Pa#ent ReAdmissions How are you Controlling? Wednesday, July 23, 2014 Disclaimer: Nothing that we are sharing is intended as legally binding or prescrip7ve advice. This presenta7on is a synthesis of publically available informa7on and best prac7ces.
Patient Re-Admissions
Nov 07, 2014
Learn strategies designed to address the issue of Patient Readmissions.
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Pa#ent Re-‐Admissions-‐ How are you Controlling? Wednesday, July 23, 2014
Disclaimer: Nothing that we are sharing is intended as legally binding or prescrip7ve advice. This presenta7on is a synthesis of publically available informa7on and best prac7ces.
• CMS defines Hospital Re-‐admission as: – Admission to a sub sec9on hospital with-‐in 30 days of discharge from the same or another sub-‐sec9on of the hospital
What is a Hospital Re-‐Admission?
• Agency for HealthCare Research and Quality Reported: – Nearly 20% of Medicare hospitaliza9ons followed by
readmission with-‐in 30 days – 90% of readmissions unplanned
• Medicare Payment Advisory Commission reported: – 4.4 million Medicare hospital readmissions may be
preventable – Translates to 75% of readmissions – Implementa9on of Hospital Readmissions Reduc9on Program
has impacted the reported outcomes
hRp://healthcare-‐execu9ve-‐insight.advanceweb.com/Web-‐Extras/Long-‐Term-‐Care-‐Feature/Best-‐Prac9ces-‐for-‐Reducing-‐Readmissions.aspx
Quick Facts
• The JAMA study reported the following outcomes: – 24.8% of HF pa9ents readmiRed – 19.9% of MI pa9ents readmiRed – 18.3% of pneumonia pa9ents readmiRed
hRp://jama.jamanetwork.com/ar9cle.aspx?ar9cleid=1558276#qundefined • JAMA (The Journal of American Medical Associa9on) conducted a study from 2007-‐2009 for Medicare beneficiaries reviewing readmissions for pa9ents with heart failure, myocardial infarc9on, and pneumonia
Pa9ent Readmission Sta9s9cs
• Sec9on 3025 of Affordable Care Act establishes the Hospital Readmissions Reduc9on Program – Requires CMS to reduce payments to IPPS Hospitals with excess admissions
– Effec9ve for discharges beginning October 1, 2012
Background
• Adopted readmission measures for condi9ons – Acute Myocardial Infarc9on – Heart Failure – Pneumonia
• Established methodology to calculate excess readmission ra9o
• Established policy of using risk adjustment methodology
• Established applicable 3 years of discharge data and the use of a minimum 25 cases to calculate hospital excess readmission ra9o
CMS Re-‐Admission Measures
CMS Payment Adjustment Process
• CMS determines which hospitals subject to Hospital Readmissions program
• Determines methodology to calculate hospital readmission
• What por9on of IPPS payment is used to calculate readjustment payment amount
• Process for hospitals to review readmission data and submit correc9ons before rates made public
CMS Formulas to Calculate the Readmission Adjustment Factor
Excess Re-‐Admission Ra9o
Aggregate payments for excess readmissions
Ra9o
– For FY 2013, the higher of the Ra9o or 0.99 (1% reduc9on
– For FY 2014, the higher of the Ra9o or 0.98 (2% reduc9on)
– For FY 2015, the higher of the Ra9o or 0.97 (3% reduc9on)
Readmission Adjustment Factor
Formulas to Compute the Readmission Payment Adjustment Amount
Wage-‐adjusted DRG opera9ng amount
Base Opera9ng DRG Payment Amount
Readmissions Payment Adjustment Amount
• CMS Proposing Rule to include 2 addi9onal readmission measures in 2015 – COPD – THA/TKA
2015 CMS IPPS Proposed Rule
• HealthCare Market Resources site 2 most common reasons for Hospital Re-‐admission – Medica9on Errors – Failure to see a physician – Strategies to reduce
• Supervised home care visits aker discharge
Common Reasons for Re-‐Admission
What are other organiza9ons Doing?
• The Agency for HealthCare Research and Quality advocates the use of a PSO Program – U9liza9on of Common Formats
• Available for hospitals to review 30 day readmissions – RED (Re-‐engineered Discharge)
• Free toolkit used to reduce readmissions by encouraging beRer communica9on between pa9ents and clinicians
– Project Boost • Provides resources to reduce readmissions in elderly popula9on
– PSNET (Pa9ent Safety Network) • Shows how problems in hospital discharge process can lead to hospital readmissions
– STAAR(State Ac9on on Avoidable Rehospitaliza9ons) Ini9a9ve • Mul9state effort to improve care transi9ons
Pa9ent Safety Organiza9on Program
– The Mayo Clinic’s Knowledge and Evalua9on Research Unit focusing on the assessment of pa9ent capacity
– Resources pa9ent has available when they discharge
– Physical and mental Limita9ons
Assessment of Pa9ent Capacity
– Support Na9onal Quality strategy focus on improving cardiovascular Health
– Use payment and reimbursement mechanisms to encourage delivery of clinical preven9ve services
– Expand use of interoperable HIT – Support implementa9on of community based preventa9ve services
– Reduce risk barriers to accessing clinical and community preventa9ve services
– Enhance coordina9on and integra9on of clinical, behavioral, and complementary health strategies.
Clinical and Community Preven9on Services Recommenda9ons
– A study conducted at Cleveland Clinic suggests a 3-‐step mini-‐ cog quiz completed by heart failure pa9ents at discharge may predict who will be readmiRed or die with-‐in 30 days
– Mini-‐cog tested for correla9on to heart failure pa9ents – Research concluded 23% of heart failure inpa9ents who completed mini-‐
cog had a high likelihood of cogni9ve impairment – 30 day re-‐admission and mortality rate for pa9ents with high cogni9ve
impairment score were twice the norm with a rate at 47% – Study recommenda9ons
» Evaluated discharge loca9ons » Structured in home support » Incorporate Mini-‐Cog test into Care rou9ne
hRp://my.clevelandclinic.org/media_rela9ons/library/2014/2014-‐3-‐29-‐cleveland-‐clinic-‐study-‐finds-‐simple-‐test-‐of-‐pa9ent-‐cogni9on-‐may-‐predict-‐heart-‐failure-‐readmissions.aspx
Mini Cog Quiz Study
– Select group of Medicare pa9ents in AZ receiving trackers in their inhalers to determine how oken medica9ons is used
– Study hopes to iden9fy pa9ents at earliest stage of aRack of exacerba9on with COPD
– Sensors monitor medica9on usage and send loca9on and data to smartphone app
– If pa9ents using medica9on more frequently or a rescue inhaler u9lized alert sent to caregiver
Mobile Aps and Sensors
– Improve communica9on • U9lize strong interac9ve communica9on • U9liza9on of EHR’s and HIE’s
– Support Care transi9ons through • Expanding care beyond medical community
– Transporta9on Services – Meal Prepara9ons – Cleaning Services
– Follow up care • Missed follow up appointments aker discharge
hRp://healthcare-‐execu9ve-‐insight.advanceweb.com/Web-‐Extras/Long-‐Term-‐Care-‐Feature/Best-‐Prac9ces-‐for-‐Reducing-‐Readmissions.aspx
Best Prac9ces
Parallel Coordina9on of Care
• Dr. Eiran Goronoski former director of Heart Care at home is advises to focus on the pa9ent as apposed to the condi9ons for readmission – Proposes partnership with quality skilled nursing facili9es • 17% of all pa9ents go to a SNF
– Parallel solu9ons for care coordina9on “A pa9ent centered, rather than a condi9on centered, mindset in the midst of care transi9ons is key” hRp://www.beckershospitalreview.com/quality/when-‐readmission-‐programs-‐fail-‐what-‐s-‐next.html
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