ACHIEVE QUALITY IMPROVEMENT BY USING THE REHOSPITALIZATION MEASUREeo2.commpartners.com/users/AHCA/downloads/150407_Slidesv2.pdf · ACHIEVE QUALITY IMPROVEMENT BY USING THE ... Avedis

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ACHIEVE QUALITY IMPROVEMENT BY USING THE REHOSPITALIZATION MEASURE

in LTC Trend Tracker and PointRight® Pro 30™

Your Speakers Today

David GiffordSR VP for Quality & Regulatory Affairs

AHCA

Steven LittlehaleExecutive Vice President and

Chief Clinical OfficerPointRight

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Objectives

Understand the Policies that Make the Standardized

Rehospitalization Measurement Important

Learn How Providers Are Succeeding and How To Access Your Data in LTC

Trend Tracker and PointRIght Pro 30

Learn How to Use Your Rehospitalization Data to

Position Your Organization with Payer Groups like MCOs and

ACOs

Learn How to Use the Measure in Quality

Improvement Programs

UNDERSTAND THE POLICIES THAT MAKE THE STANDARDIZED REHOSPITALIZATION MEASUREMENT IMPORTANT

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…all policy changes involve rehospitalizations

All roads lead to Rome…

National Policies Impacting SNFs

HHS plan to link quality with payment

Protecting Access to Medicare Act of 2014 (PAMA) requires CMS to implements a 2% withhold of SNF Part A payments that can be returned based on your rehospitalization rates

IMPACT act of 2014 requires CMS to measure and publicly report collection of PAC quality measures

President’s Executive Action to revise Five Star

ACO and MCO contracts with CMS only work by lowering rehospitalization rates

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HHS Payment Reform• HHS announced targets to increase the number of

payments that are linked to quality outcomes by 2018• “We are setting clear goals – and establishing a clear timeline --for moving

from volume to value in Medicare payments”

• “Our first goal is for 30% of all Medicare provider payments to be in

alternative payment models that are tied to how well providers care for their

patients, instead of how much care they provide – and to do it by 2016. Our

goal would then be to get to 50% by 2018”

• “Our second goal is for virtually all Medicare fee-for-service payments to be

tied to quality and value; at least 85% in 2016 and 90% in 2018”

- HHS Secretary Burwell Jan 26, 2015

President’s 2016 Budget

Implement value-based purchasing for PAC providers , including home health, SNFs, ambulatory surgical centers and hospital outpatient departments beginning in 2017. • At least 2% of payments must be tied to the quality

and efficiency of care in the first two years of implementation, and at least 5% beginning in 2019.

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PAMA of 2014 has SNF VBP section

Passed in 2014 as part of SGR fix, PAMA links SNF rehospitalization to SNF Medicare Part A

paymentsUses a with-hold approach• 2% “mathematical” withhold to create incentive pool• Incentive pool is 50-70% of the withhold

Incentive pool is “returned” to facilities based on their rehospitalization performance score

First adjustment to a SNF’s market basket will be in Oct 2018 based on performance likely starting in late 2015 or early 2016

Estimated Timeline for SNF VBP Implementation

Withhold Starts

Analyze Data

Baseline Measurement Period

SNF Comments

Post withhold in Proposed Rule

Oct 2018

Collect Data

July 2016

Oct 2016

Oct 2017

Oct 2019

Oct 2015

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SNF National Rehospitalization Rates

At risk for • 2% payment penalty; • Dropped from MCO/ACO

Networks

“IMPACT ACT OF 2014” Legislation has five parts : • Incorporate standardized clinical assessments• Public reporting of common quality

measures• Provide quality measures to consumers

when transitioning to a PAC provider• Interoperability of information at transfer• HHS and MedPAC to conduct several studies

Discuss today

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“IMPACT ACT OF 2014” Part 2

Publicly report quality measures across settings• Rehospitalizations• Discharge to community• Pressure ulcers• Medication reconciliation • Incidence of major falls• Patient preferences • Efficiency measure(s): Avg Total Medicare Spend per

Beneficiary• Plus any other measures Secretary wants

Measures to be approved by National Quality Forum (NQF)

“IMPACT ACT OF 2014” Part 3

Hospitals and PAC providers must provide quality and efficiency measures to beneficiaries to help them with their PAC decision making• Modify conditions of participation to

incorporate QMs into the discharge planning process

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President’s Executive ActionFive Star Directs CMS

• Add quality measures to Five-Star• Rehospitalizations

• Discharge back to community

• Antipsychotic use

• Staff turnover & retention

• Expand auditing of MDS data from 5 states to all states effective 01/01/15

• Collect payroll data pilot test in 2015 and begin in 2016

LEARN HOW PROVIDERS ARE SUCCEEDING AND HOW TO ACCESS YOUR DATA IN LTC TREND TRACKER AND POINTRIGHT PRO 30

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AHCA Developed PAC Measures

PointRight Pro 30 Rehospitalization• Now available

Discharge Back to the Community• Now available

Length of Stay• Now available

Improvement in Functional Status*• Available Oct 2015

Customer Satisfaction**• Available spring 2015

* Requires use of CARE tool linked with MDS admission data** Requires use of AHCA CoreQ satisfaction questionnaire

Who is using PointRight® Pro 30TM

• PointRight® Pro 30 TM Rehospitalization measure approved by NQF in Dec 2014

• Available to all AHCA members in LTC Trend Tracker

• Organizations currently using this measure• 3 MA Pioneer ACOs • 1 MA dual-eligible MCO • 1 NJ ACO • 1 SC Care Management Co• 1 large national PAC management Co• 1 Large private investment management firm

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Where do I get

my data?

Your Member

Resource

Survey History

CMS Five Star Rating

Resident Characteristics

Staffing Information

AHCA Post-Acute Measures

www.ltctrendtracker.com

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DC to community

LOS

Rehospitalization

Peer Group Selection

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LTC Trend Tracker Report

Actual rehospitalization

Expected Rehospitalization

Risk Adjusted Rehospitalization

Graphs in LTC Trend Tracker

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LEARN HOW TO USE YOUR REHOSPITALIZATION DATA TO POSITION YOUR ORGANIZATION WITH PAYER GROUPS LIKE MCOS AND ACOS

What’s your story?

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The Data the Differentiates

30 Day Rehospitalization rate, by diagnosis

Quality Measures LOS by diagnosis Types of patients you specialize in

Staffing ratios•RN to LPN•Nurse to resident

Retention Satisfaction Coverage (admissions) Five-Star Regulatory/Survey

“Fringe benefits” Staff competencies Med Director info Functional improvement Discharge Success

Med errors Strengths and Weaknesses

National PointRight Pro 30Adjusted Rehospitalization Rates

14% and below

14% to 16%

16% and above

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National PointRight Pro 30Adjusted Rehospitalization Rates

13% and below

13% to 16%

16% and above

*denotes combined survey districts

Five-Star Ratings & Rehospitalization Rates

Rating Jan-15Average Observed

Rehospitalization RateAverage Adjusted

Rehospitalization Rate

5 17.1 15.54 17.8 15.73 18.0 15.72 18.5 15.61 17.8 15.2

Rating Feb-15Average Observed

Rehospitalization RateAverage Adjusted

Rehospitalization Rate

5 16.3 15.14 17.4 15.63 17.7 15.62 18.3 15.91 19.1 16.3

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Average Length of Stay (ALOS)

Year of Entry Location Mean

2013 Nation 29.8

2012 Nation 30

2011 Nation 30.4

Year of

EntryLocation

Cognitive

ImpairmentMean

2013 Nation No 29.6

2013 Nation Yes 30.6

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Year of

EntryLocation Incontinent Mean

2013 Nation No 27.8

2013 Nation Yes 34.6

Year of

EntryLocation Pain Mean

2013 Nation No 29.4

2013 Nation Yes 32

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Year of

EntryLocation Depression Mean

2013 Nation No 29.6

2013 Nation Yes 33

LEARN HOW TO USE PRO 30 IN QUALITY IMPROVEMENT PROGRAMS

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Avedis Donabedian• Avedis Donabedian was a physician and

founder of the study of quality in health care and medical outcomes research, most famously as a creator of The Donabedian Model of care.

A Model that Bridges High Performance to Improvement

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Get a Framework!

Structure• Staff Ratios• RN vs LPN• Equipment

Available• Contracts in

place

“Rules of the Game”

Process• Medication

administration & errors

• Accuracy of assessments

• Hours to nurse evaluation

“Playing the Game”

Outcome• 30 Day Rehosp• Rehosp by

Diagnosis• Resident

satisfaction

“Who Won the Game”

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Entry Date

Length of Stay

DischargeDay

Unplanned MedicareAll

PayerCHF COPD CVA Diabetes Pneumonia

Tue 6 Mon Unplanned Y Y Y

Thu 4 Mon Unplanned Y Y Y

Fri 8 Thu Planned Y Y Y

Mon 6 Mon Unplanned Y Y Y Y Y Y Y

Thu 5 Tue Unplanned Y Y Y Y Y

Use Data To Pinpoint & Illustrate Your Competitive Advantage

What is one (or two) things

that you do better than

everyone else?

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Get a preview of what your rehospitalization rates are for your facility!

• Go to: pointright.com/ahcawebinarto request your free report.

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Contact InformationDavid Gifford MD MPH

SR VP for Quality & Regulatory Affairs

American Health Care Association

120 L St. NW

Washington DC 20005

[email protected]

202-898-3161

www.ahcancal.org

Steven LittlehaleMS, GCNS-BC

EVP & CCO

PointRight

150 CambridgePark DriveSuite 301

Cambridge, MA 02140

[email protected]

781-457-5910

pointright.com