Rehospitalizations: How Do You Measure Up?

Transcription

1 Rehospitalizations: How Do You Measure Up? National Nursing Home Quality Care Collaborative (NNHQCC) Health Services Advisory Group (HSAG)

2 Today s Objectives Recognize the role skilled nursing facilities play in keeping residents out of the hospital. Identify successful rehospitalization change ideas that proved beneficial to nursing homes and their residents. Use best practices that have demonstrated improvement in reducing emergency room (ER) utilization and rehospitalization rates in Ohio.

3 What is a QIN-QIO? Funded by the Centers for Medicare & Medicaid Services (CMS) QIN-QIO in each state Dedicated to improving health quality at the community level Ensures people with Medicare get the care they deserve, and improves care for everyone Department of Health & Human Services Centers for Medicare & Medicaid Services 3

4 New National QIN-QIO Structure 4

5 HSAG s QIN-QIO Responsibility Nearly 25 percent of the nation s Medicare beneficiaries HSAG is the Medicare QIN-QIO for Arizona, California, Florida, Ohio, and the U.S. Virgin Islands. 5

6 Medical Case Review Structural Changes CMS separated medical case review from quality improvement work creating two separate structures: Medical Case Review Beneficiary Family Centered Care-QIOs (BFCC-QIOs) Quality Improvement Quality Innovation Network-QIOs (QIN-QIO) 6

7 QIN-QIO Areas of Focus

8 Improve Hand Hygiene and Injection Practices in ASCs* Cardiac Health Disparities in Diabetes Adult Immunizations Transforming Clinical Practice Support of Clinicians in the Quality Payment Program Patient is at the center of care Antibiotic Stewardship in Communities Coordination of Care Behavioral Health Healthcare- Acquired Conditions in Nursing Homes 8

9 Better Healthcare for Communities: Improve Coordination of Care Reduce hospital readmission rates for Medicare fee-for-service patients by 20 percent by Improve overall community health and support self-care of individuals in their homes. Reduce adverse drug events (ADEs) that contribute to patient harm as a result of the care-transitions process. Convene community providers to collaborate on strategies for improvement in care coordination. 9

10 What is a Hospital Readmission? CMS defines a readmission in this context as an admission to a subsection(d) hospital within 30 days of a discharge from the same or another subsection(d) hospital. Subsection(d) hospitals, per the Social Security Act, include short-term inpatient acute care hospitals excluding critical access, psychiatric, rehabilitation, long-term care, children's, and cancer hospitals. 10

11 What is Resident Rehospitalization and How is it Measured? The SNF Readmission Measure estimates risk-standardized rate of allcause, unplanned hospital readmissions of Medicare SNF beneficiaries within 30 days of discharge from their prior proximal acute hospitalization. Hospital readmissions are identified through Medicare claims Risk-adjusted Tip Sheet Available at 11

12 All-Cause Readmission Rates in Ohio by Region (Q Q2 2017) 16.9% 18.7% 18.1% 18.4% 18.5% 12 Source: Calendar Year 2016 Medicare Fee-For-Service claims data.

13 Readmission Volume by Setting (Q Q2 2017) Hospice Hospice, 2.1 Other Other, 22.2 Home Health Home Health, 21.1 Nursing Home Nursing Home, 20.9 Home Home, Source: Q Q Medicare Fee-For-Service claims data.

14 Why Should you Care About Resident Rehospitalization?

15 Why Focus on Rehospitalizations? Resident quality of life/quality of care Survey and certification Future penalties Value-based payment (VBP) 15 Instruments/Value-Based-Programs/Other-VBPs/SNF-VBP.html

16 Success Stories

17 Best Care Nursing and Rehabilitation Center Facility Representative: Janet Conley, DON Location: Wheelersburg, OH Population: Mixture, majority older, but some younger mid-30s up Number of Beds:

18 Best Care Nursing and Rehabilitation Center Barrier: Family understanding of disease process. Change Ideas: Education, education, and did I say education? 18

19 Ohio Living Lake Vista Facility Representative: Dean Palombaro, ED Location: Cortland, OH Population: Short-term rehab and older adult residency Number of Beds: 150 total living units 73 IL 10 AL 57 SNF 19

20 Ohio Living Lake Vista Barriers: Payment reform Higher acuity Lack of education Change Ideas: Gain deeper understanding of payment reform and the relation to patent acuity Increased clinical expertise New focus on data 20

21 Signature of Coshocton Facility Representative: Deanna McCormick, DON Location: Coshocton, OH Population: Mostly geriatric with noted trend towards a younger population in past year Number of Beds: 83 SNF 21

22 Signature of Coshocton Barriers: Communication issues Education issues Family issues Change Idea: INTERACT 4.0 Clinical pathways Stop and Watch Situation, background, assessment, recommendation (SBAR) 22

23 So, how do you get Started?

24 So, how do you get Started? 1. Know your data: Certification and Survey Provider Enhanced Reports (CASPER) Access Hospital Readmission from SNF Report Available From HSAG Track your own 2. Consider some simple changes. 3. Utilize available resources. 24

25 Know your data Access CASPER: 1. Access the CMS QIES system for providers and click CASPER Reporting on the left side of your screen. 2. Use your User ID and Password to access the CASPER site. 3. Click Folders at the top of your screen. 4. Click the first item under Facility SNF Inbox and open the PDF file that appears. Tip Sheet Available at 25

26 Know your Data Hospital Readmission from Skilled Nursing Facility Report Contact HSAG for your report! 26

27 Know your Data Track your own. 27 Contact HSAG or go to

28 Consider Some Simple Changes In the pre-admission process does your facility have a process in place to ensure readiness for admissions? In the post-admission process: Are you doing quality rounding for at least the first 7 days? Is upper management involved? Are you using SBAR or an equivalent system to ensure proper/informed communication? In the discharge planning process: Are you starting the discharge process upon admission? Is it interdisciplinary? Are you properly discharging residents with clear/concise instructions? Is social services completing a post-discharge follow-up to ensure resident well-being? Should I reference the INTERACT program to help me address these questions? 28 Tip Sheet Available at

29 What are Some Resources to Help me With Resident Rehospitalization?

30 HSAG Website 30

31 Alliant Zone Tools Alliant Zone Tools: Heart failure Pneumonia Chronic obstructive pulmonary disease (COPD) Urinary tract infection (UTI) Diabetes Total hip replacement 31

32 INTERACT INTERACT Transfer log SBAR Stop and Watch Quality improvement (QI) tool QI summary tool Capabilities list form Care pathway And so much more Contact HSAG or go to 32

33 Organizational Assessment Avoidable Hospital Readmission Organizational Assessment 33

34 NNHQI National Nursing Home Quality Improvement Campaign (NNHQI) 34

35 HSAG Website Visit 35

36 Who do I call for Assistance?

37 Readmission Team Contact Information Caitlin Mocarski, MPH Erica Stanton, BSAS Bonnie Hollopeter, LPN, CPHQ, CPHIMS Rosi McGinnis, MS RN Eli DeLille, RN, BSN, CIC

38 Nursing Home Team Contact Information Jim Barnhart, LNHA Quality Improvement (QI) Project Lead Debbie Shaeffer, LPN QI Specialist Angila Anderson, BSHA LPN QI Specialist Dora Taylor, RN QI Specialist Trish Borntrager, RN QI Specialist Haley Bakies, BA Administrative Assistant/ Event Planner

39 Your To Do List: 1. Call HSAG for your Hospital Readmission from SNF Report. 2. Decide on a Goal. 3. Investigate the resources HSAG has to offer. 4. Try something!

40 Questions????? 40

41 Thank you!

42 This material was prepared by Health Services Advisory Group, the Medicare Quality Improvement Organization for Ohio, 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. OH-11SOW-XC