1 Post Acute Care Integration: Post Acute Care Integration: Post Acute Care Integration: Post Acute Care Integration: Post Acute Care Integration: Post Acute Care Integration: Connecting the Continuum for a Connecting the Continuum for a Value Value-Based World Based World Post Acute Care Integration: Post Acute Care Integration: Connecting the Continuum for a Connecting the Continuum for a Value Value-Based World Based World October 31, 2013 October 31, 2013 Renée Coughlin PT, DPT, MHS Renée Coughlin PT, DPT, MHS Cindy Vunovich RN, BSN, MSM Cindy Vunovich RN, BSN, MSM Shane Woodley RN, MSN, MBA Shane Woodley RN, MSN, MBA Objectives Objectives Objectives Objectives 1. 1. Identify three quality standards that Health Identify three quality standards that Health Systems and Accountable Care Systems and Accountable Care Organizations (ACOs) will be held to under Organizations (ACOs) will be held to under the Affordable Care Act (ACA) the Affordable Care Act (ACA) 2. 2. Describe how these quality standards aim to Describe how these quality standards aim to align incentives, and the value partnering align incentives, and the value partnering with home health providers brings to the with home health providers brings to the equation equation 3. 3. Discuss three key programming Discuss three key programming considerations for home health providers to considerations for home health providers to consider in an effort to redefine themselves consider in an effort to redefine themselves as providers of solutions, rather than as providers of solutions, rather than vendors of visits vendors of visits
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Post Acute Care Integration:Post Acute Care Integration:Post Acute Care Integration:Post Acute Care Integration:Post Acute Care Integration:Post Acute Care Integration:Connecting the Continuum for a Connecting the Continuum for a
ValueValue--Based WorldBased World
Post Acute Care Integration:Post Acute Care Integration:Connecting the Continuum for a Connecting the Continuum for a
ObjectivesObjectivesObjectivesObjectives1.1. Identify three quality standards that Health Identify three quality standards that Health
Systems and Accountable Care Systems and Accountable Care Organizations (ACOs) will be held to under Organizations (ACOs) will be held to under g ( )g ( )the Affordable Care Act (ACA)the Affordable Care Act (ACA)
2.2. Describe how these quality standards aim to Describe how these quality standards aim to align incentives, and the value partnering align incentives, and the value partnering with home health providers brings to the with home health providers brings to the equationequation
3.3. Discuss three key programming Discuss three key programming considerations for home health providers to considerations for home health providers to consider in an effort to redefine themselves consider in an effort to redefine themselves as providers of solutions, rather than as providers of solutions, rather than vendors of visitsvendors of visits
• At-home Hospice• Palliative care• End of Life community care
Center for Connected CareCenter for Connected CareCenter for Connected CareCenter for Connected Care
TODAY’s Census:• 2,152 Home Health• 272 Hospice at Home• 900 Home Infusion Pharmacy• 214 Medical Care at Home (IAH)• 135 IRF and SNF inpatients•>10,000 RT patients
13,523 Patients
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A Tale of Home CareA Tale of Home CareA Tale of Home CareA Tale of Home Care
It is theIt is the
Best Best of Times of Times
WorstWorstof Times of Times
The Future of US HealthcareThe Future of US HealthcareThe Future of US HealthcareThe Future of US Healthcare
• Starts with understanding and owning our history…
Click here to play video
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Key PointsKey PointsKey PointsKey Points
•• 50 million uninsured / 25 million under insured50 million uninsured / 25 million under insured50 million uninsured / 25 million under insured50 million uninsured / 25 million under insured•• 40 million > 65y/o40 million > 65y/o•• 80 million seniors in 204080 million seniors in 2040•• 5% of population use 49% of healthcare 5% of population use 49% of healthcare
Broken System supported by the largest per Broken System supported by the largest per capita health care spending in the worldcapita health care spending in the world
Affordable Care ActAffordable Care ActAffordable Care ActAffordable Care Act
•• Enacted March 23, 2010 Enacted March 23, 2010 Designed to:Designed to:•• Designed to:Designed to:-- Improve Improve accessaccess for 32 million lacking for 32 million lacking
insurance coverageinsurance coverage-- Improve Improve quality quality of Medicare servicesof Medicare services-- Support Support innovationinnovation
Establish neEstablish ne pa ment modelspa ment models-- Establish new Establish new payment modelspayment models-- Align Align payment models with provider costpayment models with provider cost-- Strengthen Strengthen program integrityprogram integrity-- Improve Improve financial footing of Medicare financial footing of Medicare modelmodel
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ACA ACA –– Breaking it DownBreaking it DownACA ACA –– Breaking it DownBreaking it Down
Quality Standards: 4 Key AreasQuality Standards: 4 Key Areas1.1. Patient / Caregiver care Patient / Caregiver care
experience (7 measures)experience (7 measures)2.2. Care coordination / Patient Care coordination / Patient
safety (6 measures)safety (6 measures)3.3. AtAt--risk population / Frail elderlyrisk population / Frail elderly4.4. Preventive health (8 measures)Preventive health (8 measures)
-- Hospital / Home Health Consumer Hospital / Home Health Consumer Assessment of Healthcare Providers Assessment of Healthcare Providers and Systemsand Systems
Quality Standard 1
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Care Coordination and SafetyCare Coordination and SafetyCare Coordination and SafetyCare Coordination and Safety
•• All Cause ReadmissionsAll Cause Readmissions•• Medication Reconciliation Post Medication Reconciliation Post
Accountable Care OrganizationsAccountable Care OrganizationsAccountable Care OrganizationsAccountable Care Organizations
•• By the end of Jan 2013, a total of 428 By the end of Jan 2013, a total of 428 ACO i i tACO i i tACOs were in existenceACOs were in existence
•• More than 40% are in only 5 statesMore than 40% are in only 5 states•• 9 of 32 Pioneer ACOs (28%) may 9 of 32 Pioneer ACOs (28%) may
leave the programleave the programDon’t wait to see if your referringDon’t wait to see if your referring•• Don’t wait to see if your referring Don’t wait to see if your referring providers will be part of an ACO to providers will be part of an ACO to make changes….becausemake changes….because
All Health Systems, Hospitals and All Health Systems, Hospitals and ACOs are Subject to:ACOs are Subject to:
All Health Systems, Hospitals and All Health Systems, Hospitals and ACOs are Subject to:ACOs are Subject to:
•• ValueValue--Based PurchasingBased PurchasingValueValue Based PurchasingBased Purchasing•• ReadmissionReadmission•• Patient SafetyPatient Safety•• Patient SatisfactionPatient Satisfaction•• Clinical IntegrationClinical Integration•• TechnologyTechnology•• Case ManagementCase Management•• Care TransitionsCare Transitions
Rewarding Quality Through Rewarding Quality Through MarketMarket--Based IncentivesBased Incentives
Rewarding Quality Through Rewarding Quality Through MarketMarket--Based IncentivesBased Incentives
• Quality reporting• Effective case management• Care coordination• Chronic disease management• Medication and care compliance• Medication and care compliance
Sh d i k/ h d iSh d i k/ h d i-- Shared risk/shared savingsShared risk/shared savings•• Penalties/RewardsPenalties/Rewards
-- Pay for Performance bonusesPay for Performance bonuses-- Readmission penaltiesReadmission penalties-- Bonus for Health IT implementationBonus for Health IT implementation
•• Reference pricing (fixedReference pricing (fixed--dollar dollar coverage)coverage)
Patient IncentivesPatient IncentivesPatient IncentivesPatient Incentives•• Choose highChoose high--performing physicians and performing physicians and
hospitalshospitalspp•• CoCo--pay/copay/co--insurance reductions for using insurance reductions for using
decisiondecision--support system for elective support system for elective proceduresprocedures
•• Participation in care management or Participation in care management or coaching to reduce health riskscoaching to reduce health riskscoaching to reduce health riskscoaching to reduce health risks
•• Preventive screening compliancePreventive screening compliance•• ConditionCondition--specific incentives to reduce specific incentives to reduce
financial barriers to medication adherence financial barriers to medication adherence and encourage condition managementand encourage condition management
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The Future is HereThe Future is HereThe Future is HereThe Future is Here
•• Health System success will be Health System success will be defined by those who attain the Triple defined by those who attain the Triple AimAim
Improve the Improve the Health of Health of
the Populationthe Population
Improve Improve AffordabilityAffordability
(Reducing Costs)(Reducing Costs)
Improve Improve the Experiencethe Experienceof the Individualof the Individual
Care / Health / CostCare / Health / CostCare / Health / CostCare / Health / Cost
ChoicesChoicesChoicesChoices
•• Home Health providers are faced with Home Health providers are faced with two posttwo post acute business strategies:acute business strategies:two posttwo post--acute business strategies:acute business strategies:-- Vendor of ServicesVendor of Services-- Specialized solutions providerSpecialized solutions provider
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Post-Acute Care Value ContinuumVendor to those accountable for patients’ costs
Provider partnering to solve the problems of the costliest
•• BrandingBrandingC T iti / C di ti / I tiC T iti / C di ti / I ti•• Care Transitions / Coordination / InnovationCare Transitions / Coordination / Innovation-- Heart Care @ HomeHeart Care @ Home-- Connected CareConnected Care-- Go Right HomeGo Right Home-- Care Path DevelopmentCare Path Development
Center for Connected CareCenter for Connected CareCenter for Connected CareCenter for Connected CareA new center focused on value-based home, transitional and post-acute care
HOSPITAL HOME FACILITY
home, transitional and post acute care
Disease-based transitional care programs
Excellence in home-based care: nursing, rehab, physician, pharmacy,
Innovative SNF and LTAC programs
Novel relationships ith local andp y,
respiratory, hospice and palliative medicine
with local and national providers
Reporting to the Chief of Medical Operations, the Center aims to be a resource and partner for Institutes and Hospitals as they carry out ‘connected’ care throughout the continuum
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Center for Connected CareCenter for Connected CareCenter for Connected CareCenter for Connected Care
•• The mission of the Center forThe mission of the Center for•• The mission of the Center for The mission of the Center for Connected Care is tConnected Care is to provide o provide worldworld--class transitional care class transitional care services, connecting patients services, connecting patients to care at home and atto care at home and atto care at home and at to care at home and at communitycommunity--based postbased post--acute acute facilitiesfacilities
Cl l d Cli i ill iCl l d Cli i ill i•• Cleveland Clinic will remain at Cleveland Clinic will remain at your side as you transition from your side as you transition from the hospital back to the the hospital back to the community (home or facility) community (home or facility) ––safer faster and with fewersafer faster and with fewersafer, faster, and with fewer safer, faster, and with fewer complications.complications.
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Connected CareConnected CareConnected CareConnected Care
Heart Care at HomeHeart Care at HomeTransitional Care ModelTransitional Care Model
Heart Care at HomeHeart Care at HomeTransitional Care ModelTransitional Care Model
•• Fragmented: over 12,400 SNF beds in Fragmented: over 12,400 SNF beds in Cuyahoga County (overCuyahoga County (over--bedded by 1,800)bedded by 1,800)
•• Costly: estimated $175M in SNF cost annually Costly: estimated $175M in SNF cost annually t f CCHS tt f CCHS t t ti tt ti tto payors for CCHS postto payors for CCHS post--acute patientsacute patients
•• ValueValue--based Post Acute model targets based Post Acute model targets significant improvement in SNF quality / costsignificant improvement in SNF quality / cost
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Connected Care UnitsConnected Care UnitsConnected Care UnitsConnected Care UnitsCC Staff
Physicians (0.5 FTE) and Mid-
CC CCU“Virtual Unit”
at SNF(20-30 beds)
EPIC Medical Record
Integration
)Levels (1.0
FTE)
Disease-specific care
paths and ‘Distance Health’Health
Accountable for readmits,
outcomes, and VALUE
Joint Quality Committee
What is Difference Between CCF What is Difference Between CCF CCU Model and Usual SNF Care?CCU Model and Usual SNF Care?What is Difference Between CCF What is Difference Between CCF CCU Model and Usual SNF Care?CCU Model and Usual SNF Care?Usual SNF Care Today
F t d d i blF t d d i blCCU Model for TomorrowT t l l t i i t tiT t l l t i i t ti•• Fragmented and variable Fragmented and variable
documentationdocumentation
•• Physician business based Physician business based on volume of visits and on volume of visits and stipends / facility business stipends / facility business based on volume of per based on volume of per diem paymentsdiem payments
•• Total electronic integration Total electronic integration of documentation across of documentation across venuesvenues
•• Practice and facility Practice and facility business based on value business based on value to patient / payersto patient / payers
•• Technology increasesTechnology increases•• Often disconnected from Often disconnected from
subsub--specialty care teams specialty care teams in hospitalin hospital
•• Variation in clinical Variation in clinical practice and incentivespractice and incentives
•• Technology increases Technology increases access to subaccess to sub--specialistsspecialists
•• Reduced variability, Reduced variability, increased care path increased care path adherence, aligned adherence, aligned incentives across venuesincentives across venues
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CCU RelationshipCCU RelationshipCCU RelationshipCCU Relationship
•• Collaborative Review of OutcomesCollaborative Review of Outcomes•• Education and Implementation of Education and Implementation of
EvidenceEvidence--based Practicebased Practice
L dh t M f i ld
I 271
I 271
I 271
I 271
I 271
I 271
I 271
I 271
I 271
I 90I 90I 90I 90I 90I 90I 90I 90I 90
Che
Gates Mills
Wicklif f e
Bratenahl
Collinwood
East Clev eland
Euclid
South Euclid
Noble
Richmond Hts
Connected Care Units
Garf ield Hts
Ly ndhurst-May f ield
I 480I 480I 480I 480I 480I 480I 480I 480I 480
I 71I 71I 71I 71I 71I 71I 71I 71I 71
I 90I 90I 90I 90I 90I 90I 90I 90I 90 I 77I 77I 77I 77I 77I 77I 77I 77I 77
I 480I 480I 480I 480I 480I 480I 480I 480I 480
US Hwy 422
US Hwy 422
US Hwy 422
US Hwy 422
US Hwy 422
US Hwy 422
US Hwy 422
US Hwy 422
US Hwy 422
I 271
I 271
I 271
I 271
I 271
I 271
I 271
I 271
I 271
Chagrin Falls
North Olmsted
No
Clev eland
Newburgh/Willow
Univ ersity Cir
Lakewood
Rocky Riv er
Clev eland Hts
Shaker Hts Beachwood
Fairv iew Park Warrensv ille Hts
Parma Hts Parma
Maple Heights
Bay Village
Brook Park
Brookly n
Westlake
B df d
Villa St. Joseph
Kindred FairhillLakewood SNF Menorah Park
Wellington Place
Bradley Bay Montefiore
Aurora
I 271
I 271
I 271
I 271
I 271
I 271
I 271
I 271
I 271
I 77I 77I 77I 77I 77I 77I 77I 77I 77I 7
1I 7
1I 7
1I 7
1I 7
1I 7
1I 7
1I 7
1I 7
1Berea
Columbia Station
MacedoniaNorthf ield
Twinsburg
Parma Hts
Middleburg HtsIndependence
North Roy alton
Parma
Strongsv ille
Olmsted Falls
Solon
Brecksv ille
Bedf ord
Broadv iew Heights
Specific Facilities Being Engaged Based on Quality, Interest, Current Collaboration with CCF, Practitioner Availability, Strategic Factors
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Target Patients for CCUTarget Patients for CCUTarget Patients for CCUTarget Patients for CCU•• Post acute Main Campus SNF patients without a Post acute Main Campus SNF patients without a
community PCP who provides SNF carecommunity PCP who provides SNF care
•• Key institute service lines:Key institute service lines:-- Heart Failure and Heart SurgeryHeart Failure and Heart Surgery-- Pneumonia and COPDPneumonia and COPD-- Stroke and NeurosurgeryStroke and Neurosurgery-- Joint Replacement / Hip FractureJoint Replacement / Hip Fracture
•• PayorPayor--driven models with ‘shared savings’driven models with ‘shared savings’-- Traditional Medicare Readmission RiskTraditional Medicare Readmission Risk-- Employee Health PlanEmployee Health Plan-- Medicare Advantage Risk ContractsMedicare Advantage Risk Contracts
ReadmissionsReadmissionsReadmissionsReadmissions
Source: ECIN/Readmission Report, Jan-June 2013 top 50 placed providers
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Care Delivery ModelCare Delivery ModelCare Delivery ModelCare Delivery Model
Care Delivery ModelCare Delivery ModelHow did we get started?How did we get started?
Care Delivery ModelCare Delivery ModelHow did we get started?How did we get started?
•• Industry ChallengesIndustry Challenges-- Reimbursement changes & recovery auditsReimbursement changes & recovery auditsReimbursement changes & recovery auditsReimbursement changes & recovery audits-- Regulatory changes Regulatory changes -- Call for transitional and disease management care Call for transitional and disease management care -- FragmentationFragmentation-- Accountability for value, outcomes, cost reductionAccountability for value, outcomes, cost reduction-- Increasing consumers / decreasing providersIncreasing consumers / decreasing providers
•• Center ChallengesCenter Challenges-- Limited direct care accountability for outcomesLimited direct care accountability for outcomes-- Capacity managementCapacity management-- Ability to monitor and maintain performance while Ability to monitor and maintain performance while
building quality and reducing costbuilding quality and reducing cost-- Employee engagementEmployee engagement
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Current ChallengesCurrent ChallengesBottom LineBottom Line
Current ChallengesCurrent ChallengesBottom LineBottom Line
Th h ll i H C th tTh h ll i H C th tThere are challenges in Home Care that can There are challenges in Home Care that can negatively impact patient care, financial & negatively impact patient care, financial & clinical outcomes, job satisfaction, clinical outcomes, job satisfaction, effectiveness of staff.effectiveness of staff.
Change was essential
Fundamentally transform the system to make it more Fundamentally transform the system to make it more accountable, sustainable, and patient care focusedaccountable, sustainable, and patient care focused
•• Demonstrate improved quality of work Demonstrate improved quality of work life and effectiveness of care managerslife and effectiveness of care managers-- Allow more time for care planning and Allow more time for care planning and
coordination activities. Focus on performance coordination activities. Focus on performance rather than visitsrather than visits
-- Provide staff with increased authority and Provide staff with increased authority and accountability for achieving optimal patientaccountability for achieving optimal patientaccountability for achieving optimal patient, accountability for achieving optimal patient, quality, and financial outcomesquality, and financial outcomes
-- Improve communication & collaborationImprove communication & collaboration-- Decrease unpredictability in the dayDecrease unpredictability in the day-- Improve employee engagementImprove employee engagement
•• Demonstrate optimal financial and Demonstrate optimal financial and ppquality outcomesquality outcomes-- Ensure effective care planning Ensure effective care planning -- Ensure accurate and timely completion of Ensure accurate and timely completion of
documentation (OASIS)documentation (OASIS)-- Ensure productivity standardsEnsure productivity standards-- Ensure patient satisfaction Ensure patient satisfaction –– high service high service
standardsstandards-- Eliminate unnecessary and duplicative workEliminate unnecessary and duplicative work
Where Did We Need to Go?Where Did We Need to Go?Where Did We Need to Go?Where Did We Need to Go?
•• Develop a care delivery/ compensationDevelop a care delivery/ compensationDevelop a care delivery/ compensation Develop a care delivery/ compensation model that would model that would successfullysuccessfully address address the needs of patients, management, and the needs of patients, management, and direct care staffdirect care staff
•• Develop an model that would demonstrate Develop an model that would demonstrate improved workflow processes and optimal improved workflow processes and optimal outcomesoutcomesoutcomesoutcomes
•• Develop an model that would Develop an model that would lay the foundation to support lay the foundation to support our futureour future
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Care Delivery ModelCare Delivery ModelCare Delivery ModelCare Delivery Model
give more ownership of schedule to give more ownership of schedule to the care managersthe care managers
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Care Delivery ModelCare Delivery ModelCare Delivery ModelCare Delivery Model
•• Compensation ChangesCompensation Changes-- Transition CM from per visit Transition CM from per visit
compensation to salarycompensation to salary•• Incorporate onIncorporate on--call and weekendscall and weekends•• AddAdd--on compensation for work above on compensation for work above
expected workloadexpected workload-- LPNs and select therapy staff remained LPNs and select therapy staff remained
hourlyhourly-- Weekend Staff remained per visitWeekend Staff remained per visit
Care Delivery ModelCare Delivery ModelCare Delivery ModelCare Delivery Model
•• Care Delivery ChangesCare Delivery Changes-- Increased focus on nonIncreased focus on non--visit based carevisit based care-- Increased focus on nonIncreased focus on non--visit based care visit based care
management / coordinationmanagement / coordination-- Move away from visits and move toward Move away from visits and move toward
more nonmore non--visit based management and visit based management and care plan oversightcare plan oversight
-- Emphasize case conferences / case load Emphasize case conferences / case load reviewreviewreview review
-- Leverage specialty services and Leverage specialty services and interdisciplinary collaborationinterdisciplinary collaboration
Identifying the AtIdentifying the At--Risk HH PatientRisk HH PatientIdentifying the AtIdentifying the At--Risk HH PatientRisk HH Patient
•• Challenge presented by size andChallenge presented by size and•• Challenge presented by size and Challenge presented by size and complexity of our active patient complexity of our active patient populationpopulation
•• 350350--400 Admissions weekly400 Admissions weekly•• ADC > 2100ADC > 2100•• Goal: develop a resource to focus Goal: develop a resource to focus
increased attention to the POC for our increased attention to the POC for our more complex patientsmore complex patients
•• Report created to extract dataReport created to extract data•• Report created to extract data Report created to extract data routinely collected at SOC, ROC and routinely collected at SOC, ROC and Recertification from AllscriptsRecertification from Allscripts
•• Available early in the episode Available early in the episode –– 48 48 hours following the visithours following the visit
•• Active PatientsActive Patients•• Active PatientsActive Patients•• Length of StayLength of Stay•• Revenue & CostRevenue & Cost•• CMWCMW•• DiagnosisDiagnosis
•• CMS Bundled Payment InitiativeCMS Bundled Payment Initiative•• CMS Bundled Payment InitiativeCMS Bundled Payment Initiative-- DRG 469/470 Total Hip and Knee DRG 469/470 Total Hip and Knee
ArthroplastyArthroplasty•• Applicants offer a discount (2 or 3%) to Applicants offer a discount (2 or 3%) to
CMS for Medicare FFS patients onlyCMS for Medicare FFS patients only•• Incentive: If a savings is achieved Incentive: If a savings is achieved
about the proposed discount rate, CMS about the proposed discount rate, CMS retrospectively pays the difference backretrospectively pays the difference back
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Type of BundleType of BundleType of BundleType of Bundle
•• PostPost acute period of 30 daysacute period of 30 days•• PostPost--acute period of 30 daysacute period of 30 days•• Discount rate of 3%Discount rate of 3%•• Applicable to Medicare FFS Applicable to Medicare FFS
patients as of January 1, 2013patients as of January 1, 2013
Considerations to Reduce CostConsiderations to Reduce CostConsiderations to Reduce CostConsiderations to Reduce Cost•• Reduce discharges to SNFReduce discharges to SNF•• Reduce home care costs for thoseReduce home care costs for thoseReduce home care costs for those Reduce home care costs for those
being discharged first to a SNFbeing discharged first to a SNF•• Reduce readmissionsReduce readmissions•• Shift appropriate home care volume to Shift appropriate home care volume to
Outpatient RehabOutpatient Rehab•• Shift more SNF volume to the hospitalShift more SNF volume to the hospital--
based SNFbased SNF•• Decrease SNF LOSDecrease SNF LOS
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Rapid Recovery Program GoalsRapid Recovery Program GoalsRapid Recovery Program GoalsRapid Recovery Program Goals•• Early mobilization of postEarly mobilization of post--operative patients operative patients
(Day 0)(Day 0)•• Early return to activities of daily livingEarly return to activities of daily living•• Empower patients to actively participate in Empower patients to actively participate in
their POCtheir POC•• Improve patient experience throughout the Improve patient experience throughout the
Euclid to CC Home CareEuclid to CC Home CarePopulation Overview Jan Population Overview Jan –– May 3012May 3012Euclid to CC Home CareEuclid to CC Home CarePopulation Overview Jan Population Overview Jan –– May 3012May 3012
•• 140 total joint/Birmingham hip referrals140 total joint/Birmingham hip referrals•• 140 total joint/Birmingham hip referrals 140 total joint/Birmingham hip referrals -- 108 from acute care108 from acute care-- 32 from IRF or SNF32 from IRF or SNF
•• One readmission for Ludwig AnginaOne readmission for Ludwig Angina-- Sent to Outpatient after Hospital DCSent to Outpatient after Hospital DCSent to Outpatient after Hospital DCSent to Outpatient after Hospital DC
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CC Home Care to OutpatientCC Home Care to OutpatientJan Jan –– May, 2013May, 2013
CC Home Care to OutpatientCC Home Care to OutpatientJan Jan –– May, 2013May, 2013
•• 92 referred directly to OP with CCRST: 66%92 referred directly to OP with CCRST: 66%•• 92 referred directly to OP with CCRST: 66%92 referred directly to OP with CCRST: 66%•• 22 with no OP ordered by surgeon: 15.7%22 with no OP ordered by surgeon: 15.7%•• 12 chose OP outside of CCHS: 8.6%12 chose OP outside of CCHS: 8.6%•• 10 geographic outliers with “unknown” OP 10 geographic outliers with “unknown” OP
facility: 7.1%facility: 7.1%•• 3 refused OP therapy: 2.1%3 refused OP therapy: 2.1%•• Potential OP referrals placed with CCRST: Potential OP referrals placed with CCRST:
87.6%87.6%
Type of ProcedureType of ProcedureType of ProcedureType of Procedure
Birmingham Hip, 6%
Bilat TKA, 10%
THA, 20%
Hip, 6%10%
TKA, 64%
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Home Care ReferralsHome Care ReferralsEuclid Hospital Total, JanEuclid Hospital Total, Jan--MayMayHome Care ReferralsHome Care Referrals