TEXAS HEALTHCARE TRANSFORMATION & QUALITY IMPROVEMENT PROGRAM. Jackson Healthcare Center

Transcription

1 TEXAS HEALTHCARE TRANSFORMATION & QUALITY IMPROVEMENT PROGRAM Regional Healthcare Partnership Region 4 Jackson Healthcare Center Delivery System Reform Incentive Payment (DSRIP) Projects

2 Category 1 DSRIP Projects: Infrastructure Development

3 Jackson County Hospital District / Expand Specialty Care Capacity Pulmonary Rehabilitation Clinic Provider: Jackson County Hospital is a 25-bed critical access hospital serving an 800 square mile district and a population of about 15,000. Intervention: This project will expand specialty care capacity by establishing an outpatient pulmonary rehabilitation clinic, thereby reducing unnecessary emergency room visits and improving patient quality of life in a region with high COPD. Need for the project: Patients with pulmonary disorders currently must drive 50 to 100 miles for treatment, at great inconvenience and cost. Target population: The target population for the project is older adult and geriatric patients in the hospital district, including: (a) an estimated 760 patients with COPD in the market area; (b) Many patients are Medicaid eligible and the hospital district is responsible by law for healthcare for the needy inhabitants of the district. JCHD efforts will focus on education and outreach with several RHP 4 agencies that serve Medicaid eligible and indigent patients. Based on rural trends, we expect that the Medicaid eligible/indigent patients served will increase each year with our minimum target for DY1 at 12%. It is important to note that the baseline conversion rates as well as compliance to treatment percentages have not been established to date and that our projections may need to be adjusted based on annual outcomes. And, for this reason, these projections are conservative with the understanding that the OPR will treat Medicaid eligible or indigent patients that are referred for treatment that meet criteria for treatment and that are willing to be treated. Category 1 or 2 expected patient benefits: Establish an outpatient pulmonary specialty clinic in DY2. Train staff and establish baseline referral numbers in DY3. Increase referral numbers to 80 patients in DY4. Increase referral numbers to 100 patients in DY5. Category 3 outcomes: IT 9.2 Our goal is to reduce COPD related visits to the Emergency Department by 3% in DY3, 6% in DY4, and 9% below the baseline by DY5. RHP Plan for Region 4 242

4 Project Title: Expand Specialty Care Capacity Pulmonary Rehabilitation Clinic Performing Provider: Jackson County Hospital District/ RHP Project Number: Project Description: This project will expand specialty care capacity in the Region by establishing a hospital-based outpatient pulmonary rehabilitation (OPR) clinic. The purpose of OPR is to enhance the ability of older adults with chronic obstructive pulmonary disease (COPD) to perform activities of daily living (ADL) and improve quality of life. Jackson County Hospital District will partner with the Diamond Healthcare Corporation to provide OPR services that are patient-centered, physician-directed, multidisciplinary (e.g. occupational therapy, respiratory therapy, social work, pharmacological review, nutrition, and nursing), and outcome oriented. Each patient who visits the clinic will receive an individualized treatment plan with short and long-term goals based on a comprehensive initial assessment. Typically, a course of OPR lasts six weeks with patients seen at the clinic two to three days per week. The OPR program will provide a combination of endurance training, rehabilitation, education, behavioral health and psychosocial support to patients with the ultimate goal of reducing disability and improving control over COPD symptoms. Currently the Region faces challenges in providing specialty care services to the community. Like most counties in the Region, Jackson County is a designated Medically Underserved Area and Health Professional Shortage Area 22. The low provider to patient ratio in the region results in many patients with COPD not having access to a necessary level of pulmonary care to adequately manage symptoms and reduce disability. A market analysis conducted by the Diamond Healthcare Corporation found that between 65 and 140 potential OPR patients in the areas served by Jackson County Hospital District are not receiving treatment 23. Consequently, these patients are at risk for acute exacerbations of their COPD which often necessitates emergency department utilization and hospitalization. Patient participation in OPR programs can significantly reduce acute care utilization and associated costs for rural hospital systems. 24 Project goals: Improve access to pulmonary rehabilitation for patients with COPD Increase the number of referrals of targeted patients to the OPR program Reduce emergency department utilization and hospitalization due to acute exacerbations of COPD Reduce patient disability and improve quality of life This project addresses the following regional goals: Improve specialty care capacity so that patients have timely access to necessary healthcare services provided in the most appropriate and cost-efficient setting Improve the provision and coordination of healthcare services for persons with chronic disease Five year expected outcome: Jackson County Hospital District anticipates that referrals of patients with COPD to the outpatient pulmonary rehabilitation clinic will increase by 8% over baseline by DY5. 22 U.S. Department of Health & Human Services, Health Resources and Services Administration 23 Diamond Healthcare Corporation, Jackson Healthcare Center Summary Market Analysis: Outpatient Pulmonary Rehabilitation Services, Rasekaba TM, Williams E, Hsu-Hage B. Can chronic disease management pulmonary rehabilitation program for COPD reduce acute rural hospital utilization? Chron Respir Dis. 2009;6(3): RHP Plan for Region 4 243

5 Starting Point/Baseline: Currently, Jackson County Hospital District does not have an OPR program. Therefore, the baseline for the number of patient referrals to the clinic is zero in DY2. Rationale: The OPR clinic will be located adjacent to Jackson County Hospital in Edna, Texas. Jackson County Hospital (JCH) is a 25-bed critical access hospital with a service area covering Jackson, Calhoun, Lavaca, Matagorda, Victoria, and Wharton counties. JCH is the sole hospital located in Jackson County which has a population of nearly 15, The median household income for the county is $38,137 with 16% of residents living at or below the poverty level. 26 Medicaid enrollment is 12% with 25% of enrollees qualifying as aged, blind, or disabled 27, the populations most likely to benefit from an expansion of pulmonary care services. The defined market for the OPR clinic is comprised of Jackson, Victoria, and Wharton counties. From 2005 to 2010, potentially preventable hospitalizations due to COPD in these counties totaled 1,379 at a cost of over $29 million. 28 As previously noted, participation in OPR programs by patients with COPD can reduce hospitalizations due to acute exacerbations of the disease. Because emphysema and chronic bronchitis become more prevalent with age, a majority of the clinic s patients are expected to come from the community s older adult and geriatric populations. According to the market analysis conducted by the Diamond Healthcare Corporation, approximately 27% of residents in the clinic s defined market area are 55 years of age or older. Furthermore, the portion of the population within this age range is expected to increase by 13% by Based on national prevalence rates for emphysema and chronic bronchitis, the estimated number of COPD cases in the defined market is approximately 760 with an estimated 265 to 340 of these patients being candidates for OPR. 30 Currently, there are four OPR programs located in, or adjacent to, the proposed OPR clinic service area, each with a maximum capacity of 50 patients. This suggests there are at least 65 to 140 individuals who would benefit from OPR and may currently be untreated. 31 Therefore, JCH s OPR clinic will fill a critical need to provide medically necessary care to individuals who currently lack access to these services. Project components: We propose to meet all of the required project components as follows: a) Increase service availability with extended hours. The clinic will operate during regular business hours Monday through Friday. Although evening and weekend hours will not be available initially, service availability is being substantially increased as previously there was no clinic. In the future, extended hours will be considered if it better meets the needs of our patients. 25 Texas State Data Center, Texas Population U.S. Census Bureau, Small Area Income and Poverty Estimates 2010 County Level Estimations; U.S. Census Bureau, American Community Survey, Texas Health and Human Services Commission 28 Texas Department of State Health Services, Potentially Preventable Hospitalizations County Profiles, Diamond Healthcare Corporation, Jackson Healthcare Center Summary Market Analysis: Outpatient Pulmonary Rehabilitation Services, Ibid. 31 Diamond Healthcare Corporation, Jackson Healthcare Center Summary Market Analysis: Outpatient Pulmonary Rehabilitation Services, RHP Plan for Region 4 244

6 b) Increase number of specialty clinic locations. As previously discussed, we will establish a new OPR clinic located adjacent to Jackson County Hospital. This will increase the number of OPR clinics in our three-county service area from four to five. c) Implement transparent, standardized referrals across the system. All providers and staff will be trained on the processes, guidelines, and technology for the referral of patients to the OPR clinic. d) Conduct quality improvement for project. This will be accomplished through the assessment of project impacts. Data will be collected on the number of referrals of patients to the clinic, number of patient encounters, and emergency department utilization due to COPD. This information will provide a measure of our success and identify areas in which we need to improve. Milestones and Metrics: P-11 Launch a specialty care clinic for pulmonary rehabilitation P-11.1 Establish specialty care clinic P-2 Train care providers and staff on processes, guidelines, and technology for referrals and consultations into selected medical specialties P-2.1 Training of staff and providers on referral guidelines, process and technology I-29 Increase number of referrals of targeted patients to the specialty care clinic I-29.1 Targeted referral rate Unique community need identification numbers: CN.1 Improve access to care for primary care and specialty services CN.2 Improve the provision and coordination of health care services for persons with chronic conditions Related Category 3 Outcome Measure: The selected Category 3 Outcome Measure for this project is IT-9.2 ED appropriate utilization for the targeted condition of COPD. In FY 2012, 520 patients with COPD accessed acute care services at Jackson County Hospital District. Many of these encounters may have been preventable with an appropriate level of outpatient care. Recent research has indicated that participation in a pulmonary rehabilitation program can reduce emergency department utilization by patients with COPD. 32 Relationship to other Projects: This project s focus on improving access to care also enhances care for chronic conditions and improves patient outcomes. The project also will assist patients in navigating the maze of difficult healthcare options, and will reduce health care costs while improving patient satisfaction. This project will enhance and support a number of other projects within the region, including the following: and Expand high impact specialty care in most impacted medical specialties and Expand primary care capacity through FZHC providers. Related Category 4 measures included potentially preventable admissions measures in RD-1, potentially preventable readmissions measures in RD-2, and patient satisfaction in RD Rasekaba TM, Williams E, Hsu-Hage B. Can chronic disease management pulmonary rehabilitation program for COPD reduce acute rural hospital utilization? Chron Respir Dis. 2009;6(3): RHP Plan for Region 4 245

7 Relationship to Other Performing Providers Projects and Plan for Learning Collaborative: We plan to participate in a region-wide learning collaborative(s) as offered by the Anchor entity for Region 4, Nueces County Hospital District. Our participation in this collaborative with other Performing Providers within the region that have similar projects will facilitate sharing of challenges and testing of new ideas and solutions to promote continuous improvement in our Region s healthcare system. Other Performing Providers with similar projects with which we will collaborate include Corpus Christi Medical Center and Christus Spohn. Project Valuation: When determining a value for expanding access to specialty care through an OPR clinic in Jackson County, we first determined the priority of this initiative to our community. As a critical access hospital in a Medically Underserved Community and Health Professional Shortage Area, the hospital is forced to use limited resources to serve a wide variety health conditions. When scarce medical resources are used it must be for the greater good of the most residents. And as in most rural communities, the demographic in Jackson County is older with nearly 30% of the population 55 years old or older. Utilizing the Office of Extramural Research, National Institute of Health model, we identified the impact of this project as a high level. The insufficient access to these services in our area, results in patients delayed diagnoses and treatment which leads to more serious health care conditions and higher costs; inappropriate utilization of emergency room facilities and higher costs; lack of care coordination and patient education. By providing access to pulmonary care locally, many older residents in need of treatment will be spared the expense and hardship of traveling 60 to 100 miles for pulmonary care. Finally, we calculated the tangible expenses of space, utilities, technology, supplies, equipment, physician recruitment and staffing to determine the total project value. Living in rural Texas, we are painfully aware of the challenges to attract physicians to our area. Therefore, recruitment and salary packages must be competitive and access to health care resources plentiful to grow programs and patient satisfaction. The building for the OPR program will be renovated, the service area informed, and staff recruited and trained in DY2. Operational guidelines and baseline referral numbers will be established in DY3. Patient referrals are projected to increase to 80 patients in DY4 and to 100 patients by DY5. RHP Plan for Region 4 246

8 UNIQUE IDENTIFIER: Related Category 3 Outcome Measure(s): Year 2 (10/1/2012 9/30/2013) Milestone 1 [P-11]: Launch a specialty care clinic for pulmonary rehabilitation Metric 1 : [P-11.1] Establish specialty care clinic Baseline/Goal: Open Clinic Data Source: Documentation of new specialty care clinic Milestone 1 Estimated Incentive Payment (maximum amount): $400,000 RHP PP REFERENCE NUMBER: PROJECT COMPONENTS: 1.9.2(A-D) EXPAND SPECIALTY CARE CAPACITY PULMONARY REHABILITATION CLINIC Jackson County Hospital District TPI IT-9.2 ED appropriate utilization Year 3 (10/1/2013 9/30/2014) Milestone 2[P-2] Train care providers and staff on processes, guidelines, and technology for referrals and consultations into selected medical specialties. Metric 1: [P-2.1] Training of staff and providers on referral guidelines, process and technology Baseline/Goal: 90% of expected goal/10 hospital staff Data Source: Log of specialty care personnel trained and curriculum for training Year 4 (10/1/2014 9/30/2015) Milestone 3 [I-29]: Increase number of referrals of targeted patients to the specialty care clinic Metric 1 [I-29.1]: Targeted referral rate Baseline/Goal: Increase referrals to at least 80 for the calendar year. Data Source: Registry and/or paper documentation as designated by Performing Provider Milestone 3 Estimated Incentive Payment: $300,000 Year 5 (10/1/2015 9/30/2016) Milestone 4 [I-29]: Increase number of referrals of targeted patients to the specialty care clinic Metric 1 [I-29.1]: Targeted referral rate Baseline/Goal: Increase referrals to at least 100 for the calendar year. Data Source: Registry and/or paper documentation as designated by Performing Provider Milestone 4 Estimated Incentive Payment: $400,000 Milestone 2 Estimated Incentive Payment: $200,000 Year 2 Estimated Milestone Bundle Amount: (add incentive payments amounts from each milestone): Year 3 Estimated Milestone Bundle Amount: $200,000 Year 4 Estimated Milestone Bundle Amount: $300,000 $400,000 TOTAL ESTIMATED INCENTIVE PAYMENTS FOR 4-YEAR PERIOD (add milestone bundle amounts over Years 2-5): $1.3 million Year 5 Estimated Milestone Bundle Amount: $400,000 RHP Plan for Region 4 247

9 Category 2 DSRIP Projects: Program Innovation & Redesign NONE SUBMITTED

10 Category 3 DSRIP Projects: Quality Improvements

11 Category 3: Quality Improvements Outcome Measure: IT-9.2 ED appropriate utilization Performing Provider: Jackson County Hospital District RHP Project Number: Performing Provider TPI: Outcome Measure Description: IT-9.2 ED appropriate utilization Reduce emergency department visits for target conditions: Chronic Obstructive Pulmonary Disease Process Milestones: DY2: P-2: Establish baseline rates Outcome Improvement Targets: DY3: IT-9.2: Reduce emergency department visits for COPD by 3% below baseline DY4: DY5: IT-9.2: Reduce emergency department visits for COPD by 6% below baseline IT-9.2: Reduce emergency department visits for COPD by 9% below baseline Rationale: Process milestone P-2 was selected due to the need to establish a baseline rate for emergency department visits due to chronic obstructive pulmonary disease. This will enable us to determine if we have successfully reduced emergency department visits and met our improvement targets in DY3-5. The improvement targets of reducing emergency department visits for COPD by 3% per year are based on the current rate of increase of COPD visits and the lack of specialty treatment for this condition in the county. The introduction of an outpatient pulmonary clinic within the proximity of the Emergency Department will result in a direct decrease in the number of patients with COPD related conditions in the Emergency Department. Outcome Measure Valuation: Jackson County Hospital District values each project based on the specific needs of the community, the projected impact on the health outcomes of the community, the level of advancement to the healthcare delivery system, and the time, effort, and clinical resources necessary to implement each project. RHP Plan for Region

12 In valuing this project, Jackson County took into account the extent to which the expansion of specialty care capacity would potentially meet the goals of the Waiver (support the development of a coordinated care delivery system, improve outcomes while containing costs, improve the healthcare infrastructure), the extent to which it will address the community needs, the population served, and the resources and cost necessary to implement the project. The expansion of specialty care capacity for COPD patients will promote and encourage patients to access care which will lead to better clinical outcomes for the community. We took these potential effects into account when considering the appropriate incentive payment value for this project. RHP Plan for Region

13 IT-9.2 ED Appropriate Utilization Jackson County Hospital District Related Category 1 or 2 Projects:: Starting Point/Baseline: TBD Year 2 (10/1/2012 9/30/2013) Process Milestone 2 [P-2]: Establish baseline rates Metric 1: Baseline/Goal: TBDData Source: Performing Provider records Process Milestone 1 Estimated Incentive Payment (maximum amount): $100,000 Year 3 (10/1/2013 9/30/2014) Outcome Improvement Target 1 [IT- 9.2]: ED Appropriate Utilization Improvement Target: Reduce emergency department visits for COPD by 3% below baseline Data Source: Hospital records Outcome Improvement Target 1 Estimated Incentive Payment: $125,000 Year 4 (10/1/2014 9/30/2015) Outcome Improvement Target 2 [IT- 9.2]: ED Appropriate Utilization Improvement Target: Reduce emergency department visits for COPD by 6% below baseline Data Source: Hospital records Outcome Improvement Target 2 Estimated Incentive Payment: $150,000 Year 5 (10/1/2015 9/30/2016) Outcome Improvement Target 3 [IT- 9.2]: ED Appropriate Utilization Improvement Target: Reduce emergency department visits for COPD by 9% below baseline Data Source: Hospital records Outcome Improvement Target 3 Estimated Incentive Payment: $200,000 Year 2 Estimated Outcome Amount: $100,000 Year 3 Estimated Outcome Amount: $125,000 Year 4 Estimated Outcome Amount: $150,000 Year 5 Estimated Outcome Amount: $200,000 TOTAL ESTIMATED INCENTIVE PAYMENTS FOR 4-YEAR PERIOD (add outcome amounts over DYs 2-5): $575,000 RHP Plan for Region

14 Category 4 DSRIP Projects: Population-Focused Improvements EXEMPT