Readmissions Review Committees

Transcription

1 Readmissions Review Committees Lindsay Holland, MHA Director, Care Transitions, Health Services Advisory Group (HSAG) Albert H. Lam, MD Palo Alto Foundation Medical Group (PAFMG) Geriatric Medicine Chair California Association of Long-Term Care Medicine (CALTCM) Board Member Tracie E. Murray, JD Administrator, Cedar Crest Nursing and Rehab Center May 23, 2018

2 How to Submit a Question 1. To submit a question, click on the Chat option at the top right of the presentation. 2. The Chat panel will open. 3. Indicate that you want to send a question to All Panelists. 4. Type your question in the box at the bottom of the panel. 5. Click on Send. To connect to the audio portion of the webinar, please have WebEx call you. Type message here 2

3 Reducing Readmissions Preparation Program Lindsay Holland, MHA Director, Care Transitions, HSAG

4 4 Thank you to our California Reducing Readmissions Preparation Program partners

5 Reducing Readmissions Preparation Program Goals: Improve nursing home staff knowledge on readmission interventions Assist nursing homes to create and strengthen their readmission prevention programs Help facilities be a preferred provider to your local hospitals Improve readmission rates by October

6 Congratulations! Facilities That Have Completed Phase 1 Driftwood Health Care and Wellness Center Freemont Healthcare Center Inglewood Health Care Center Palm Spring Healthcare and Rehabilitation Center Professional Post Acute Center Santa Monica Health Care Center Skyline Healthcare Center 6

7 Reduce Readmissions Sign up Today Complete commitment agreement: California Arizona Ohio 7

8 Phase 1: Starting the Journey Sign Up! Submit commitment agreement to participate Submit Reducing Readmissions Committee Roster Submit Nursing Home Readmission Pre-Assessment Submit QAPI Self-Assessment Survey Work with your Reducing Readmissions Committee to: Request and review available CMS 1 readmissions data to establish your baseline readmission rate Begin QAPI 2 and PIP 3 project to implement a readmission intervention 8 1. Centers for Medicare & Medicaid Services (CMS) 2. Quality Assurance Performance Improvement (QAPI) 3. Performance Improvement Project (PIP)

9 Nursing Home Readmission Assessment Work with your Reducing Readmissions Committee to complete the readmission assessment Focused on operational processes Pre-admission Admission/transfer from hospital Submit completed form online or scan and to your state contact:

10 Readmissions Review Committees Albert H. Lam, MD PAFMG Geriatric Medicine Chair CALTCM Board Member Tracie E. Murray, JD Administrator, Cedar Crest Nursing and Rehab Center 10

11 Objectives Demonstrate how to run a readmission review committee. Explore best practice nursing home presentation on how the INTERACT readmission review tool can be utilized. Discuss the importance of physician leadership in reducing preventable readmissions to the hospital. 11

12 Care Transitions in America

13 There s No Place Like Home Hospital SNF 1 Home Skilled nursing facility (SNF)

14 Achieving Maximum Adjustment in Chronic Illness Bessie Schless The author is a caseworker in the Social Service Department of the Montefiore Hospital, New York, NY [Social] Worker wondered if readmission to Montefiore were the answer, suggesting that the patient, in the light of the way the program at Montefiore had previously been interpreted to him, might see rehospitalization as an indication that he was ill. She saw admission at this time as fostering patient's dependency when he was still able to function outside the hospital. Journal of Social Casework 14

15 Expansion of Cooperative Relationships Between Hospitals and Nursing Homes Robert Morris, DSW Hospitals have often complained about conditions of care in nursing homes: that simple physical and nursing care is poor, that patients are admitted who might be better cared for elsewhere, that they are kept bedridden unnecessarily. Public Health Reports 15

16 Expansion of Cooperative Relationships Between Hospitals and Nursing Homes Robert Morris, DSW Nursing homes in turn have complained that hospitals are officious and authoritarian, that they refuse to share information about patients to be transferred or to plan in advance for their post-hospital care, that they refuse to help the homes do those realistic things which can raise the level of care and still be within the reach of institutions with limited staffs or within patients' ability to pay. Public Health Reports 16

17 Old People Leaving Hospital A Follow-Up of 200 Discharged Geriatric Patients J.C. Brocklehurst and Margaret Shergold Bromley and Sidecup Geriatric Service Two hundred geriatric patients discharged from hospital have been followed up for two years; one hundred of them were interviewed in depth. The readmission rate was high (26%). The Lancet 17

18 National Medicare Readmission Rates Started to Fall in

19 Affordable Care Act: Hospital Readmissions Reduction Program (HRRP) Payment Adjustment Factor Fiscal Year (FY) 2013 FY CMS HRRP Payment Adjustment Factor Formula. Service-Payment/AcuteInpatientPPS/Readmissions-Reduction-Program.html

20 Protecting Access to Medicare Act 2014: SNF VBP * Includes all SNFs under Prospective Payment System (PPS) payment model Calendar year (CY) 2015 Baseline period standardized readmission rate CY 2017 First performance period June 26, 2018 Last date to submit comments on CY 2019 payment model October 1, 2018 PPS payments reduced 2% CY 2019 Payments calculated according to CY 2017 Performance 20 *SNF VBP= Skilled nursing facility value-based purchasing

21 Cost and Benefits Table 1: Cost and Benefits Provision description Proposed FY 2019 SNF PPS payment rate update Proposed FY 2019 SNF VBP changes Total transfers The overall economic impact of this proposed rule would be an estimated increase of $850 million in aggregate payments to SNFs during FY The overall economic impact of the SNF VBP Program is an estimated reduction of $211 million in aggregate payments to SNFs during FY CMS VBP Program. VBPs/SNF-VBP.html, and 21

22 Reviewing Readmissions Together

23 CALTCM SNF 2.0 Train the Mentor Principles Principle 1: See every moment as a Teaching Moment, Principle 2: Promote Accountability in a "No shame, No blame" environment, Principle 3: Never allow someone to do a first situation, background, assessment, response (SBAR)/provider call alone, Principle 4: Learn to walk others through the process, and Principle 5: Show appreciation. Copyright SNF 2.0 All rights reserved. This training material may not be modified, adapted or reproduced in part or whole without express written consent of Albert Lam, MD. 23

24 Where Should the Focus Be? It s not what you expect, it s what you inspect. 24

25 Description of Review Team Nursing Facility Director of Nursing (DON) Administrator Minimum Data Set Coordinator Director of Staff Development Medical Director Outside Participants Physicians Hospital Readmission Team Home Health/Hospice (if appropriate) 25

26 The Review Process Patient readmission triggers review within 1 2 weeks DON gathers SBAR 1, Stop and Watch data, reviews with administrator and staff members, and completes INTERACT quality improvement (QI) tool/root cause analysis (RCA). Physician review and input follows Hospital readmissions team also sends list of patients for facility readmission review at the beginning of each month Situation, background, assessment, recommendation

27 Quality Improvement Tools For Review of Acute Care Transfers Section 1: Risk Factors for Hospitalization and Readmission Section 2: Describe the Acute Change in Condition and Other Non-Clinical Factors that Contributed to the Transfer Section 3: Describe Action(s) Taken to Evaluate and Manage the Change in Condition Prior to Transfer a. Briefly describe how the changes in Section 2 were evaluated and managed and check each item that applies Section 4: Describe the Hospital Transfer Section 5: Identify Opportunities for Improvement a. In retrospect, does your team think this transfer might have been prevented? No/Yes (describe) 27 INTERACT Program.

28 Challenges Priorities Time Timing Need to perform INTERACT QI Tool/RCA as close to the readmission as possible Team Aligning internal partners Hospitals do not all have robust readmission teams to help with external accountability 28

29 Outcomes 29 Source: Cedar Crest Nursing and Rehab Center

30 Keys to Success Tools INTERACT QI Tool/RCA Priorities Time Daily standup Monthly hospital review Team Internal partners: motivated, aligned External partners: strong, supportive 30

31 The Review Committee Wish List Emergency department communication and coordination Dialysis center coordination On-call physicians Home health agencies I wish 31

32 Questions? 32

33 Avoidability of Hospital Transfers of Nursing Home Residents: Perspectives of Frontline Staff 45% Lamb G, Tappen R, Diaz S, Hernon L, Ouslander JG 40% 39% 35% 30% 25% 28% 27% 30% 20% 15% 10% 5% 0% 18% 20% 18% 15% 12% 7% 7% 3% July August September October November December Engaged Minimally engaged 33 Journal of the American Geriatrics Society, Available at:

34 References Boccuti C, Casillas G. Aiming for Fewer Hospital U-turns: The Medicare Hospital Readmission Reduction Program. Kaiser Family Foundation Issue Brief Brocklehurst P. What happens when geriatric patients leave hospital? The Lancet CMS VBP Program. Initiatives-Patient-Assessment-Instruments/Value-Based- Programs/Other-VBPs/SNF-VBP.html INTERACT Program. Morris R. Expansion of cooperative relationships between hospitals and nursing homes. Public Health Reports Schless B. Achieving maximum adjustment in chronic illness. Journal of Social Casework

35 Register Now for Upcoming Webinars COACHING CALL RRPP Coaching Call Tuesday, June 5, noon PT CLINICAL SKILLS Change in Condition: Diabetes and Hypoglycemia Wednesday, June 27, a.m. 12 noon PT 35

36 Thank you! Lindsay Holland, MHA Director, Care Transitions, HSAG Albert H. Lam, MD Geriatrician, Board Member, CALTCM Tracie E. Murray, JD Administrator, Cedar Crest Nursing and Rehab Center

37 Disclaimer This material was prepared by Health Services Advisory Group, the Medicare Quality Improvement Organization for Arizona, California, Florida, Ohio, and the U.S. Virgin Islands, 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. Publication No. QN-11SOW-C