From effectively implementing electronic health records to reducing hospital readmissions to reporting more specific Medicare patient data, health care providers are reaping rewards from the Centers for Medicare and Medicaid Services for improving particular quality and safety measures. But many are also facing penalties, and the results for some institutions have been mixed. On the whole, the national readmission rate is dropping, but in 2014 a record 2,600-plus hospitals were fined for seeing too many patients return for care within 30 days, according to federal data. This session will help attendees understand the range of CMS cuts and bonuses and a firsthand look at how the new regulations can help providers improve care.

1. Intermountain’s
Journey
Kim
Henrichsen,
RN,
MSN
Vice
President,
Clinical
Opera2ons
and
CNO

2. GETTING
TO
KNOW
INTERMOUNTAIN
Who
are
we?

3. Since
1975
• 22
hospitals
• 2,784
licensed
beds
Since
1983
• Health
plans
• 700,000+
members
Since
1994
• 1,200
employed
physicians
• 558
advanced
pracOce
clinicians
• 30
Instacare
Clinics
Since
1997
• 10
key
service
lines
Highly
Integrated
Health
System
Hospitals
SelectHealth
Medical
Group
Clinical
Programs
Our
Charge:
To
become
a
“Model
Healthcare
System”

4. OUR
MISSION
Helping
people
live
the
healthiest
lives
possible

5. OUR
VISION
Be
a
model
health
system
by
providing
extraordinary
care
and
superior
service
at
an
affordable
cost

6. GETTING
TO
KNOW
INTERMOUNTAIN
How
are
we
doing?

7. The
Intermountain
Way
Engage
paGents
&
align
incenGves
Evidence-­‐
based
best
pracGces
SystemaGc
approach-­‐
measure
&
improve
OpOmal
Outcomes

8. High
Quality
Clinical
Care
Utah
Rank
Utah
Amount
U.S.
Median
Utah
Differ.
Healthcare
expenditures
per
capita*
1
$5,031
$6,815
-­‐26%
Medicare
admits
75
yrs+
/
1,000
beneficiaries
2
42.0
68.0
-­‐38%
Medicare
30-­‐day
hospital
readmission
rate
3
28.0
45.0
-­‐38%
Mortality
amenable
to
healthcare
/
100,000
4
62.0
82.0
-­‐24%
Home
health
paOents
with
hosp.
admission
1
14.0
17.0
-­‐18%
Source:
Commonwealth
Fund
State
Scorecard,
April
2014;
*Wall
Street
Journal,
April
8,
2013

9.
• There
is
usually
wide
variaOon
in
clinical
pracGce
• ObjecOve
data
measurement
will
demonstrate
opportunity
for
improvement
• Performance
improves
with
systemaGc
adopGon
of
best
pracOces
• Intermountain’s
main
physician
engagement
strategy:
OpGmal
paGent
outcomes
Clinical
Program
Principles

10. Our
Experience
Value
Based
Purchasing

11. Intermountain
Discharge
MedicaOons
in
2000
99%
95%
91%
94%
90%
30%
40%
50%
60%
70%
80%
90%
100%
ASA HmG BB p MI ACE for CHF Coumadin
% Eligible Patients Treated at Discharge
with Appropriate Medications
2000 National Statistics

12. Impact
of
Intermountain
Discharge
Med
Program
on
Heart
Failure
Readmissions/Mortality
ACE
inhibitor
prescripGon
at
hospital
discharge
increased
from
65%
in
1997
to
95%
in
1999-­‐2001
and
for
these
IHC
heart
failure
paGents:
• One-­‐year
readmissions
were
reduced
from
46.5
%
to
38.5%
• 551
readmissions
are
prevented
per
year
• $2,480,000
are
saved
based
on
avoided
readmissions
• One-­‐year
mortality
rate
reduced
from
22.7%
to
17.8%
• 331
lives
are
saved
per
year

13.
CMS
Pay
for
Performance
Programs
VBP,
Readmission
ReducGon,
HAC
Intermountain
Healthcare
Hospital
Acquired
CondiOons
Value
Based
Purchasing
Readmission
ReducOon
Program
FY
2015
9
of
22
(penalty)
1
of
22
(penalty)
3
of
22
(penalty)
FY
2016
9
of
22
(penalty)
2
of
22
(penalty)
5
of
22
(penalty)

14. Awards
&
RecogniOon
Benefits
Credibility
Strategic
Fit
Low
Low
High
High

15. Public
Quality
ReporGng

16. • Intermountain
Healthcare
hospitals
score
very
well
on
some
surveys
and
poorly
on
others
with
similar
metrics.
• There
is
variability
exisGng
even
between
our
faciliGes
• Intermountain
was
an
early
leader
in
core
measures,
we
fell
in
ranking,
not
in
performance
as
public
reporGng
increased
Summary

17. Closing
Thoughts
• CMS
Pay
for
Performance
metrics
are
aimed
at
improving
care
for
paGents
• CMS
should
conGnue
to
replace
process
measures
with
outcome
measures
• OrganizaGons
should
conGnue
to
focus
on
areas
where
literature
supports
improved
paGent
outcomes
• ConsideraGon
should
be
given
to
reducing
complexity
for
those
delivering
the
care
(and
burden
of
measurement)

18. Right
Thing
Right
Time
Every
Time