomplish their goals, solve their problems, with EQuIP. The point you are trying to emphasize is that you are competent as a software organization, you understand their challenges, you have a semi-unique way of identifying risks, and you are there to support efforts to improve results for their organization. With each step in the cycle, you eliminate more of your competition. You also stress that this can turn all their hard work into measurable results.
  • Now that we know what the QM/QIs are, why do I need to should I be interested in them? Well, it’s because there are many entities looking at your QM/QIs – regulators the public lawyers insurance agents Medicare, Medicaid & insurance payors. So if all of these entities are looking, I guess we better be looking too.
  • Christie tiegland state_veterans_homes_not_your_average_nursing_home

    1. 1. State Veteran’s Homes: Not Your “Average” Nursing Home Turning data into information and knowledge into practice
    2. 2. Use of Information Technology for Decision Support Is A Key Survival Strategy To Meet Increasing Regulatory and Public Scrutiny
    3. 3. Your Challenges <ul><li>Too much data </li></ul><ul><li>Too little information </li></ul><ul><li>Too little time to analyze the data </li></ul><ul><li>Too many best-practice protocols to remember and apply at the resident level </li></ul><ul><li>Too many issues to identify and address with the right protocols for the right resident at the right time </li></ul><ul><li>EQUIP informatics can help with an evidence- based, data-driven approach to care </li></ul>
    4. 4. Clinical Informatics for Continuous Quality Improvement MDS Data  Information  Knowledge Person-Centered Risk Identification Based on Evidence/Best Practice Protocols Targeted Care Plan Interventions to Prevent Adverse Outcomes and Improve Quality of Care / Life Ongoing Evaluation of Systems, Processes and Outcomes
    5. 5. EQUIP for Quality ® <ul><li>The only QM/QI software with complete drill down analysis : </li></ul><ul><li> national and state level </li></ul><ul><li> facility level </li></ul><ul><li> unit level (UNIQUE!) </li></ul><ul><li> resident level (individualized risk profiles) </li></ul><ul><ul><li>reports and graphs use the most current clinical assessment information available </li></ul></ul><ul><li>Supports an evidence-based approach to inter-disciplinary, coordinated care </li></ul><ul><li>Focus on actionable items that improve resident outcomes, save time, enhance revenue, enable compliance with regulators and avoid litigation </li></ul>
    6. 6. Who’s Looking at My MDS Data and Quality Outcomes? <ul><li>Regulators/surveyors </li></ul><ul><li>Payment sources </li></ul><ul><li>The public (Nursing Home Compare Five Star Rating System) </li></ul><ul><li>Lawyers and insurance agents </li></ul><ul><li>Oversight agencies (OIG, GAO) </li></ul><ul><li>ME !!! </li></ul>
    7. 7. MDS Accuracy Audit Run MDS data logic and consistency checks before you finalize and submit your MDS files.
    8. 8. Click any resident name to see audit report
    9. 9. <ul><li>Examples of warnings: </li></ul><ul><li>Resident has limitations in ROM and no OT or PT and no nursing restorative—resident may benefit from restorative program. </li></ul><ul><li>Resident has pressure ulcer and NO turning/positioning program? </li></ul>
    10. 10. Do the Medicare Math! <ul><li>RUX = $564.83 </li></ul><ul><li>RUL = $496.04 $68.79/day </li></ul><ul><li>x 20 assessments/month x 30 days/assessment = $41,274/month </li></ul><ul><ul><li>= $495,288 /year / facility </li></ul></ul><ul><li>*Based on FY 2006 federal urban rates </li></ul>One coding error can cost the facility thousands of $$
    11. 11. FACILITY CHARACTERISTICS REPORT Veterans Home resident population is very different from “typical nursing home” used in CMS national and state benchmarks
    12. 12.
    13. 13. 89% age 75+ vs. 78% nationally 89% male vs. 31% nationally
    14. 14. Fewer More!
    15. 15. Far more residents with no potential for discharge—long stay chronic care
    16. 16. Far more hospice and end stage disease w/6 months or less life expectancy.
    17. 17. Population Benchmarks Are Critical! <ul><li>Using CMS Benchmarks results in </li></ul><ul><li>Missed opportunities to improve outcomes in care areas with higher occurrences than average nursing home population. </li></ul><ul><li>Missed opportunities to show superior care provided in State Veteran’s Homes nationwide. </li></ul>
    18. 18. QM/QI Suite <ul><li>Easy to use—automatically highlights quality problem areas in real time </li></ul><ul><li>Flags priority issues affecting largest number of residents </li></ul><ul><li>Complete drill down capability from QM/QI report—saves time and takes QM analysis to the next level </li></ul>
    19. 19. Can select Vet’s Home Benchmark or Your State—National always displayed Report clearly identifies your likely problem areas
    20. 20. Access summary, detail, graph and analysis charts directly from QM/QI Rates report. Will automatically show results for time period selected and specific problem areas flagged, unless you check other areas of interest.
    21. 21.
    22. 22. Resident QM/QI Report—Much easier to read/use! Easily see related outcomes for comprehensive care plan approach.
    23. 23. Evidence based risk factors from research and best-practice protocols
    24. 24. QM Detail: Systems Perspective
    25. 25.
    26. 26.
    27. 27. Graphs Trend QM outcomes over time—early warning of emerging problem areas
    28. 28. Appropriate Benchmark Data for Comparison Purposes Are Critical <ul><li>Facility QM rates are not meaningful without some standard for comparison. </li></ul><ul><li>What standard of comparison? </li></ul><ul><ul><li>Rates can vary widely based on resident characteristics and risk factors unless quality measures are risk adjusted. </li></ul></ul><ul><ul><li>Statewide and regional benchmark rates vary dramatically. </li></ul></ul>
    29. 29. Facility rate is Facility rate is BELOW both state and national CMS benchmark so outcome would not flag as potential issue. BUT…facility rate is well above Vet’s Homes benchmark and presents a quality of care issue that should be addressed!
    30. 30. Showcase care areas where Vets Homes excel and perform far better than average nursing homes.
    31. 31. Analysis Charts—How Am I Doing? Control Charts Comparison Charts
    32. 32. Control Chart <ul><li>Control charts are effective quality management tools for health care organizations by helping to determine whether a process is: </li></ul><ul><ul><li>“ In control”—process is stable with only common cause variation ; or </li></ul></ul><ul><ul><li>“ Out of control”—process is unstable as special cause variation exists. </li></ul></ul>
    33. 33.
    34. 34. Process Improvements <ul><li>Special cause variation means process is no longer predictable within normal ranges. </li></ul><ul><ul><li>Facility should not make any changes in the process until the special cause is identified and eliminated. </li></ul></ul><ul><li>When process is stable, can make changes to improve future outcomes </li></ul><ul><li>Under a stable process </li></ul><ul><ul><li>Productivity is maximized </li></ul></ul><ul><ul><li>Costs are minimized </li></ul></ul><ul><ul><li>Future outcomes and costs are predictable </li></ul></ul>
    35. 35. Promote Safer Care Through Use of Proactive Risk Assessment
    36. 36. Healthcare is transitioning to a model of preventive focused care delivery. <ul><li>This shift creates a huge opportunity to keep residents healthier and save costs. </li></ul><ul><li>Predictive modeling is used extensively by health plans and in acute care and use has grown dramatically over past two years. </li></ul><ul><li>NOW is the time for long term care to adopt this innovative strategy to bring your quality of care to the next level. </li></ul>
    37. 37. Predictive Technology Improves Accuracy of Resident Risk Assessment <ul><li>Predictive models use wealth of resident data (current and historical) to provide highly accurate assessment of risk for future adverse outcomes: </li></ul><ul><ul><li>The EQUIP models predict more than 80% of all future falls, fractures and undetected pain; and more than 75% of future pressure ulcers. </li></ul></ul><ul><li>Far exceeds accuracy of manual risk assessment tools (e.g. Braden Scale)—uses many more risk factors and properly weights the contribution to risk </li></ul>
    38. 38. Risk Level Analysis
    39. 39.
    40. 40.
    41. 41. Risk Score Interpretation
    42. 42.
    43. 43. And, as always, clicking on resident name will bring to resident centered risk profile listing risk factors that must be addressed to prevent adverse outcome.
    44. 44. Predictive Technology Improves Accuracy of Resident Risk Assessment <ul><li>EQUIP risk reports can help you dramatically reduce long term adverse outcomes and utilization costs through early identification of high risk residents. </li></ul><ul><li>Risk scores allow you to stratify your population by risk levels and determine which residents have the greatest opportunity for achieving successful care interventions. </li></ul>
    45. 45. Patient Safety Project Nursing Home QA Falls Study 300 Bed Facility—Albany Area ”It’s Not the Full Moon!!”
    46. 46. Facility Replaced Manual Fall Risk Assessment Tool with EQUIP Fall Risk Reports in 2004 ~ 5 7% Reduction in Total Falls
    47. 47. <ul><li>“ Medicare is spending billions to treat preventable injuries…average cost $1,272 per incident … interventions are not widely disseminated.” </li></ul><ul><ul><li>(Nov-Dec 2002 issue of Health Affairs) </li></ul></ul><ul><li>“ Each fall-related injury adds $5,325 to the cost of care .” </li></ul><ul><ul><li>(Pittsburgh Regional Healthcare Initiative, Executive Summary, October 2005) </li></ul></ul><ul><li>Average cost of fall resulting in ER visit $9,400 (excluding prescription drugs) . </li></ul><ul><ul><li>(AARP Pubic Policy Institute Issue Brief #56, A. Kochera, March 2002) </li></ul></ul>Improve Quality of Care While Reducing Costs
    48. 48. <ul><li>10%-25% of falls result in injury. </li></ul><ul><ul><li>(Rubenstein LZ, et al, Falls in the nursing home. Annals of Internal Medicine 1994;121:442-451) </li></ul></ul><ul><li>Case Study Example  Estimated $61,056 - $1.13 million per year cost savings! </li></ul>Improve Quality of Care While Reducing Costs
    49. 49. Corporate Level Reports
    50. 50.
    51. 51. Example of better risk adjusted measure and impact on facility QM rate—22% lower! Can drill down to facility and resident level directly
    52. 52.
    53. 53. National Benchmark Veterans Homes Benchmark One facility is above BOTH the national and Vets Home benchmarks. The other two are below the national benchmark, but ABOVE the Vets Home benchmark—this issue would not be flagged as a quality issue unless you compared to your peers.
    54. 54. Also can select peer group: National Vets Homes, NYS Vets Homes, CMS National, Your State
    55. 55. A B C D E For this QM, facility C is well below the national benchmark, but well above the Vets Home benchmark (34.1% vs. 26.8%).
    56. 56. <ul><li>How does your facility use EQUIP? </li></ul><ul><li>We use EQUIP in each of our care plan meetings. We are able to look at it as a team to get a more complete picture of the resident. </li></ul><ul><li>It assists us with our CQI process especially in the area of skin integrity. </li></ul><ul><li>It is used for the quarterly CQI meeting with the Dean of Medicine at Stony Brook University Hospital. </li></ul><ul><li>It prepares us for reviews within the survey process. </li></ul>
    57. 57. <ul><li>How does your facility use EQUIP? </li></ul><ul><li>Utilize to follow our monthly CMS data – QM and comparative data easy to access and much more timely </li></ul><ul><li>Auditing tool utilizing the QM/QI and High Risk reports </li></ul><ul><li>Benchmarking tool for quality improvement </li></ul><ul><li>What has been the most helpful feature of EQUIP for your facility? </li></ul><ul><li>Ease in obtaining data </li></ul><ul><li>Ability to sort data by unit and other ways </li></ul><ul><li>Provision of links to access reference tools, websites etc. </li></ul><ul><li>Posting links to the CMS updates </li></ul>
    58. 58. <ul><li>Important differentiators to keep in mind: </li></ul><ul><ul><li>EQUIP takes advantage of wealth of resident MDS assessment data already required to be collected --requires no new data collection or data entry . </li></ul></ul><ul><ul><li>EQUIP was developed in collaboration with and designed to be easily used by nursing staff </li></ul></ul><ul><ul><li>EQUIP provides access to experienced RNs who provide ongoing clinical support as part of the program (no extra cost for this valuable service) </li></ul></ul><ul><ul><li>EQUIP provides extensive policy info/updates and education </li></ul></ul>
    59. 59. Other Research & Enhancement Efforts Underway…. <ul><li>DHHS HRSA grant: “ The Numbers Count: Using MDS Quality Measures to Improve Resident Outcomes” – FREE Web based training in clinical informatics </li></ul><ul><ul><li>Sign up your staff today! </li></ul></ul>
    60. 60.
    61. 61.
    62. 62. Turning data into information and knowledge into practice Questions? Christie Teigland, PhD Director Health Informatics and Research NYAHSA/EQUIP 150 State Street Albany, NY 12207 518.449.2707 x119 (work) 518.810-9122 (cell) [email_address]