No Place Like Home: A Community Approach to Reduce Avoidable Hospital Readmissions and Improve Medication Management

Transcription

1 No Place Like Home: A Community Approach to Reduce Avoidable Hospital Readmissions and Improve Medication Management Barb Averyt, BSHA Program Director, Care Coordina8on Health Services Advisory Group (HSAG) September 18, 2015

2 HSAG: Your Partner in Healthcare Quality Nearly 25 percent of the naeon s Medicare beneficiaries HSAG is the Medicare QIN- QIO for Arizona, California, Florida, Ohio, and the U.S. Virgin Islands. 2

3 Objec8ves Illustrate why a community approach is necessary to reduce avoidable hospital readmissions. Describe how the community approach is actually working in the Phoenix West Valley. Iden8fy current strategies being used to effect medica8on management across the con8nuum. 3

4 Centers for Medicare & Medicaid Services (CMS) Hospital Readmission Penalty Age 65 or over Discharged from non- federal acute- care hospitals Not transferred to another acute care facility Enrolled in Part- A Medicare for the 12 months prior to the date of the index admission Penalty determined by readmissions for CHF, AMI, PNE, COPD, TKA/THA; however, applied to all DRG payments Can be up to a 3% financial penalty for the year 4

5 The Inclusion/Exclusion Algorithm for Index Admission 5 Source document: 2014 Measures Updates and Specifica8ons Report Hospital- Wide All- Cause Unplanned Readmission Version 3.0, CMS, March 2014

6 Na8onal Impact: How Did Hospitals Fare? FY 2013 FY 2014 FY ,217 2,225 2, at 1% 154 at 1% 18 at 2% 39 at 3% Na8onal average fine $$ recouped by CMS $280 million $227 million $428 million Began Oct Began Oct Began Oct Total hospitals penalized Hospitals receiving maximum penalty 6

7 What Is in Store for Fiscal Year 2016? Based on claims data from July 1, 2011, to June 30, 2014 Up to 3 percent financial penalty to all readmissions The penalty determining diagnos8c- related group (DRGs) remain the big five : Acute myocardial infarc8on (AMI) Pneumonia (PNE) Conges8ve heart failure (CHF) Chronic obstruc8ve pulmonary disease (COPD) Total knee arthroplasty/total hip arthroplasty (TKA/THA) For fiscal year 2017, coronary artery bypass gran (CABG) will be added 7 Source Document: Federal Register / Vol. 80, No. 83 / Thursday, April 30, 2015 / Proposed Rules

8 What Does the 2016 Penalty Look Like? CMS es8mates that 2,666 hospitals will have their payments reduced. Na8onally, es8mated payment reduc8on of approximately $420 million in fiscal year $ Recouped by CMS, in Millions $450 $428 $ $400 $350 $300 $280 $250 $227 $

9 Arizona Impact: How Did Arizona Hospitals Fare? No penalty 27 < or =50% 22 > or =51% Full penalty

10 Readmission Penal8es Are Coming to Others 10

11 Why a Community Approach Makes Sense 11

12 Medicare Fee- For- Service Pa8ent Ac8vity in

13 30- Day Readmissions by Volume

14 All- Cause Readmissions to Another Hospital 14

15 West Valley 2013: Five or More Emergency Department (ED) Visits 458 dis8nct Medicare beneficiaries (MBs); 3,532 ED visits annually Treat and release not admited The top diagnoses for ED visits were due primarily to causes such as abdominal pain, urinary- tract infec8ons, headaches, and backaches Diagnosis Code DescripEon Abdominal pain, other specified site Urinary tract infec8on, site not specified Headache Abdominal pain, unspecified site Backache, unspecified

16 Hot- Spoung by Zones 16

17 Hot- Spoung: Blue Zone 126 MBs 751 Admissions/Readmissions ZIP Code # of MBs Admissions A[ributed 18

18 Hot Spoung: Orange Zone 58 MBs 351 Admissions/Readmissions ZIP Code # of MBs Admissions A[ributed

19 Source of Readmissions Within 7 Days of Hospital Discharge 60 percent of pa8ents readmited within 7 days from hospital discharge had been discharged to home without home health agency (HHA). Readmited from these care seungs 229, 16% 11, 1% 110, 8% 204, 15% , 60% Home HHA Hospice Other Nursing Home

20 7- Day Readmissions and High- Risk Medica8ons Of the 1,400 pa8ents readmited within 7 days of hospital discharge, 396 pa8ents were on high- risk medica8ons. That is more than one out of every four. 20

21 Group Ques8on Which high- risk medica8on had the largest usage? A. An8coagulants B. Diabe8c medica8ons C. Opioids 21

22 High- Risk Medica8ons Readmissions drug category breakdown: 20% Diabe8c agents = 26% 104 pa8ents Opioids = 53% 212 pa8ents An8coagulants = 80 pa8ents 22

23 Community Root Cause Analysis 23

24 WVCCC Structure WVCCC Steering Commitee 7- Day Care TransiEon Workgroup MedicaEon Management Workgroup Hospice and PalliaEve Care Workgroup (pending) Community Paramedicine StandardizaEon 24

25 7- Day Care Transi8on The interven8on is to have a face- to- face touch- point within hours of hospital discharge. Hospital Discharges Medicare FFS or ACO* pa8ents Discharged to home Pa8ents on High Risk Meds and/ or AMI, CHF, PNE, and COPD** 25 Target Popula8on for Interven8on * Fee- for- service (FFS), accountable care organiza8on (ACO) ** Acute myocardial infarc8on (AMI), conges8ve heart failure (CHF), pneumonia (PNE), chronic obstruc8ve pulmonary disease (COPD)

26 Community Paramedicine Standardiza8on Involves nine city fire departments Six- month pilot project underway with Buckeye Fire Department and Banner Estrella Medical Center Gleaning the lessons learned from the pilot and establishing standardized elements to the visits for a community approach 26

27 Medica8on Management Workgroup Chair: Tim Ranney, MD Chief Medical Officer, Banner Estrella Medical Center Comm. Pharmacy/ Health Plan Subcommi[ee Interven8on: Appointment- Based Model 1. Medica7on Synchroniza7on 2.Monthly pt. call 3. Scheduled monthly visit 27 In Home/ Home Health Subcommi[ee Interven8on: U7lizing monthly rapid- cycle process improvement. One focus: Opioids Nursing Homes Subcommi[ee Interven8on: Medica7on reconcilia7on upon admission and/or discharge from hospital to nursing home. Hospital Subcommi[ee Interven7on: Obtain an accurate medica7on history for admiied pa7ents using a pharmacy technician model. Technology Subcommi[ee Interven8on: Interoperability across provider sejngs.

28 Next Steps Spread to East Phoenix EVEVCCC 28

29 Ques8ons? Thank you! Barb Averyt, BSHA

30 This material was prepared by Health Services Advisory Group, the Medicare Quality Improvement Organiza8on for Arizona, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. Publica8on No. AZ- 11SOW- C