Harnessing the Power of DataVision Toolpacks

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Milton Greer
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1 Harnessing the Power of DataVision Toolpacks Barbara Schork, DataVision Product Specialist and Brenda Pettyjohn, Solutions Advisor A Story About Tools 2014 Midas+ Symposium May Tucson, AZ 1

DataVision Users Have Many Tools in Their Arsenal

Offer both graphical and tabular displays of a

Enable you to review outcomes and events to

Allow you to view both high level data and

2 DataVision Users Have Many Tools in Their Arsenal Why Use DataVision Toolpacks? Offer both graphical and tabular displays of a wide variety of data. Enable you to review outcomes and events to improve processes and quality of care. Allow you to view both high level data and patient level detail Can be easily modified to focus on clinical subpopulations Midas+ Symposium May Tucson, AZ 2

We know this is a particularly problematic population at our hospital.

3 Where to Start Pneumonia is one of three key clinical topics tied to reimbursement (along with AMI & CHF). Pneumonia patients are especially prone to readmissions and comorbid conditions. We know this is a particularly problematic population at our hospital. What process changes might we make to improve outcomes and reduce readmissions? Examining the Pneumonia Population High Volume 2014 Midas+ Symposium May Tucson, AZ 3

4 Very High LOS High Mortality 2014 Midas+ Symposium May Tucson, AZ 4

5 Very High Readmission Rate Many of the Readmissions Could Be Prevented 2014 Midas+ Symposium May Tucson, AZ 5

6 Average Costs for Pneumonia MS-DRGs 193, 194, 195 Above the Median Let s Take a Deeper Dive into the Data 2014 Midas+ Symposium May Tucson, AZ 6

7 What Issues Do We Find? Top Principal Diagnoses Is there an opportunity to improve clinical documentation? 2014 Midas+ Symposium May Tucson, AZ 7

8 Top Principal Procedures Two-thirds of procedures were either a Level 5 ED Visit or a Closed bronchial biopsy. Admits by Day of Week Nearly 25% of patients are admitted on Saturday or Sunday, when access to physicians and other care providers may be limited Midas+ Symposium May Tucson, AZ 8

9 Admits by Time of Day Nearly half of all Pneumonia admissions occur between 6 PM and 7 AM. Discharge Status The vast majority of patients were discharged home Midas+ Symposium May Tucson, AZ 9

10 Major Complications of Care 100 of 478 adult pneumonia patients had one or more NPOA diagnoses, with the most common being Acute Pulmonary Failure. Drill-down to Major Complication Detail 2014 Midas+ Symposium May Tucson, AZ 10

Severity of Illness (SOI) and LOS O/E ratios by Discharge APR DRG for each

11 Provider Utilization This analysis enables you to compare costs and charges among attending physicians Provider APR-DRG LOS Use this report to examine Severity of Illness (SOI) and LOS O/E ratios by Discharge APR DRG for each provider, as well as average charges and costs Midas+ Symposium May Tucson, AZ 11

DRG Mortality by Attending Here again, we see the vast majority of encounters in APR DRG

12 APR DRG Severity by Attending Looking at the aggregate of all providers, 82% of patients had a severity level of 2 or 3, most of whom were in APR DRG 139 (Other pneumonia) APR DRG Mortality by Attending Here again, we see the vast majority of encounters in APR DRG 139, with ROM levels clustering around 2 or Midas+ Symposium May Tucson, AZ 12

13 LOS Outliers Patients with LOS >2 SD from your hospital s ALOS are most likely to have adverse events. A Few Areas for Further Investigation Review clinical documentation practices to optimize specificity where possible. (451 of 478 patients had a diagnosis labeled as NOS.) Examine LOS outliers to determine if patients may have been kept too long or sent home too soon or perhaps not admitted at all. Expected LOS averaged 4.80 but observed LOS averaged Drill down into mortalities to determine risk vs. outcomes. For example, one of our mortalities had a risk of 2, and two had an SOI of Midas+ Symposium May Tucson, AZ 13

14 DataVision Risk Management Toolpack Were Risk Events a Contributing Factor to Pneumonia Outcomes? Since we know that respiratory patients account for the most falls in our hospital, let s start there Midas+ Symposium May Tucson, AZ 14

15 Focus in on Falls Among Respiratory Patients One Unit Is Not Specific About Falls 2014 Midas+ Symposium May Tucson, AZ 15

16 Types of Falls Falls by Location MDC Midas+ Symposium May Tucson, AZ 16

17 Falls by Time of Day Falls by Day of Week 2014 Midas+ Symposium May Tucson, AZ 17

18 Falls by Principal Diagnosis Falls by Outcomes 2014 Midas+ Symposium May Tucson, AZ 18

19 Days Between Admit and Event Falls are Reported Promptly 2014 Midas+ Symposium May Tucson, AZ 19

20 High Readmissions DataVision Readmission Toolpack 2014 Midas+ Symposium May Tucson, AZ 20

21 What does the DataVision Readmission Toolpack do? The Readmission Toolpack can be used to evaluate readmissions DataVision measures/clinical populations All inpatients/acute care inpatients Acute care excludes: - Rehabilitation, skilled nursing, behavioral health/psychiatric, and hospice - Inpatient delivery encounters with ICD-9 V codes V27.0 V Inpatient newborn encounters with ICD-9 V codes V30.00 V39.01 Your encounter-based custom Midas+ Indicators Things You Need to Know Midas+ reports readmissions in pairs. The pair consists of the initial (index, or #1) encounter and a readmission (#2) encounter. Events that might have precipitated the readmission encounter likely occurred in the index encounter. However, a causal relationship might not exist between events in the two encounters. The index encounter qualifies for an Indicator based on its discharge date Midas+ Symposium May Tucson, AZ 21

22 Things You Need to Know (continued) The readmission encounter qualifies for an Indicator based on its admission date. The readmission encounter does not require a discharge date; an active (nondischarged) encounter qualifies as a readmission encounter. An index encounter can also be a readmission encounter if it has a qualifying admission. In some cases, a single encounter qualifies as an index encounter and a readmission Choosing Parameters 2014 Midas+ Symposium May Tucson, AZ 22

23 What trends do we see? Since most patients are discharged to home, do we need to evaluate discharge planning? 2014 Midas+ Symposium May Tucson, AZ 23

24 More reason to look at discharge planning Continued example of non-specific diagnosis Most patients returning with pneumonia, but note other diagnoses that are likely related Midas+ Symposium May Tucson, AZ 24

Continued indication that patients returning for reasons related

support at home and understanding of ongoing treatment?

25 Continued indication that patients returning for reasons related care during initial encounter Was discharge planning adequate for support at home and understanding of ongoing treatment? Were some of the early returns because of a missed diagnosis during the first encounter? Is there a trend amongst the attending physicians for this population? 2014 Midas+ Symposium May Tucson, AZ 25

improvement opportunity Attending physicians with the low admitting volume have high readmission rates Many or returning patients are in

26 Trends that could have financial impact? What have we learned and what questions were raised that need further investigation? High percentage of returning population are elderly and were discharged to home There is continued evidence of a significant documentation improvement opportunity Attending physicians with the low admitting volume have high readmission rates Many or returning patients are in the self-pay or Medicare categories for payment How many of the readmissions were potentially preventable? 2014 Midas+ Symposium May Tucson, AZ 26

27 DataVision 3M PPR Toolpack What does the 3M PPR Toolpack Do? The DataVision 3M PPR Toolpack can be used to evaluate potentially preventable readmissions (PPRs) at your facility. The report generates an Excel workbook with several worksheets that provide details about various aspects of the selected population. Because it includes only admissions that might be preventable, the 3M PPR methodology helps you identify case areas where clinical or care management processes might be less than optimal. To better understand the selected population, review APR DRG comparative data along with the PPR data Midas+ Symposium May Tucson, AZ 27

28 Things You Need to Know PPR methodology links clinically related admissions within a selected readmission time interval (15 or 30 days). To be clinically related, the readmission must be reasonably linked to the care given during or immediately after a previous admission, and not due to unrelated events. Readmissions are reviewed in chains which contain an initial admission and all clinically related PPRs. Within a chain, the number of days between the discharge date of an earlier admission and the admit date of a subsequent admission determines the number of days between those contiguous admissions. Things You Need to Know (continued) The chain is broken when a subsequent admission exceeds the selected readmission interval. The readmission interval applies to contiguous encounters within the chain, so the time span of the entire chain can exceed the readmission interval. In a corporate group, where multiple facilities share a single server, PPR data is based only on encounters that are readmitted to the same facility as the initial encounter. PPR calculations include behavioral health admissions. So if a patient is discharged from a medical service and then returns 3 days later for a behavioral health (BH) admission, the BH admission could be included in an All Inpatient PPR readmission chain Midas+ Symposium May Tucson, AZ 28

Even More Things You Need to Know Some same-day transfers within a hospital are considered nonevents if the discharge disposition of the first encounter is mapped Discharge to Rehabilitation,

29 Even More Things You Need to Know Some same-day transfers within a hospital are considered nonevents if the discharge disposition of the first encounter is mapped Discharge to Rehabilitation, Discharge to Skilled Nursing Facility, Psych, Discharge to Acute Care, or Hospice. The subsequent encounter is treated as a nonevent if its admission date is the same as the discharge date of the previous encounter. In this way, patients who are discharged from a medical unit and readmitted on the same day to a psychiatric unit (or vice versa) are excluded from the PPR calculation. Encounters are ignored if classified as a nonevent during the interval between an Initial Admission and a readmission. Generating the Toolpack 2014 Midas+ Symposium May Tucson, AZ 29

30 Easy Access to Definitions Focusing on Trends Previously Noted 2014 Midas+ Symposium May Tucson, AZ 30

31 High percentage returning with non-specific pneumonia diagnosis Attending Physician Trends Validated 2014 Midas+ Symposium May Tucson, AZ 31

32 Further Analysis of Attending Physicians with Highest Volumes and/or Charges Filtered by chosen physician Clinical Relationships 2014 Midas+ Symposium May Tucson, AZ 32

Evaluate Possible Losses for Potentially Preventable Readmits Wrap Up By using DataVision Toolpacks we were able to confirm possible issues with the pneumonia population DataVision Toolpacks allow

33 Evaluate Possible Losses for Potentially Preventable Readmits Wrap Up By using DataVision Toolpacks we were able to confirm possible issues with the pneumonia population DataVision Toolpacks allow you to look at several levels of data going from a general overview of the population down to risk adjusted specificity The Toolpacks output provides you with multiple data points to bring to your peers for validation of issues and provide recommendations for improvement activities 2014 Midas+ Symposium May Tucson, AZ 33

And One More Thing. Don t forget to utilize the DataVision Comparative reports to support your Analysis References Quick Start Guides are available from www.midasplus.com.

34 And One More Thing. Don t forget to utilize the DataVision Comparative reports to support your Analysis References Quick Start Guides are available from After logging in, select User Documentation, select DataVision (or CPMS) from the Category list, click Search, and then double-click the Quick Start Guides entry in the table. Self-paced e-learning is available from After logging in, select Training, select DataVision/CPMS and choose from the list in the appropriate folder 2014 Midas+ Symposium May Tucson, AZ 34

Thanks for attending. Are there any questions? Barbara Schork, DataVision Product Specialist barbara.

35 Thanks for attending. Are there any questions? Barbara Schork, DataVision Product Specialist Brenda Pettyjohn, Solutions Advisor 2014 Midas+ Symposium May Tucson, AZ 35

Reducing Readmissions One-caseat-a-time Using Midas+ Community Case Management

Reducing Readmissions One-caseat-a-time Using Midas+ Community Case Management John Playford, Senior Midas+ Solutions Advisor Barb Craig, Midas+ SaaS Advisor The Problem Historically, up to 25% of patients