Outcomes Reporting: Be Ready to Negotiate with a Hospital

Transcription

1 Outcomes Reporting: Be Ready to Negotiate with a Hospital Tanya Procell, RN ADN Director of Clinical Services Provider Professional Services Teresa Chase President & CEO American HealthTech July 24 th, Objectives What are outcomes reports? What can outcomes reporting do for me in five strategic ways? 1. Re-hospitalization prevention: attacking and measuring success 2. New corporate compliance requirements in QAPI: preparing for upcoming regulations 4. Marketing: creating a 'sales pitch' to win census from hospitals 5. Benchmarking: comparing facilities and replicating best practices 2 1

2 Let s get started What are Outcomes Reports? 3 What are Outcomes Reports? Dynamic Reporting Tools Calculate Readmissions, Quality, Cost Measure, Monitor, Improve, Market Hospitals/ACOs Regulators Patients/Families Census QAPI & Compliance Reputation People don t do what the boss says, they do what the boss measures. Jack Welch 4 2

3 Where does the data come from? Quality Readmissions Myself as a provider EMR reports or manual My SNF Competitors NH Compare, AHCA s LTC Trend Tracker Hospitals Hospital Compare Hospital Compare, USA Today 5 What can outcomes reporting do for me in five strategic ways? #1: Re-hospitalization prevention - attacking and measuring success 6 3

4 The Bar Will be Ever-Increasing Average Hospital Readmission Rates Heart attack 19.9% Heart failure 24.7% Pneumonia 18.3% Source: MedPac 7 SNF Frequent Flyers From 2000 to 2006, the rate of SNF readmissions grew 29%. MedPAC sees avoidable readmissions as a cost-savings opportunity. Today five conditions account for 78% of all avoidable 30-day SNF readmissions: Congestive heart failure (CHF) Respiratory infection Urinary tract infection (UTI) Sepsis Electrolyte imbalance Source: MedPac 8 4

5 March 2012 MedPAC Report to Congress We recommend reducing payments to SNFs with relatively high rates of re-hospitalizations. Avoidable rehospitalizations of SNF patients increase Medicare s spending, expose beneficiaries to additional disruptive care transitions, and can result in hospital-acquired infections or other adverse health consequences. 9 How to Get Started There s a LOT of data out there At first, too much Then, too little Focus on hospital penalties Targeted diagnosis: COPD CHF Pneumonia The results you get Have great outcomes? Market them! Need work? QAPI and Corporate Compliance 10 5

6 Outcomes Reporting Look at discharges as a whole Find common denominators Treat with vigilance See opportunities for training? 11 Re-hospitalization Prevention Education with nurses and CNAs Clinical pathways When to notify physicians Have a plan when we call 12 6

7 Example: COPD Worked proactively with physicians to update orders Inserviced staff on respiratory assessment skills Watched for specific areas of decline Got involved earlier Key was using real data Found facilities are NOT the same 13 Example: Rural Hospital Medically complex patients Discharged too early; sometimes directly from ICU Multiple complexities Physicians were frustrated Hospital didn t see the issue of early discharge of unstable residents They do now ($) It s about relationships SNF = case manager Quality transitions 14 7

8 What can outcomes reporting do for me in five strategic ways? #2: New Corporate Compliance Requirements in Nursing Home Compliance Plans Section 6102 of the Affordable Care Act requires nursing homes to operate a compliance and ethics program, containing at least 8 components, to prevent and detect criminal, civil, and administrative violations and promote quality of care. Effective 10/1/2012 We will review Medicare- and Medicaid-certified nursing homes implementation of compliance plans as part of their day-to-day operations and whether the plans contain elements identified in OIG s compliance program guidance

9 OIG Work Plan Reducing rehospitalization rates Quality of care Sufficient staffing Comprehensive care plans Medication management Use of psychotropic meds Resident safety (interactions, staff screening) We will also assess CMS s oversight of nursing homes whose residents have high rates of hospitalization. Hospitalizations and re-hospitalizations of nursing home residents are costly to Medicare and may indicate quality-of-care problems at nursing homes. A 2007 OIG study found that 35 percent of hospitalizations during a SNF stay were caused by poor quality of care or unnecessary fragmentation of services What can outcomes reporting do for me in five strategic ways? #3: QAPI - preparing for upcoming regulations 18 9

10 F-Tag 520 Compliance Nursing homes are required to have a committee and process in place to identify quality deficiencies, develop and implement plans to correct these deficiencies, monitor the effects of the changes and make needed revisions to the plan in order to assure ongoing compliance. 19 What is QAPI? Affordable Care Act, Section 6102 requires CMS to: Elements Establish standards relating to Quality Assurance and Performance Improvement (QAPI) Provide technical assistance to facilities on the development of best practices for QAPI. Meaningful issues Measureable Benchmarks Evidence-based interventions Improvement "This work will take nursing homes beyond compliance with rules. It will engage whole organizations in programs that aspire to everimproving quality." Jennifer Lundblad, PhD, President and CEO, Stratis Health Sources:

11 Demonstration Project Lead nationwide by the University of Minnesota and Stratis Health California 1. Cedar Crest Nursing and Rehabilitation Center, Sunnyvale 2. Lincoln Glen Nursing Facility, San Jose 3. Mercy Retirement & Care Center, Oakland 4. San Miguel Villa, Concord Florida 5. Habana Health Care Center, Tampa 6. The Home Association, Tampa 7. Oak Manor Healthcare and Rehabilitation, Largo 8. St. John's Nursing Center, Lauderdale Lakes Massachusetts 9. D'Youville Life and Wellness Community, D'Youville Senior Care, Lowell 10.Julian J. Leavitt Family Jewish Nursing Home, Longmeadow 11.Liberty Commons, North Chatham 12.Stonehedge Rehabilitation and Skilled Care Center, West Roxbury Minnesota 13. Benedictine Health Care Center, Duluth 14. Ecumen Parmly LifePointes, Chisago City 15. Good Samaritan, Ambassador, New Hope 16. Perham Living, Perham 17. Sterling Park Health Care Center, Waite Park The demonstration will run from September 2011 through August Data Collection Objectives Wave 1 Wave 2 Establish a baseline of QAPI practices in nursing homes Gather information on the challenges and barriers to implementing effective QAPI programs Assess the development of QAPI systems Determine what types of technical assistance to make available to nursing homes

12 June 2012 CMS Voluntary Survey: 4200 Facilities Written plan or policy for QA Roles and responsibilities for Administrator DON MD Residents QA committee Governing body Direct care staff How often they meet How often required Succession plan Model for QA activities Formal quality training Satisfaction surveys Consistent caregivers Frequency of QM reviews Re-hospitalization rates Turnover Deficiencies Incidents 5-star Advancing Excellence And on and on 23 Example 24 12

13 What can outcomes reporting do for me in five strategic ways? #4: Marketing - creating a 'sales pitch' to win census from hospitals 25 Source: Health Dimensions Group National Summit, February 2, Used witih permission from CHI

14 Source: Health Dimensions Group National Summit, February 2, Used witih permission from CHI. 27 Where can I get readmission rates for my local hospital? 1 2 Source:

15 Sample Data: Readmission Rates for Local Hospitals US averages Heart attack 19.9% Heart failure 24.7% Pneumonia 18.3% Source: 29 Prepare Your Sales Pitch Ask a hospital executive: Top 5 DRGs? Top readmit DRGs? Goals? US averages Heart attack 19.9% Heart failure 24.7% Pneumonia 18.3% 30 15

16 What can outcomes reporting do for me in five strategic ways? #5: Benchmarking - comparing facilities and replicating best practices 31 How are we doing overall? 32 16

17 How do my facilities compare? 33 How do I compare against my competitors? AHCA s LTC Trend Tracker Claims Data from Compare your facility to peer groups: National State County City Congressional District Facility C County All Facilities You Peer cluster 34 17

18 The Bottom Line: Getting patients home is no longer enough. Your performance will be measured by data-driven outcomes. Your EMR is Mission Critical for Outcomes Reporting 35 Questions? Tanya Procell, RN ADN Director of Clinical Services Provider Professional Services Teresa Chase President & CEO American HealthTech July 24 th,