Presented by: Darren Swenson, MD Director of Medical Affairs, IPC of Nevada, Inc. March 30, 2010

Transcription

1 Presented by: Darren Swenson, MD Director of Medical Affairs, IPC of Nevada, Inc. March 30, 2010

2 Healthcare reform Costs: +$15 billion Medicare alone Increasing number of readmissions 18.2% (2000) to 23.5% (2006) from SNF in 30 days Miscommunication in transition Lack of coordination between providers PPACA (Patient Protection and Affordable Care Act) Hospital Readmission Reduction Program Medicare Shared Savings Program - ACO National Pilot Program on Payment Bundling Value Based Purchasing or Pay for Performance 2

3 We cannot solve our problems with the same thinking we used when we created them. Albert Einstein 3

4 Effective Transfer of Information Effective Transfer of Accountability Home Home Healh Hospital PATIENT PCP Subacute 4

5 Hospital Loyalty Engagement Involvement Patient Health Family Cost Payer Costs Length of Stay Continuity Hospitalist Practice Partners Teamwork and Dedication Reliability Skills 5

6 Patient needs Hospital and medical staff culture Community impact Payer requirements Physician practice style and quality of life 6

7 Yesterday 7

8 I d Like To Teach The World To Sing In Perfect Harmony... Not 8

9 Partnership Hospital needs and requirements Payer requirements Federal and state requirements IPC UCSF Physician Leadership Training 9

10 Monthly/Quarterly JOC Weekly Meetings Daily Conferencing Promote ongoing alignment of goals and priorities Integrate key leaders from facility and medical practice group Improve focus on quality, productivity, utilization, satisfaction Share executive-level and detailed operational reports Expand attention to medical staff, case management and related initiatives 10

11 Writing order for home health, subacute evaluations on the first day Preplan discharge communication Effective transition management 11

12 Patient Family Hospital Payer Healthcare Team Referring Physician Hospitalist 12

13 40% to 80% of medical information is forgotten immediately Almost 50% of the information is remembered incorrectly The more information given, the more information forgotten Problem PCC / Liaison White board Written instructions Discharge Notifications to PCP Solution 13

14 IPC-Link : Example Personalized system to manage post hospital discharge >20% of patients require intervention Call center contacts patients to ensure compliance Identifies patient medical issues within 72 hours of discharge to home Coordinates care with appropriate care providers Hospitalist-specific patient satisfaction measures Lowers malpractice risk IPC-Link Personalized Patient Surveys IPC Discharge Call Center Discharged Patients 14

15 BOOST (Better Outcomes for Older Adults Through Safe Transitions) Project RED (Reengineered Discharge Care Transitions Program INTERACT Tool Kit (Improve Care and Reduce Acute Transfers) AMDA Transitions of Care Guidlines See references at the end of presentation for for further details. 15

16 ALOS Costs Readmission rates Satisfaction Quality of care delivery Completion of records 1-day stays HCAHPS Discharge times Physician, group, and hospital level Transparency 16

17 1. Create a plan that balances constituencies needs 2. Establish dedicated hospitalists 3. Integrate effective leadership 4. Improve provider-to-provider communication 5. Implement discharge planning day 1 6. Involve key stakeholders 7. Ensure effective patient communication 8. Utilize integrated technology 9. Share ideas and successes 10. Monitor data-driven results and adapt 17

18 Effective Transfer of Information Effective Transfer of Accountability Home Home Health Hospital PATIENT PCP Subacute 18

19 Doing The Same Thing Over and Over Again and Expecting Different Results Albert Einstein 19

20 Programs AHRQ, Implementing Re-Engineered Hospital Discharges (Project RED), Coleman, Eric, Care Tranistions Program, GeriU.org - OnLine Geriatric University, INTERACT II, Society of Hospital Medicine, Project BOOST (Better Outcomes for Older Adults Through Safe Transitions), American Medical Director Association, Transitions of Care in the long-term Continuum Clinical Practice Guideline, AMDA Other References AHRQ, Aiming High: Toward a High Performance, High Value U.S. Health System Slide Presentation, AHRQ, Developing New Patient Care Models, 2010 AHRQ Conference, Betbeze, Philip, Hospitalist Outsourcing Becoming Common, Healthleaders, December Jones, Elizabeth, Readmission Rates Top Of Mind for Regulators Hospitalists Can Help, Medical Staff Leader, January 26, Mcguire, Phyllis, Have A Problem With Readmissions? Why Bouncebacks Might Be The Next Big Thing For Hospitalists, Today s Hospitalist, June Michota, Franklin, Trends in Hospital Medicine: Hospitalist Advantages Revealed, Cleveland Clinic Journal of Medicine, July Singer, Adam, Aligning With Your Outsourced Hospitalists: A Ten-Point Road Map, Becker s Hospital Review, January 4, Taylor, Mark, Shutting The Door On Readmissions, HHN Magazine, January Taylor, Mark, You Don t Have To Be A Kaiser To Reduce Readmissions, HHN Magazine, January Winslow and Goldstein, Cutting Repeat Hospital Trips -- Simple Idea, Hard to Pull Off, Wall Street Journal, July 28, VanDeusen Lukas, Carol, So You Think You Can Coordinate Care? Prove It! Slide Presentation, AHRQ 2010 Annual Conference. 20