2. National Scene
250,000 hospitalizations caused by IPD in 2010
75% to 85% could be prevented with immunization- PN23
Focused attention on IPD
CDC identification of high risk factors
High Risk Patients: Ages 2-64 - 18.5% immunized
Ages 65 & Over - 59.7% immunized
Joint Commission
CMS Increase incident rates of prevention
DHHS
74 million high risk patients are unvaccinated
3. Currently at Wilson Health System
PN23 Ratio
Wilson Health System—NOW 58.3 to 1
Best Practice (Board agreed upon) 5.5 to 1
Board requested Root Cause Analysis (RCA)
Steering Committee Developed:
RCA
Identify Solution
4. Root Cause Analysis
1. Lack of clear direction provided to staff
nursing and pharmacy
2. Substandard admission assessment tool
3. Lack of clear documentation
4. Lack of physician immunization standing
order
5. Timing of vaccination results in low
compliance
6. No measurement tool in place
5. Solution
Senior Leadership will communicate new direction:
Old – screening
New – Immunization
Repurpose screening section of EMR
Identification of risk factors
Blanket order for immunization of high risk patients
Order electronically submitted to pharmacy
Automation of order on MAR
Monthly monitoring of PN23 ratio
7. Financial Justification
Accountable Care Organization (ACO)
120,000 lives
Conversion from VOLUME to VALUE
Patient days, procedures, visits become costs and no longer revenue
Margins are driven by QUALITY instead of VOLUMES
8. Financial Justification
Cost of pneumonia stay $ 7033.
Pneumonia Admissions 294
prevented by implementing
recommended solution ____________
Reduction $2,067,702.
Costs to implement $ 323,009.
Net Savings $1,744,693.
BREAK EVEN POINT 59 days
9. Our Mission
Wilson Health System provides high
quality, cost effective healthcare services to
improve the well being of those it serves
Reduction of hospitalization for pneumonia
patients through improved immunizations fits
perfectly within our mission as it improves
patient care quality, is more cost effective , and
improves the well being of those we serve.
10. Request for Funding
We are requesting Board approval for
funding for the process changes identified :
Upfront costs $925
Annual operating costs $322,084
Editor's Notes
Invasive Pneumococcal Disease (IPD) immunization rates have recently been identified as a national concern by many national healthcare organizations. 250,000 hospitalizations were caused by IPD in the past year and 75-80% could have been prevented through immunization. The CDC, Joint Commission, CMS and Department of Human Services have all focused attention and have specified processes to increase the incidence rates of immunizations. But, at this point those efforts have proven unsuccessful with 74 million high-risk patients still unvaccinated. This is really low hanging fruit in the eyes of these organizations as our industry fights to reduce healthcare costs. New reimbursement systems brought forth by healthcare reform such as Accountable Care Organizations and Value Based Purchasing will incentivize health systems to take accountability for these types of incidence rates.
At our hospital, we currently have an immunization rate of 58.3 to 1. This falls far short of our goal and a best practice rate of 5.5 to 1. In response to this major gap you, our board has called for a Root Cause Analysis to be performed. The Steering committee developed to perform the RCA and also charged with finding a solution to this problem consists of the CNO, DON, Planning Director, IT Director and Infectious Disease Physician.
The Root Cause Analysis unveiled several process problems starting with lack of clear direction from leadership with regard to pneumococcal immunizations. Several other process issues identified provides for several opportunities for improvement.
Three potential solutions were identified but the solution that best met the needs of the organization involved communication of a clear message from senior leadership focusing on immunization. Providing nursing with a better tool to identify risk factors through the repurpose of the EMR screening section is a key component. Improved automation of current tools available and monthly monitoring to assure we are meeting our goals round out the solution.
The up front cost to implement this proposal are minimal; only $925. First year annual operating costs are projected at approximately $322,000.
Wilson Health System has entered a new era with the strategic decision to secure ACO contracts; reimbursing based on a per member – per month system. Financially, we no longer will strive for high volumes. Instead providing better value and quality with the intent to keep patients out of the hospital will be our financial incentive. Patient days, procedures, and visits no longer convert to revenues and higher margins; instead they are simply a cost center.
Through the proposed solution we anticipate reducing pneumonia admission by 294 annually. This coverts to a reduction of cost of over $2 million. When comparing that to the costs to implement our proposal, we see a net savings of $1,744,693. This provides for a breakeven point on this project of only 59 days.
We believe this proposal helps us better achieve our mission as it improves patient care quality, is more cost effective and improves the well being of those we serve.
We are asking for the board to approve the solution identified at an up front cost of $925 and first year operating cost of $322,084. Thank you for your consideration.
