The Hospital Readmissions Puzzle: Where Does Nutrition Fit?
|
|
- Bathsheba Peters
- 6 years ago
- Views:
Transcription
1 The Hospital Readmissions Puzzle: Where Does Nutrition Fit? JOY W. DOUGLAS, PHD, RD, CSG, LD ASSISTANT PROFESSOR DEPARTMENT OF HUMAN NUTRITION THE UNIVERSITY OF ALABAMA
2 Outline CMS Readmissions Programs Overview: Hospital Readmissions Reduction Program (HRRP) Skilled Nursing Facility Value-Based Purchasing Program (SNF VBP) The Readmission Nutrition Link Strategies for Clinicians
3 Participant Learning Objectives Explain the differences between the Hospital Readmissions Reduction Program and the Skilled Nursing Facility Value-Based Purchasing Program Describe the link between hospital readmissions and poor nutritional status Generate 2 strategies they can implement in their facility to reduce hospital readmissions
4 Participant Poll What type of facility do you work in? -Hospital -Nursing Home -Rehabilitation Facility -Home Health Agency -Academia/Research -Other
5 The Hospital Readmissions Reduction Program 1,2 Result of the 2010 Affordable Care Act Goal: Improve quality of care and save taxpayer dollars by incentivizing providers to reduce excess readmissions Links payment to quality of hospital care Excess Readmissions = Poor quality of care Facilities can lose up to 3% of CMS reimbursement for all Medicare claims
6 The Hospital Readmissions Reduction Program 1,2 WHAT IS A READMISSION? Admission to an applicable hospital within 30 days of being discharged with an eligible diagnosis Readmission diagnosis and facility can vary ELIGIBLE DIAGNOSES? Acute MI Heart Failure Pneumonia COPD Elective primary THA or TKA CABG surgery *Includes ICD-9 & -10 codes
7 What s an Applicable Hospital? 1,2 General, acute care, short-stay hospitals (Subsection D) Maryland hospitals participating in the All-Payer Model, although financial penalties are not in place for FY 2018 Does not include: Long-term care hospitals Children s hospitals Psychiatric hospitals PPS-exempt cancer hospitals Rehabilitation hospitals and units Critical Access hospitals
8 How Are 30-Day Readmission Rates Measured? 1,2 Over a rolling 3-year period for Medicare beneficiaries: July 1, 2013 June 30, 2016 Each hospital receives an Excess Readmissions Ratio (ERR), comparing actual readmissions to predicted ones Lower ratios are better (<1.0); higher are worse (>1.0) Adjusted for case mix and patient risk factors Determine Medicare payments to facilities See Hospital Compare website:
9 Participant Poll How familiar are you with the Skilled Nursing Facility Value-Based Purchasing program? Not familiar at all Slightly familiar Moderately familiar Very familiar
10 The Hospital-SNF Relationship 3 20% of hospital Medicare patients D/C to SNFs 2017 Study: The SNF a patient is discharged to is a greater predictor of rehospitalization than the hospital they came from The SNF s operations directly impact their own finances, and those of the hospital Hospitals want to discharge patients to SNFs that have low rehospitalization rates establishing preferred provider networks with SNFs to partner in reducing readmissions
11 The Skilled Nursing Facility Value-Based Purchasing Program (SNF VBP) 4, Protecting Access to Medicare Act (PAMA) Takes effect in FY 2019 October 1, 2018 Measures all-cause rehospitalizations from a SNF within 30 days of hospital discharge Impacts SNFs paid under the Prospective Payment System (PPS) *Will transition to measuring 30-day potentially preventable readmissions as soon as it is practicable
12 The Skilled Nursing Facility Value-Based Purchasing Program (SNF VBP) 4,5 2% of Medicare reimbursement will be withheld from SNFs and given as incentives for top-performers Baseline period: January 1 December 31, 2015 Performance period: January 1 December 31, 2017 During the performance period, each facility will be compared to: Their own 2015 baseline period = Improvement score Other SNFs during the current period = Performance score
13 Scores will range Higher = better
14 Facility Score Reporting 5 Confidential, quarterly facility updates available in QIES and CASPER
15 Public Reporting: Nursing Home Compare 5
16 What does this have to do with nutrition?
17 Most Common Readmission Diagnoses 6 30-day Readmission Rate 30% 25% 20% 15% 10% 5% 25% 20% 18% 0% Heart Failure* Heart Attack* Pneumonia* *Condition has a direct connection to nutritional status
18 Common Causes of Readmission Among Older Adults in Long Term Care 7 Lung disease (COPD)* Low body weight or low BMI* Pressure ulcers* Diabetes* Cognitive impairment Depression Swallowing difficulties* Presence of a urinary catheter or feeding tube* Urinary tract infections* Increasing number of medications taken daily* *Condition/factor has a direct connection to nutritional status
19 The Readmission Nutrition Link: What Does All of This Mean? Nutrition is closely related to readmission risk Malnourished patients have higher readmission rates. 8,9 YOU can help reduce rehospitalizations!
20 Reducing Readmissions: Strategies for Clinicians Establish a Nutrition Support Team Designate a Nutrition Champion Upon Admission During Inpatient/Nursing Home Stay Preparing for Discharge Appropriate Use of Palliative Care
21 Establish A Nutrition Support Team 10 Interdisciplinary Nutrition Support Teams (NSTs) have been associated with improved nutrition-related outcomes. Advocate for the creation of an active interdisciplinary NST for the patients/residents in your facility. Include representatives from pharmacy, nursing, the therapies, etc.
22 Designate A Nutrition Champion 10 Designate a Nutrition Champion at the facility to provide increase awareness of the importance of nutrition, and to provide training to other disciplines. Champions can be nutrition specialist physicians, dietitians, and/or nurse leaders. Champions Champions would advocate, model, teach, and reinforce best-practice nutrition.
23 Upon Admission 11,12 Aggressively identify and treat malnutrition/undernutrition Use evidence-based, validated screening tools Mini Nutritional Assessment (MNA) Malnutrition Screening Tool (MST) Malnutrition Universal Screening Tool (MUST) Nutrition Risk Screening 2002 (NRS-2000) Short Nutritional Assessment Questionnaire (SNAQ)
24 Upon Admission 11,12 Implement interventions promptly Consider nutritional protocols that nursing staff can immediately implement upon admission, when indicated Study by Sulo et al (2017): Nurses screened patients using the MST upon admission If score 2, oral nutrition supplements were automatically ordered in EMR Estimated readmissions cost savings of $310,061 for 769 patients ($403 per patient), and reduced hospital length of stay by 0.6 days per patient
25 During Inpatient/Nursing Home Stay 13 Try innovative approaches to improve oral intake Hydration Programs To reduce readmissions for dehydration and UTIs Hydration stations with fruit and herb-infused beverages, served in clear dispensers Display in common areas and serve during activities
26 During Inpatient/Nursing Home Stay 13 Try innovative approaches to improve oral intake Appetizing pureed foods To combat poor intake among those with dysphagia Use food molds and piping sets to make food visually appealing One Michigan facility saw unplanned wt. loss decrease from 3.7% to 1.3% after implementing a pureed foods program
27 During Inpatient/Nursing Home Stay 13 Fortified Foods Program To reduce readmissions related to weight loss, anorexia, pressure ulcers, and debility Replace liquid nutrition supplements with fortified menu items Examples: fortified smoothies, super cereal, fortified mashed potatoes, etc. Will also help to reduce nutrition supplement costs
28 Preparing for Discharge Coordination of Care Address food insecurity before discharging patients/residents back into the community
29 Coordination of Care 10 Malnutrition is a risk factor for readmission, so providing for adequate nutrition care after discharge is essential. Discharging individuals without planning for how to continue their interventions and plan of care causes fragmented care. Fragmented care wastes as much as $25-45 billion annually, and leads to increased readmission rates, complications, and decreased independence and functional ability for patients. Fragmented care example: A complicated tube-fed patient with documented intolerances to multiple formulas is transferred to a rehab facility. Rehab facility RD receives no nutrition information about the patient upon admission. Rehab RD then spends 7 days trying various feeding formulas and regimens to find something that the patient can tolerate.
30 Coordination of Care 10 Things to think about: Where is this patient going after discharge? Are your nutrition interventions appropriate and realistic for the patient to continue after leaving your facility? Does the facility they are going to next have a dietitian? Can the next facility continue your nutrition care plan? Can you communicate with the healthcare team who will be caring for this patient after discharge?
31 Addressing Food Insecurity 14,15 As of 2010, an estimated 5.6 million older adults either lived below the poverty level, or were considered near poor (<125% of the poverty level) Food insecurity is associated with hospital admissions Greatest risk: older minorities and older females Before discharge home, assess whether patients have access to adequate food to meet their needs
32 Addressing Food Insecurity 14 Food Insecurity Programs Healthy Food Prescriptions MD rx provides vouchers to pay for healthy food options, primarily fruits and vegetables Multiple programs in pilot stages in the U.S. Funded by health systems, or by community agencies Medically Tailored Meals Dx-specific meals planned by RDs, delivered to the patient s home Funded by Medicaid as part of the waiver program Nutrition champion: advocate for your facility to participate in programs that connect at-risk patients with community resources to ensure adequate nutrition.
33 Appropriate Use of Palliative Care 16,17 Palliative care is: A team-based approach, focusing on improving the patient s overall quality of life through: Symptom management Clarifying the priorities of the patient Matching treatments to the patient s goals Appropriate for any age and any stage of serious disease Compatible with curative treatment, and can be provided at the same time
34 Appropriate Use of Palliative Care 16,17 Palliative care is NOT: Limited to those with a life expectancy of < 6 months Hospice care Giving up on a patient; rather, it focuses on identifying and meeting the needs and wishes of the patient
35 Appropriate Use of Palliative Care 16,17 Active palliative care programs are associated with: patient quality of life patient and family satisfaction with care hospital readmission rates health care costs Without palliative care, older adults with terminal conditions are subjected to: hospital readmissions Medical interventions and procedures that quality of life
36 Palliative Care: How Do We Get There? 16,17,18 Designate a Palliative Care Champion at your facility Train staff members on the components and purpose of palliative care Educate family members on palliative care Use a team approach to clearly define the patient s goals of care Improve communication between the patient, their family members, and the health care team members Collaborate with palliative care teams at local hospitals
37 Figure 1 from Tappenden et al (2013)
38 Figure 3 from Tappenden et al (2013)
39 References 1. Centers for Medicare & Medicaid Services. Hospital Readmissions Reduction Program - Frequently Asked Questions - Fiscal Year QualityNet website. er2&cid= Accessed February 22, Centers for Medicare & Medicaid Services. Hospital Readmissions Reduction Program: Fiscal Year 2018 Fact Sheet. QualityNet website. er2&cid= Accessed February 22, Rahman M, McHugh J, Gozalo PL, Ackerly DC, Mor V. The contribution of skilled nursing facilities to hospitals readmission rate. Health Services Research. 2017;52(2): Centers for Medicare & Medicaid Services. The Skilled Nursing Facility Value-Based Purchasing Program (SNF VBP). Centers for Medicare & Medicaid Services Website. Programs/Other-VBPs/SNF-VBP.html Last updated December 20, Accessed February 22, Medicare Learning Network. Skilled Nursing Facility (SNF) Value-Based Purchasing (VBP) Program Fiscal Year (FY) 2018 Final Rule. Education/Outreach/NPC/Downloads/ SNF-VBP-Presentation.pdf Presented November 16, Accessed February 22, 2018.
40 References 6. Dharmarajan K, Hsieh AF, Krumholz HM, et al. Diagnoses and timing of 30-day readmissions after hospitalization for heart failure, acute myocardial infarction, or pneumonia. Journal of the American Medical Association. 2013;309(4): Dwyer R, Stoelwinder J, Gabbe B, Lowthian J. Unplanned transfer to emergency departments for frail elderly residents of aged care facilities: a review of patient and organizational factors. Journal of the American Medical Directors Association. 2015;16(7): Agarwal E, Ferguson M, Isenring E, et al. Malnutrition and poor food intake are associated with prolonged hospital stay, frequent readmissions, and greater in-hospital mortality: Results from the Nutrition Care Day Survey Clinical Nutrition. 2013;32: Fingar KR, Weiss AJ, Barrett ML, Elixhauser A, Steiner CA, Guenter P, et al. All-cause readmissions following hospital stays for patients with malnutrition, HCUP Statistical Brief #218. December Agency for Healthcare Research and Quality, Rockville, MD. Accessed March 21, Rosen B, Maddox P, Ray N. A position paper on how cost and quality reforms are changing healthcare in America: focus on nutrition. Journal of Parenteral and Enteral Nutrition. 2013;37(6): Sulo S, Feldstein J, Partridge J, Schwander B, Sriram K, Summerfelt W. Budget Impact of a Comprehensive Nutrition-Focused Quality Improvement Program for Malnourished Hospitalized Patients. American Health & Drug Benefits. 2017;10(5):
41 References 12. Tappenden K, Quatrara B, Parkhurst M, Malone A, Fanjiang G, Ziegler T. Critical Role of Nutrition in Improving Quality of Care: An Interdisciplinary Call to Action to Address Adult Hospital Malnutrition. Journal of the Academy of Nutrition and Dietetics. 2013;113(9): LaVecchia-Ragone G. Using nutrition to battle readmissions. Long-Term Living: For The Continuing Care Professional. 2014;63(1): Swinburne M, Garfield K, Wasserman A. Reducing Hospital Readmissions: Addressing the Impact of Food Security and Nutrition. Journal Of Law, Medicine & Ethics. 2017;45(S1): Bernstein M, Munoz N. Position of the Academy of Nutrition and Dietetics: Food and Nutrition for Older Adults: Promoting Health and Wellness. Journal of the Academy of Nutrition and Dietetics. 2012;112(8): Silvers A, Rogers M. Minimizing Readmission Penalties with Palliative Care. Hfm (Healthcare Financial Management) [serial online]. March 2018: Giuffrida J. Palliative Care in Your Nursing Home: Program Development and Innovation in Transitional Care. Journal Of Social Work In End-Of-Life & Palliative Care. 2015;11(2):
42 References 18. Cherlin E, Brewster A, Curry L, Canavan M, Hurzeler R, Bradley E. Interventions for Reducing Hospital Readmission Rates: The Role of Hospice and Palliative Care. American Journal Of Hospice & Palliative Medicine. 2017;34(8):
43 Questions?
Outline. The Hospital Readmissions Puzzle: Where Does Nutrition Fit? Participant Poll. Participant Learning Objectives 3/26/2018
The Hospital Readmissions Puzzle: Where Does Nutrition Fit? JOY W. DOUGLAS, PHD, RD, CSG, LD ASSISTANT PROFESSOR DEPARTMENT OF HUMAN NUTRITION THE UNIVERSITY OF ALABAMA Outline CMS Readmissions Programs
More informationIntroduction to the Malnutrition Quality Improvement Initiative (MQii)
Introduction to the Malnutrition Quality Improvement Initiative (MQii) 1 Overview The Case for Malnutrition Quality Improvement Background on the Malnutrition Quality Improvement Initiative (MQii) The
More informationMalnutrition Quality Improvement Opportunities for the District Hospital Leadership Forum. May 2015 avalere.com
Malnutrition Quality Improvement Opportunities for the District Hospital Leadership Forum May 2015 avalere.com Malnutrition Has a Significant Impact on Patient Outcomes MALNUTRITION IS ASSOCIATED WITH
More informationSNF * Readmissions Bootcamp The SNF Readmission Penalty, Post-Acute Networks, and Community Collaboratives
SNF * Readmissions Bootcamp The SNF Readmission Penalty, Post-Acute Networks, and Community Collaboratives Lindsay Holland, MHA Associate Director, Care Transitions Health Services Advisory Group (HSAG)
More informationIntroduction to the Malnutrition Quality Improvement Initiative (MQii)
Introduction to the Malnutrition Quality Improvement Initiative (MQii) Presentation Outline Business Case for the Malnutrition Quality Improvement Initiative (MQii) Background on the MQii and Learning
More informationProgram Summary. Understanding the Fiscal Year 2019 Hospital Value-Based Purchasing Program. Page 1 of 8 July Overview
Overview This program summary highlights the major elements of the fiscal year (FY) 2019 Hospital Value-Based Purchasing (VBP) Program administered by the Centers for Medicare & Medicaid Services (CMS).
More informationMQii Malnutrition Knowledge and Awareness Test
MQii Malnutrition Knowledge and Awareness Test This test intends to assess hospital staff members knowledge of the impact of malnutrition and importance of optimal malnutrition care practices, specifically
More informationSet Yourself Up for Success: How VBP is Changing the Game NYSHFA January 26, 2018 Presented by, Maureen McCarthy, RN, BS, RAC-MT, QCP-MT
Set Yourself Up for Success: How VBP is Changing the Game NYSHFA January 26, 2018 Presented by, Maureen McCarthy, RN, BS, RAC-MT, QCP-MT 1 Maureen McCarthy, RN, BS, RAC-MT, QCP-MT 2 Maureen is the President
More informationTroubleshooting Audio
Welcome! Audio for this event is available via ReadyTalk Internet Streaming. No telephone line is required. Computer speakers or headphones are necessary to listen to streaming audio. Limited dial-in lines
More informationHospital Inpatient Quality Reporting (IQR) Program
Fiscal Year 2018 Hospital VBP Program, HAC Reduction Program and HRRP: Hospital Compare Data Update Questions and Answers Moderator Maria Gugliuzza, MBA Project Manager, Hospital Value-Based Purchasing
More informationWelcome to the Reducing Readmissions Preparation Program: Understanding Changes in Readmission Measures for Nursing Homes
Welcome to the Reducing Readmissions Preparation Program: Understanding Changes in Readmission Measures for Nursing Homes Lindsay Holland, MHA Director, Care Transitions, HSAG California Jennette Silao,
More informationHospital Inpatient Quality Reporting (IQR) Program
Hospital Readmissions Reduction Program Early Look Hospital-Specific Reports Questions and Answers Transcript Speakers Tamyra Garcia Deputy Division Director Division of Value, Incentives, and Quality
More informationRehospitalizations: How Do You Measure Up?
Rehospitalizations: How Do You Measure Up? National Nursing Home Quality Care Collaborative (NNHQCC) Health Services Advisory Group (HSAG) Today s Objectives Recognize the role skilled nursing facilities
More informationThe Role of Analytics in the Development of a Successful Readmissions Program
The Role of Analytics in the Development of a Successful Readmissions Program Pierre Yong, MD, MPH Director, Quality Measurement & Value-Based Incentives Group Centers for Medicare & Medicaid Services
More informationReadmission Program. Objectives. Todays Inspiration 9/17/2018. Kristi Sidel MHA, BSN, RN Director of Quality Initiatives
The In s and Out s of the CMS Readmission Program Kristi Sidel MHA, BSN, RN Director of Quality Initiatives Objectives General overview of the Hospital Readmission Reductions Program Description of measures
More informationFinal Rule Summary. Medicare Skilled Nursing Facility Prospective Payment System Fiscal Year 2017
Final Rule Summary Medicare Skilled Nursing Facility Prospective Payment System Fiscal Year 2017 August 2016 Table of Contents Overview and Resources... 2 Skilled Nursing Facility (SNF) Payment Rates...
More informationQuality Outcomes and Data Collection
Quality Outcomes and Data Collection Presented By: Joanne Jones Director, Clinical Consulting Services August 30, 2016 Quality Measurement in LTC CMS Nursing Home Compare 5 Star Rating System New measures
More informationUnderstanding Hospital Value-Based Purchasing
VBP Understanding Hospital Value-Based Purchasing Updated 12/2017 Starting in October 2012, Medicare began rewarding hospitals that provide high-quality care for their patients through the new Hospital
More informationwith Food, Nutrition, and Dining
by Brenda Richardson, MA, RDN, LD, CD, FAND 1 HOUR CE CBDM Approved Reducing Hospital Admissions with Food, Nutrition, and Dining NUTRITION CONNECTION FOOD, NUTRITION, AND DINING ARE INTEGRAL COMPONENTS
More informationReducing Preventable Hospital Readmissions in Post Acute Care Kim Barrows RN BSN
Reducing Preventable Hospital Readmissions in Post Acute Care Kim Barrows RN BSN Session Objectives At the end of the session the learner will be able to: 1. Discuss the history of hospital readmission
More informationPHCA Webinar January 30, Latsha Davis & McKenna, P.C. Kimber L. Latsha, Esq.
PHCA Webinar January 30, 2014 Latsha Davis & McKenna, P.C. Kimber L. Latsha, Esq. 1 2 Intended to: Encourage the development of ACOs in Medicare Promotes accountability for a patient population and coordinates
More informationThe President s and Other Bipartisan Proposals to Reform Medicare: Post-Acute Care (PAC) Reform. Summary
Current Law The President s and Other Bipartisan Proposals to Reform Medicare: Post-Acute Care (PAC) Reform Summary Home Health Agencies Under current law, beneficiaries who are generally restricted to
More informationAugust 1, 2012 (202) CMS makes changes to improve quality of care during hospital inpatient stays
DEPARTMENT OF HEALTH & HUMAN SERVICES Centers for Medicare & Medicaid Services Room 352-G 200 Independence Avenue, SW Washington, DC 20201 FACT SHEET FOR IMMEDIATE RELEASE Contact: CMS Media Relations
More informationCMS Initiative to Reduce Avoidable Hospitalizations Among Nursing Facility Residents Phase 2--Payment Model
CMS Initiative to Reduce Avoidable Hospitalizations Among Nursing Facility Residents Phase 2--Payment Model The Revolving Door One fourth of all nursing home resident go the hospital each year - Some many
More informationCMS QUALITY MEASURES, COULD MEAN TO YOU MALNUTRITION, AND WHAT IT. Part I of Nutrition Division Webinar Series
CMS QUALITY MEASURES, MALNUTRITION, AND WHAT IT COULD MEAN TO YOU Part I of Nutrition Division Webinar Series Welcome! During the webinar, the phone lines will be muted. There will be a 15 minute Q&A session
More informationBowling Green State University Dietetic Internship Program
Rotation: Acute Care Pre-rotation check-list Readings completed Complete quizzes Bowling Green State University Dietetic Internship Program Nutrition Care Process Worksheet printed and ed Review formal
More informationMEDICARE FFY 2017 PPS PROPOSED RULES OVERVIEW OHA Finance/PFS Webinar Series. May 10, 2016
MEDICARE FFY 2017 PPS PROPOSED RULES OVERVIEW 2016 OHA Finance/PFS Webinar Series May 10, 2016 Spring is Medicare PPS Proposed Rules Season Inpatient Hospital Long-Term Acute Care Hospital Inpatient Rehabilitation
More informationCMS Proposed SNF Payment System -- Resident Classification System: Version I (RCS-1)
CMS Proposed SNF Payment System -- Resident Classification System: Version I (RCS-1) Ohio Health Care Association Mike Cheek, Senior Vice President, Reimbursement Policy October 3, 2017 Background 1 FY18
More informationMaryland Medicaid Program. Aaron Larrimore Medicaid Department of Health and Mental Hygiene May 31, 2012
Maryland Medicaid Program Aaron Larrimore Medicaid Department of Health and Mental Hygiene May 31, 2012 1 Maryland Medicaid In Maryland, Medicaid is also called Medical Assistance or MA. MA is a joint
More informationFactors that Impact Readmission for Medicare and Medicaid HMO Inpatients
The College at Brockport: State University of New York Digital Commons @Brockport Senior Honors Theses Master's Theses and Honors Projects 5-2014 Factors that Impact Readmission for Medicare and Medicaid
More informationJanuary 4, Via Electronic Mail to file code CMS-3317-P
701 Pennsylvania Ave., NW, Suite 800 Washington, DC 20004-2654 Tel: 202 783 8700 Fax: 202 783 8750 www.advamed.org Via Electronic Mail to file code CMS-3317-P Andrew M. Slavitt Acting Administrator Centers
More informationMedicare P4P -- Medicare Quality Reporting, Incentive and Penalty Programs
Medicare P4P -- Medicare Quality Reporting, Incentive and Penalty Programs Presenter: Daniel J. Hettich King & Spalding; Washington, DC dhettich@kslaw.com 1 I. Introduction Evolution of Medicare as a Purchaser
More informationFlorida Health Care Association 2013 Annual Conference
Florida Health Care Association 2013 Annual Conference The Westin Diplomat Resort & Spa Session #53 Assess and Educate to Prevent Rehospitalizations Thursday, August 8 10:00 to 11:30 a.m. Regency 1 Upon
More informationImproving Resident Care: A look at CMS quality of care initiatives
Improving Resident Care: A look at CMS quality of care initiatives W H I T E P A P E R by Diane L. Brown dbrown@hcpro.com What do reduction in rehospitalization, caring for dementia patients and preventing
More informationTransitioning Care to Reduce Admissions and Readmissions. Sven T. Berg, MD, MPH Julie Mobayed RN, BSN, MPH
Transitioning Care to Reduce Admissions and Readmissions Sven T. Berg, MD, MPH Julie Mobayed RN, BSN, MPH Disclaimer: Potential for Error Type One Error Rejecting the null hypothesis when it is true
More informationPatient Driven Payment Model (PDPM) and the MDS: A Total Evolution of the SNF Payment Model
Patient Driven Payment Model (PDPM) and the MDS: A Total Evolution of the SNF Payment Model By Devin Kassi, PT, DPT, and Melissa Keiter, RN, RAC-CT, DNS-CT, DON Centers for Medicare & Medicaid Services
More informationINTERACT 4 Patty Abele, FNP BC
INTERACT 4 Patty Abele, FNP BC (No relevant financial relationships to disclose) TODAY WE WILL Identify the risks and disadvantages associated with avoidable hospitalizations Identify the goals of the
More informationMEDICARE UPDATES: VBP, SNF QRP, BUNDLING
MEDICARE UPDATES: VBP, SNF QRP, BUNDLING PRESENTED BY: ROBIN L. HILLIER, CPA, STNA, LNHA, RAC-MT ROBIN@RLH-CONSULTING.COM (330)807-2850 MEDICARE VALUE BASED PURCHASING 1 PROTECTING ACCESS TO MEDICARE ACT
More information2017 Quality Reporting: Claims and Administrative Data-Based Quality Measures For Medicare Shared Savings Program and Next Generation ACO Model ACOs
2017 Quality Reporting: Claims and Administrative Data-Based Quality Measures For Medicare Shared Savings Program and Next Generation ACO Model ACOs June 15, 2017 Rabia Khan, MPH, CMS Chris Beadles, MD,
More informationCMS Proposed Payment Rule FY Cheryl Phillips, MD Evvie Munley
CMS Proposed Payment Rule FY 2017 Cheryl Phillips, MD Evvie Munley Key Points The link for the full rule: https://www.gpo.gov/fdsys/pkg/fr-2016-04- 25/pdf/2016-09399.pdf Comments due CoB 6/20/16 You do
More informationTRANSITIONS of CARE. Francis A. Komara, D.O. Michigan State University College of Osteopathic Medicine
TRANSITIONS of CARE Francis A. Komara, D.O. Michigan State University College of Osteopathic Medicine 5-15-15 Objectives At the conclusion of the presentation, the participant will be able to: 1. Improve
More informationSTRATEGIES AND SOLUTIONS FOR REDUCING INAPPROPRIATE READMISSIONS
WHITE PAPER STRATEGIES AND SOLUTIONS FOR REDUCING INAPPROPRIATE READMISSIONS This paper offers a two-pronged approach to lower readmission rates and avoid Federal penalties. Jasen W. Gundersen, M.D., M.B.A.,
More information3/19/2013. Medicare Spending Per Beneficiary: The New Link Between Acute and Post Acute Providers
The New Link Between Acute and Post Acute Providers Carol Quiring, RN President and CEO, Home Care and Hospice Saint Luke s Health System Shauna Thompson, RHIT Senior Director, Quality & Patient Safety
More informationP4P Programs 9/13/2013. Medicare P4P Programs. Medicaid P4P Programs
P4P Programs Medicare P4P Programs Hospital Quality Reporting Programs (IQR and OQR) Hospital Value-Based Purchasing (VBP) Program Hospital Readmissions Reduction Program (HRRP) Hospital-Acquired Conditions
More informationBased on the comprehensive assessment of a resident, the facility must ensure that:
7. QUALITY OF CARE Each resident must receive, and the facility must provide, the necessary care and services to attain or maintain the highest practicable physical, mental and psychosocial wellbeing,
More informationHealthy Aging Recommendations 2015 White House Conference on Aging
Healthy Aging Recommendations 2015 White House Conference on Aging Chronic diseases are the leading causes of death and disability in the U.S. and account for 75% of the nation s health care spending.
More informationDeborah Perian, RN MHA CPHQ. Reduce Unplanned Hospital Admissions: Focus on Patient Safety
Deborah Perian, RN MHA CPHQ Reduce Unplanned Hospital Admissions: Focus on Patient Safety Objectives At the end of this lesson, the learner will be able to: Identify key clinical and policy issues associated
More informationHospital Readmissions
Hospital Readmissions The Long-Term Care Provider s Ultimate Survival Guide to Incorporating INTERACT TM Into Health Information Technology (HIT) In this survival guide, we ll give you the tips you need
More informationGoing The Distance To Improve The Care Span: The Duel Over The Dual Eligibles And The Implications For Health Reform
+ Going The Distance To Improve The Care Span: The Duel Over The Dual Eligibles And The Implications For Health Reform By Susan Dentzer Editor in Chief, Health Affairs Presentation to the First National
More informationCare Transitions: Don t Lose Your Patients
Care Transitions: Don t Lose Your Patients Sabrina Edgington, MSSW Program and Policy Specialist National Health Care for the Homeless Council March 14, 2013 CARE TRANSITIONS Definition The movement of
More information3/14/2014. Preventing Rehospitalizations How to Change Your When in Doubt, Send em Out Way of Thinking. Objectives. Background Information
Preventing Rehospitalizations How to Change Your When in Doubt, Send em Out Way of Thinking Jennifer Moore, RN Content Developer Objectives Describe two reasons why returns to the hospital are not desirable
More informationWebinar. Reducing Readmissions with BI and Analytics. 23 March 2018 Copyright 2016 AAJ Technologies All rights reserved.
Webinar Reducing Readmissions with BI and Analytics Copyright Reducing 2016 Readmissions AAJ Technologies with BI and All rights Analytics reserved. www.aajtech.com Hospital Readmissions Michele Russell,
More informationRegulatory Advisor Volume Eight
Regulatory Advisor Volume Eight 2018 Final Inpatient Prospective Payment System (IPPS) Rule Focused on Quality by Steve Kowske WEALTH ADVISORY OUTSOURCING AUDIT, TAX, AND CONSULTING 2017 CliftonLarsonAllen
More informationSession Objectives 10/27/2014. How Can I get Beyond the Basics of Hospital Readmission and Become a Preferred Provider? Kim Barrows RN BSN
How Can I get Beyond the Basics of Hospital Readmission and Become a Preferred Provider? Kim Barrows RN BSN Session Objectives At the end of the session the learner will be able to: 1. Discuss the history
More informationWhat s Happening in the Nursing Home? Cherry Meier, RN, MSN, NHA Vice President of Public Affairs
What s Happening in the Nursing Home? Cherry Meier, RN, MSN, NHA Vice President of Public Affairs Objectives Describe the benefits of partnering with hospice Explain the regulations for the interface between
More informationSummary of U.S. Senate Finance Committee Health Reform Bill
Summary of U.S. Senate Finance Committee Health Reform Bill September 2009 The following is a summary of the major hospital and health system provisions included in the Finance Committee bill, the America
More informationSNF REHOSPITALIZATIONS
SNF REHOSPITALIZATIONS David Gifford MD MPH SVP Quality & Regulatory Affairs National Readmission Summit Arlington VA Dec 6 th, 2013 Use of Long Term Care Services 19% 4 35% 2 20% 1 23% 1 20% 3 1. Mor
More informationReducing Readmissions: Potential Measurements
Reducing Readmissions: Potential Measurements Avoid Readmissions Through Collaboration October 27, 2010 Denise Remus, PhD, RN Chief Quality Officer BayCare Health System Overview Why Focus on Readmissions?
More informationNew Models in Payment: Joint Replacements. Sharon Eloranta, MD February 18, 2016
New Models in Payment: Joint Replacements Sharon Eloranta, MD February 18, 2016 Qualis Health A leading national population health management organization The Medicare Quality Innovation Network - Quality
More informationHOSPITAL QUALITY MEASURES. Overview of QM s
HOSPITAL QUALITY MEASURES Overview of QM s QUALITY MEASURES FOR HOSPITALS The overall rating defined by Hospital Compare summarizes up to 57 quality measures reflecting common conditions that hospitals
More informationThe Pharmacist s Role in Reducing Readmissions
The Pharmacist s Role in Reducing Readmissions John Vinson, Pharm.D. UAMS West Family Medical Center Fort Smith, Arkansas Assistant Professor Co-Chair Clinical Leadership Committee UAMS Regional Programs
More informationTransitions of Care: From Hospital to Home
Transitions of Care: From Hospital to Home Danielle Hansen, DO, MS (Med Ed) Associate Director, LECOM VP Acute Care Services & Quality/Performance Improvement, Millcreek Community Hospital Objectives Discuss
More informationClinical Documentation: Beyond The Financials Cheryll A. Rogers, RHIA, CDIP, CCDS, CCS Senior Inpatient Consultant 3M HIS Consulting Services
Clinical Documentation: Beyond The Financials Cheryll A. Rogers, RHIA, CDIP, CCDS, CCS Senior Inpatient Consultant 3M HIS Consulting Services Clinical Documentation: Beyond The Financials Key Points of
More informationVNAA BLUEPRINT FOR EXCELLENCE BEST PRACTICES TO REDUCE HOSPITAL ADMISSIONS FROM HOME CARE. Training Slides
VNAA BLUEPRINT FOR EXCELLENCE BEST PRACTICES TO REDUCE HOSPITAL ADMISSIONS FROM HOME CARE Training Slides 061015 Why Take Action to Prevent Readmissions? Better patient care and patient experience Home
More informationDialogue Proceedings / Advancing Patient-Centered Malnutrition Care Transitions
Dialogue Proceedings / Advancing Patient-Centered Malnutrition Care Transitions Dialogue Proceedings / Advancing Patient-Centered Malnutrition Care Transitions As people age, their health needs are likely
More informationCMS Quality Program- Outcome Measures. Kathy Wonderly RN, MSEd, CPHQ Consultant Developed: December 2015 Revised: January 2018
CMS Quality Program- Outcome Measures Kathy Wonderly RN, MSEd, CPHQ Consultant Developed: December 2015 Revised: January 2018 Philosophy The Centers for Medicare and Medicaid Services (CMS) is changing
More informationQuality Based Impacts to Medicare Inpatient Payments
Quality Based Impacts to Medicare Inpatient Payments Overview New Developments in Quality Based Reimbursement Recap of programs Hospital acquired conditions Readmission reduction program Value based purchasing
More informationValue Based Care in LTC: The Quality Connection- Phase 2
Value Based Care in LTC: The Quality Connection- Phase 2 Joseph J. Tomaino, M.S., R.N., Principal Healthcare Transformation Consulting ChemRx/PharmMerica Geriatric Skilled Nursing Seminar December 7, 2017
More informationWhat is SNF Value Based Purchasing?
SNF Value Based Purchasing How reducing rehospitalizations impacts revenue and margins James Muller, Senior Director of Research, AHCA Marinela Shqina, Chief Financial Officer, Manchester and Vernon Manor
More informationHOSPITAL READMISSION REDUCTION STRATEGIC PLANNING
HOSPITAL READMISSION REDUCTION STRATEGIC PLANNING HOSPITAL READMISSIONS REDUCTION PROGRAM In October 2012, CMS began reducing Medicare payments for Inpatient Prospective Payment System (IPPS) hospitals
More informationNational Provider Call: Hospital Value-Based Purchasing
National Provider Call: Hospital Value-Based Purchasing Fiscal Year 2015 Overview for Beneficiaries, Providers, and Stakeholders Centers for Medicare & Medicaid Services 1 March 14, 2013 Medicare Learning
More informationFinal Rule Summary. Medicare Skilled Nursing Facility Prospective Payment System Fiscal Year 2016
Final Rule Summary Medicare Skilled Nursing Facility Prospective Payment System Fiscal Year 2016 August 2015 Table of Contents Overview and Resources... 2 SNF Payment Rates... 2 Effect of Sequestration...
More informationMedical Management. G.2 At a Glance. G.3 Procedures Requiring Prior Authorization. G.5 How to Contact or Notify Medical Management
G.2 At a Glance G.3 Procedures Requiring Prior Authorization G.5 How to Contact or Notify Medical Management G.6 When to Notify Medical Management G.11 Case Management Services G.14 Special Needs Services
More informationAN OPPORTUNITY TO INTEGRATE NUTRITION SERVICES IN YOUR LOCAL HEALTHCARE SYSTEM
AN OPPORTUNITY TO INTEGRATE NUTRITION SERVICES IN YOUR LOCAL HEALTHCARE SYSTEM KIMBERLY K. DELP, RN BSN January 26, 2017 AN OPPORTUNITY TO INTEGRATE NUTRITION SERVICES IN YOUR LOCAL HEALTHCARE SYSTEM 1
More informationHospital Readmission Reduction: Not Just Nursing s Job
Hospital Readmission Reduction: Not Just Nursing s Job David Farrell, LNHA, MSW Affordable Care Act - Three Aims Better patient experience Better outcomes Lower costs 1 Linking Payments to Quality Outcomes
More informationBeyond the Hospital Walls: Impact of a SNFist Practice Model
Beyond the Hospital Walls: Impact of a SNFist Practice Model Aaron Snyder, MD Vice President, US Acute Care Solutions Kim Repac Chief Financial Officer, WMHS Aging Population 50 Million Distribution
More informationNavigating the Hospital Readmission Reduction Program
Navigating the Hospital Readmission Reduction Program Since the Affordable Care Act passed in 200, a hospital s 30-day readmission rate has become synonymous with quality of care. Beginning in 202, the
More informationTest bank PowerPoint slides for each chapter Instructor guides for each chapter (with answers for discussion questions and case studies)
This is a sample of the instructor materials for Dimensions of Long-Term Care Management: An Introduction, second edition, edited by Mary Helen McSweeney-Feld, Carol Molinari, and Reid Oetjen. The complete
More informationTHE ART OF DIAGNOSTIC CODING PART 1
THE ART OF DIAGNOSTIC CODING PART 1 Judy Adams, RN, BSN, HCS-D, HCS-O June 14, 2013 2 Background Every health care setting has gone through similar changes in the need to code more thoroughly. We can learn
More informationPartners in the Continuum of Care: Hospitals and Post-Acute Care Providers
Partners in the Continuum of Care: Hospitals and Post-Acute Care Providers Presented to the Wisconsin Association for Home Health Care November 3, 2017 By: Laura Rose WHA Vice President, Policy Development
More informationRisk Adjusted Diagnosis Coding:
Risk Adjusted Diagnosis Coding: Reporting ChronicDisease for Population Health Management Jeri Leong, R.N., CPC, CPC-H, CPMA, CPC-I Executive Director 1 Learning Objectives Explain the concept Medicare
More informationThe 5 W s of the CMS Core Quality Process and Outcome Measures
The 5 W s of the CMS Core Quality Process and Outcome Measures Understanding the process and the expectations Developed by Kathy Wonderly RN,BSPA, CPHQ Performance Improvement Coordinator Developed : September
More informationSucceeding in a New Era of Health Care Delivery
March 14, 2012 Succeeding in a New Era of Health Care Delivery Building Value-Based Partnerships LeadingAge Pennsylvania Kathleen Griffin, PhD, National Director Post-Acute and Senior Services 1 Your Presenter
More informationMDS 3.0: What Leadership Needs to Know
MDS 3.0: What Leadership Needs to Know especially prepared for CANPFA Ann Spenard RN, MSN History of the MDS and RAI Process The Resident Assessment Instrument (RAI) was part of a set of reforms enacted
More informationHealthcare Reimbursement Change VBP -The Future is Now
Healthcare Reimbursement Change VBP -The Future is Now 1 On the Move Volume/ Fee-for-Service Fee-for-service reimbursement High quality not rewarded No shared financial risk Stand-alone systems can thrive
More informationReadmissions Review Committees
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
More informationUsing Structured Post Acute Assessment Data as the Raw Material for Predictive Modeling. Speaker: Thomas Martin November 2014
Using Structured Post Acute Assessment Data as the Raw Material for Predictive Modeling Speaker: Thomas Martin November 2014 1 Learning Objectives SNF s place in continuum of care Large variance across
More informationHospital Inpatient Quality Reporting (IQR) Program
Hospital Inpatient Quality Reporting (IQR) and Hospital Value-Based Purchasing (VBP) Programs Claims-Based Measures Hospital-Specific Report (HSR) Overview and Updates Questions and Answers Moderator Bethany
More informationCareTrek : Nebraska s Journey to Safe Care Transitions
CareTrek : Nebraska s Journey to Safe Care Transitions Audrey Paulman, MD, MMM Principal Clinical Coordinator CIMRO of Nebraska This material was prepared by CIMRO of Nebraska, the Medicare Quality Improvement
More informationThe POLST Conversation POLST Script
The POLST Conversation POLST Script The POLST Script provides detailed information in order to develop comfort and competence when facilitating a POLST conversation. The POLST conversation utilizes realistic
More informationMedical Management. G.2 At a Glance. G.2 Procedures Requiring Prior Authorization. G.3 How to Contact or Notify Medical Management
G.2 At a Glance G.2 Procedures Requiring Prior Authorization G.3 How to Contact or Notify G.4 When to Notify G.7 Case Management Services G.10 Special Needs Services G.12 Health Management Programs G.14
More informationCenters for Medicare & Medicaid Services (CMS) Quality Improvement Program Measures for Acute Care Hospitals - Fiscal Year (FY) 2020 Payment Update
ID Me asure Name NQF # Value- (VBP) - (HACRP) (HRRP) ID Me asure Name NQF # Value- (VBP) - (HACRP) (HRRP) CMS s - Fiscal Year 2020 Centers for Medicare & Medicaid Services (CMS) Improvement s for Acute
More informationMALNUTRITION QUALITY IMPROVEMENT INITIATIVE (MQii) FREQUENTLY ASKED QUESTIONS (FAQs)
MALNUTRITION QUALITY IMPROVEMENT INITIATIVE (MQii) FREQUENTLY ASKED QUESTIONS (FAQs) What is the MQii? The Malnutrition Quality Improvement Initiative (MQii) aims to advance evidence-based, high-quality
More information2013 Health Care Regulatory Update. January 8, 2013
2013 Health Care Regulatory Update January 8, 2013 Quality-Based Payment Reform, ACOs and Clinical Integration Bruce Johnson and Tom Donohoe Overview Quality-based payment reform programs Major programs
More informationREDUCING READMISSIONS through TRANSITIONS IN CARE
REDUCING READMISSIONS through TRANSITIONS IN CARE Christina R. Whitehouse, PhD, CRNP, CDE Postdoctoral Research Fellow NewCourtland Center for Transitions and Health University of Pennsylvania School of
More informationHospital Value-Based Purchasing (VBP) Program
Fiscal Year (FY) 2018 Percentage Payment Summary Report (PPSR) Overview Questions & Answers Moderator Maria Gugliuzza, MBA Project Manager, Hospital VBP Program Hospital Inpatient Value, Incentives, and
More informationDelivery System Reform The ACA and Beyond: Challenges Strategies Successes Failures Future
Delivery System Reform The ACA and Beyond: Challenges Strategies Successes Failures Future Arnold Epstein MSU 2018 Health Care Policy Conference April 6, 2018 The Good Ole Days 2 Per Capita National Healthcare
More informationValue based Purchasing Legislation, Methodology, and Challenges
Value based Purchasing Legislation, Methodology, and Challenges Maryland Association for Healthcare Quality Fall Education Conference 29 October 2009 Nikolas Matthes, MD, PhD, MPH, MSc Vice President for
More informationInpatient Quality Reporting Program
Hospital Value-Based Purchasing Program: Overview of FY 2017 Questions & Answers Moderator: Deb Price, PhD, MEd Educational Coordinator, Inpatient Program SC, HSAG Speaker(s): Bethany Wheeler, BS HVBP
More informationThe Shift is ON! Goodbye PPS, Hello RCS
The Shift is ON! Goodbye PPS, Hello RCS Presented By Maureen McCarthy, RN, BS, RAC-MT, QCP-MT President/CEO Maureen McCarthy, RN, BS, RAC-MT, QCP-MT Maureen is the President of Celtic Consulting, LLC and
More information