Cutting Avoidable Readmissions Starts in the Emergency Department

Size: px
Start display at page:

Download "Cutting Avoidable Readmissions Starts in the Emergency Department"

Transcription

1 WHITE PAPER Cutting Avoidable Readmissions Starts in the Emergency Department SMARTER EMERGENCY CARE: EVERYWHERE, EVERY TIME. Our experience and innovative approach offers smarter solutions for emergency care.

2 Abstract On Oct. 1, 2012, the Centers for Medicare and Medicaid Services (CMS) began penalizing hospitals with excessive preventable readmissions for acute myocardial infection, heart failure and pneumonia. Beginning October 1, 2014 those penalties will include chronic obstructive pulmonary disease, coronary artery bypass graft, percutaneous transluminal coronary angioplasty and other vascular conditions. Under the Readmissions Reduction Program, two-thirds of U.S. hospitals stand to lose up to 1 percent of Medicare payments in 2013, with payment cuts growing to 3 percent for hospitals that fail to improve by In 2012, it was estimated that approximately 55% of U.S. hospitals were affected by these penalties. To avoid crippling financial repercussions, hospitals must address the readmissions problem, starting with the most significant entry point to the hospital: the emergency department (ED). This white paper outlines eight actionable steps involving processes and technology that hospitals can take to improve patient care post-ed discharge and prevent avoidable readmissions. An Unavoidable Problem Approximately 2,200 hospitals will lose more than $300 million in Medicare payments in 2013 as a result of penalties from the Readmissions Reduction Program. 2 These looming financial losses threaten already tight hospital margins. Indeed, a 2012 survey of hospital CEOs cited financial challenges as the chief issue they face, and more than 72 percent of respondents specified Medicare reimbursement as the leading cause. 3 To understand where to begin addressing the avoidable readmissions problem, hospitals must first recognize where their patients are most frequently entering their facility the emergency department. Between 50 and 70 percent of admitted patients enter the hospital through the ED. 4 Patients often present to the ED because Between 50 and 70 they haven t received appropriate follow-up care in the community and/or they have no percent of admitted medical home or primary care provider to manage their outpatient care. patients enter the hospital through the According to a study appearing in the January 2013 issue of the Journal of the American ED...often because they Medical Association: An improved understanding of how the ED setting is best used in haven t received the management of acute care needs particularly for patients recently discharged from appropriate follow-up the hospital is an important component of the effort to improve care transitions Just as care in the community the Patient Protection and Affordable Care Act requires the development of programs to or have no medical home reduce readmissions, further initiatives are necessary to understand the drivers of or primary care provider post-discharge ED use and the clinical and financial efficiency associated with providing for outpatient care. such acute care in the ED. 5 In short, examining what happens to patients post-ed discharge can lead to solutions that prevent repeat visits to the ED and, ultimately, admissions to the hospital. Hospital leaders should consider the following steps when designing a plan to prevent avoidable readmissions.

3 1. Start with Goals Understanding the true scope of the readmissions issue is necessary to determine the appropriate allocation of resources required to solve it. Hospital leaders can begin to frame the problem by reviewing patient data from the previous three to six months. Identify patterns in readmission that could have been prevented through better care coordination. Look for common threads, such as chronic disease states (congestive heart failure, coronary artery disease, COPD, etc.) or patients who don t have a primary care provider. Calculate how frequently these patient groups are seen in the ED, and use these measures as a benchmark for setting goals. While the overall goal of a hospital s readmissions reduction initiative might be, To reduce unnecessary readmissions by 20 percent, the goal can and should be broken into smaller, more targeted objectives. These objectives will vary by hospital, and examples include: Care Transitions Intervention Reduce Readmissions 6 25% 20% ED who have no primary care physician. a primary care physician to an affiliated practice or clinic. Readmission Rate 15% 10% 30 days will be evaluated by case management upon arrival in the ED. 5% patients are seen in the ED. 0% No Follow-up Care CTI Group heart failure will be enrolled in the disease management program. Smart objectives must be measurable as they are used to evaluate the initiative s success. Be aware at the outset of where the hospital stands in relation to its objectives. If the objective is to match 90 percent of ED patients without a primary care provider to an affiliated practice or clinic, what is the hospital s current rate? In other words, what level of improvement is required? If the hospital is starting from 0 percent or an unknown percent, consider the steps it will take to implement (and measure) a new process. To maintain focus, it can be helpful to begin a readmissions reduction initiative by selecting only one or two of the most potentially impactful objectives.

4 2. Form a Dedicated Project Team Create a multi-disciplinary team that will develop and roll out a plan based on the program s chosen objectives. It is important to include members from a variety of stakeholder groups to ensure cross-departmental and community buy-in. Team members might include representation from the ED, case management, discharge planning, social work, patient financial services and an affiliated community healthcare provider. With a team in place, select the team leader and an executive-level sponsor who can support the leader and hold him/her accountable for the program s progress. Cox Medical Center Branson, a 165-bed hospital in southwestern Missouri, experienced remarkable success with this strategy. It formed a 14-member team to work more closely with primary care physicians to manage patients chronic conditions, setting out to reduce all cause readmissions by 20 percent. The hospital began 2012 with a readmissions rate close to the state s average of 11.5 percent. By December 2012, the hospital readmissions rate was below eight percent. Preventing readmissions requires concerted efforts across the hospital and the community, said Lori Brown, RN, HCM, executive director of accountable care at Cox Medical Center Branson. Putting the right team together to achieve our readmissions goal was the first and most critical step toward our success. 3. Choose Technology to Support the Goals Create a multi-disciplinary team that will develop and roll out a plan based on the program s chosen objectives. It is important to include members from a variety of stakeholder groups to ensure cross-departmental and community buy-in. Team members might include representation from the ED, case management, discharge planning, social work, patient financial services and an affiliated community healthcare provider. With a team in place, select the team leader and an executive-level sponsor who can support the leader and hold him/her accountable for the program s progress. When evaluating a system to support your team s goal, evaluate if the system will: Automate alerts (e.g., to text or primary care providers when their patients are seen in the ED) (e.g., Set appointment with patient to see endocrinologist by end of week. ) (e.g., percent of discharged ED patients who have a follow-up appointment scheduled with a community physician this week ) The system chosen should be easy for all team members to: Access (remote users, even if all not on the same EHR) tasks to be done (care/plan/track patients, visibility into patient status, referral acceptance) target patient populations (clinical high risk, multiple ED visits) Deliver the medical record of the ED visit to the next care setting (secure, on-line access, ED record available at the time follow up care is delivered) One of the key features of the system we selected is that it matches patients without a medical home to a provider based on location, insurance coverage and other criteria, said Brown. The system then sends an accept/decline referral to the provider. This process is repeated until a provider accepts the patient.

5 4. Develop a Plan After forming the team and selecting the required technology tools, define the scope of the plan and keep it manageable. Meaningful results can be achieved from small but targeted efforts. Consider a phased approach that can be expanded later. Design a process that addresses the changes to be made. Map each step of the new workflow process, and define the who, what, how, when and why for each step. For example, using the goal, All patients admitted in the last 30 days will be evaluated by case management upon arrival in the ED to identify ongoing care needs, determine: 5. Take Action When the readmissions reduction team is ready to take action, begin by tackling just one of the set objectives with a small target population. Doing too many tasks or changing too many processes at once can be overwhelming, and it can also make it difficult to identify which specific action(s) achieved the most significant results. Continuously monitor the workflow of the new process, and make sure that all involved groups are abiding by it. Don t underestimate how challenging change can be; you are redesigning a process that has likely been in place for a long time. However, don t get discouraged. Stick to the plan for at least 30 days. The team will have many opinions and new ideas, and it can be tempting to modify the program too soon. It takes time for people to adjust to a new process and work out the kinks, said Brown. We avoided making changes to the process early on because we wanted to give it a real shot at success before going back to the drawing board. 6. Review Results At the end of the first 30 days, measure the hospital s progress. Compare current metrics against the ones collected prior to the start of the program. Keep in mind that readmission rates typically don t drop rapidly, but you should see some improvement with regard to your objective.

6 Use the reports from the technology tools you have selected to reduce manual data collection needs. Many systems allow users to set up custom, automatic reports. Quantify the results with a visual chart and a quick summary, and communicate the findings to other stakeholder groups. The 30-day mark also presents a good opportunity to gather the project team to discuss lessons learned and suggestions for improvement. 7. Revise Plan as Needed Taking into consideration the results, objectives, suggestions and team discussion, make revisions to the plan where it makes sense. Consider how any changes might impact the objectives, employees involved or even the ED patients. It s crucial to obtain input from the entire project team and other stakeholders prior to making changes. Once it is determined what changes (if any) need to be made, document and communicate the new process, then make the changes. Continuously monitor and track the progress toward your objective. The display of trending charts where staff can see progress that has been made can be a helpful motivator. 8. Expand the Program Once the hospital has experienced success with one objective, it becomes easier to expand the program and target the next objective. Identify the next patient group to manage, and work through the aforementioned steps again to plan, implement, review and revise. At this stage, it can be helpful to invite some new team members who will offer a fresh perspective. However, it s suggested that some of the program s previous team members remain to serve as the project leaders. Once the new program is implemented, ensure that progress is continuously monitored and that the team is communicating regularly to evaluate the program s success. The Time to Change is Now The financial ramifications of avoidable readmissions are undeniably expensive for hospitals, and they will only get more costly in the years ahead. But the disservice to patients experiencing readmission is equally significant. Targeting patients starting at the hospital s front door the ED allows the hospital to prevent these unnecessary repeat visits wherever possible. As outlined above, a multi-pronged strategy that blends technology and processes is required to solve such a complex problem. See how T-System can help: T-System Care Continuity An automated, web-based ED patient management tool that: o Actively manages workflow with separate work queues for care team members who are key to effective patient transition, including medical home, case manager, discharge planning and specialists.

7 o Automatically identifies patients at high risk for readmission using customizable filters that allow identification for repeat visits, specific conditions and PCP status. o Instantly notifies the care team of high-risk patients via text and/or . o Connects the hospital care team to providers, incorporates existing patient/provider relationships, includes patient referral functionality and provides customizable provider alerts for changes in patient status. o Includes closed-loop care coordination with communication log and management functionality, care team notes and secure messaging. o Provides measurement and goal-tracking with pre-built reports and advanced analytics for usage, patient status, managed/target populations, key providers and business development opportunities. ED Performance Consulting Focus on patients while T-System focuses on your ED. With decades of experience, T-System professionals support more than 1,900 hospitals nationwide hospitals ranging in age, size, location, staffing and resources. T-System offers a range of services to address your facility s needs, including: workflow optimization, clinical quality optimization, risk analysis, continuing education and more Archives of Internal Medicine, The Care Transitions Intervention: translating from efficacy to effectiveness, Voss et al, July 27, 2011.

8 About T-System T-System, Inc. advances the practice of emergency medicine with solutions proven to solve clinical, financial, operational and regulatory challenges for hospitals and urgent care clinics. Approximately 40 percent of the nation s emergency departments leverage T-System solutions to provide an unmatched patient experience. Through gold-standard documentation, revenue cycle management, and performance-enhancing solutions, T-System optimizes care delivery from the front door through discharge and beyond. Today, more than 1,900 facilities rely on T-System solutions. For more information, visit on Twitter, or become a T-System fan on Facebook. SMARTER EMERGENCY CARE: EVERYWHERE, EVERY TIME McEwen Drive :: Dallas, Texas :: ::

Hospital Readmissions

Hospital 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 information

Joseph W. Thompson, MD, MPH Arkansas Surgeon General Director, Arkansas Center for Health Improvement

Joseph W. Thompson, MD, MPH Arkansas Surgeon General Director, Arkansas Center for Health Improvement Joseph W. Thompson, MD, MPH Arkansas Surgeon General Director, Arkansas Center for Health Improvement Arkansas Health System Improvement Workforce Payment System Health Information Technology Insurance

More information

SNF * 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 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 information

Adopting Accountable Care An Implementation Guide for Physician Practices

Adopting Accountable Care An Implementation Guide for Physician Practices Adopting Accountable Care An Implementation Guide for Physician Practices EXECUTIVE SUMMARY November 2014 A resource developed by the ACO Learning Network www.acolearningnetwork.org Executive Summary Our

More information

ramping up for bundled payments fostering hospital-physician alignment

ramping up for bundled payments fostering hospital-physician alignment REPRINT May 2016 Angie Curry James P. Fee healthcare financial management association hfma.org ramping up for bundled payments fostering hospital-physician alignment AT A GLANCE When hospitals embark on

More information

STRATEGIES AND SOLUTIONS FOR REDUCING INAPPROPRIATE READMISSIONS

STRATEGIES 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 information

Overview. Overview 01:55 PM 09/06/2017

Overview. Overview 01:55 PM 09/06/2017 01:55 PM Inactive No Effective Date Date of Last Change 07/16/2017 08:34:13.108 AM Job Profile Name Director of Clinical Quality Informatics for Regulatory Performance- Enterprise Job Profile Summary Job

More information

Home Health. Improving Patient Outcomes & Reducing Readmissions. Home Health: Improving Outcomes & Reducing Readmissions

Home Health. Improving Patient Outcomes & Reducing Readmissions. Home Health: Improving Outcomes & Reducing Readmissions Home Health Improving Patient Outcomes & Reducing Readmissions Home Health: Improving Outcomes & Reducing Readmissions Benefits of Home Health Care Scientific evidence proves people heal more quickly,

More information

PHCA Webinar January 30, Latsha Davis & McKenna, P.C. Kimber L. Latsha, Esq.

PHCA 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 information

Analytics in Action. Using Data to Improve Care and Reduce Costs CUSTOM MEDIA SPONSORED BY

Analytics in Action. Using Data to Improve Care and Reduce Costs CUSTOM MEDIA SPONSORED BY Analytics in Action Using Data to Improve Care and Reduce Costs CUSTOM MEDIA SPONSORED BY Imagine an 82-year-old gentleman walks in to your emergency department. He presents with a productive cough and

More information

Healthy Aging Recommendations 2015 White House Conference on Aging

Healthy 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 information

Chronic Care Taking Disease Management Beyond Hospital Walls

Chronic Care Taking Disease Management Beyond Hospital Walls Chronic Care Taking Disease Management Beyond Hospital Walls Sandra Garrison BSN MBA Director Chronic Heart Failure Initiative The Chester County Hospital Alan Barbell MBA Product Manager, Siemens Medical

More information

40,000 Covered Lives: Improving Performance on ACO MSSP Metrics

40,000 Covered Lives: Improving Performance on ACO MSSP Metrics Success Story 40,000 Covered Lives: Improving Performance on ACO MSSP Metrics EXECUTIVE SUMMARY The United States healthcare system is the most expensive in the world, but data consistently shows the U.S.

More information

Transforming Clinical Care: Why Optimization of Clinical Systems Can t Wait

Transforming Clinical Care: Why Optimization of Clinical Systems Can t Wait Transforming Clinical Care: Why Optimization of Clinical Systems Can t Wait A White Paper March 2016 Impact Advisors LLC 400 E. Diehl Road Suite 190 Naperville IL 60563 1-800-680-7570 Impact-Advisors.com

More information

AGENDA. QUANTIFYING THE THREATS & OPPORTUNITIES UNDER HEALTHCARE REFORM NAHC Annual Meeting Phoenix AZ October 21, /21/2014

AGENDA. QUANTIFYING THE THREATS & OPPORTUNITIES UNDER HEALTHCARE REFORM NAHC Annual Meeting Phoenix AZ October 21, /21/2014 QUANTIFYING THE THREATS & OPPORTUNITIES UNDER HEALTHCARE REFORM NAHC Annual Meeting Phoenix AZ October 21, 2014 04 AGENDA Speaker Background Re Admissions Home Health Hospice Economic Incentivized Situations

More information

Using Data for Proactive Patient Population Management

Using Data for Proactive Patient Population Management Using Data for Proactive Patient Population Management Kate Lichtenberg, DO, MPH, FAAFP October 16, 2013 Topics Review population based care Understand the use of registries Harnessing the power of EHRs

More information

HOSPITAL READMISSION REDUCTION STRATEGIC PLANNING

HOSPITAL 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 information

Healthcare Solutions Nuance Clintegrity Quality Management Solutions. Quality. The Discipline to Win.

Healthcare Solutions Nuance Clintegrity Quality Management Solutions. Quality. The Discipline to Win. Quality. The Discipline to Win. Brochure 2 It s not wanting to win that makes you a winner; it s refusing to fail. Peyton Manning, the first NFL quarterback to achieve 200 career wins (regular and post-season)

More information

Hospital Readmissions Survival Guide

Hospital Readmissions Survival Guide WHITE PAPER Hospital Readmissions Survival Guide The Long-Term Care Provider s Ultimate Survival Guide to Incorporating INTERACT into Health Information Technology (HIT) March 2017 In this survival guide,

More information

3/14/2014. Preventing Rehospitalizations How to Change Your When in Doubt, Send em Out Way of Thinking. Objectives. Background Information

3/14/2014. 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 information

Strategic Plan. Becoming the Preferred Academic Medical Center of the 21st Century ONEUABMedicine.org/AMC21

Strategic Plan. Becoming the Preferred Academic Medical Center of the 21st Century ONEUABMedicine.org/AMC21 ENGAGEMENT QUALITY FINANCE ADVANCEMENT OF KNOWLEDGE FOUNDATIONS Strategic Plan Becoming the Preferred Academic Medical Center of the 21st Century ONEUABMedicine.org/AMC21 TABLE OF CONTENTS Overview...3

More information

Community Health Excellence (CHE) Grant Program Application Guide

Community Health Excellence (CHE) Grant Program Application Guide Community Health Excellence (CHE) Grant Program 2018 2019 Application Guide CHE Mission and Goals The PacificSource Community Health Excellence (CHE) initiative was created to align with and support the

More information

Community Performance Report

Community Performance Report : Wenatchee Current Year: Q1 217 through Q4 217 Qualis Health Communities for Safer Transitions of Care Performance Report : Wenatchee Includes Data Through: Q4 217 Report Created: May 3, 218 Purpose of

More information

Using Facets of Midas+ Hospital Case Management to Support Transitions of Care. Barbara Craig, Midas+ SaaS Advisor

Using Facets of Midas+ Hospital Case Management to Support Transitions of Care. Barbara Craig, Midas+ SaaS Advisor Using Facets of Midas+ Hospital Case Management to Support Transitions of Care Barbara Craig, Midas+ SaaS Advisor What does Transitional Care Include? Transitional Care is the smooth conversion of a patient

More information

Better care coordination requires streamlined, efficient, secure clinical communication

Better care coordination requires streamlined, efficient, secure clinical communication Better care coordination requires streamlined, efficient, secure clinical communication May 2015 Contents The current state of clinical communications: Inefficient and error-prone 3 The obstacles to care

More information

Technology Fundamentals for Realizing ACO Success

Technology Fundamentals for Realizing ACO Success Technology Fundamentals for Realizing ACO Success Introduction The accountable care organization (ACO) concept, an integral piece of the government s current health reform agenda, aims to create a health

More information

Joint Replacement Outweighs Other Factors in Determining CMS Readmission Penalties

Joint Replacement Outweighs Other Factors in Determining CMS Readmission Penalties Joint Replacement Outweighs Other Factors in Determining CMS Readmission Penalties Abstract Many hospital leaders would like to pinpoint future readmission-related penalties and the return on investment

More information

Managing Patients with Multiple Chronic Conditions

Managing Patients with Multiple Chronic Conditions Best Practices Managing Patients with Multiple Chronic Conditions Arch Health Partners Case Study Organization Profile Palomar Pomerado Health, a public hospital system that includes 2 hospital campuses

More information

Transitional Care Clinic and post-discharge calls boost patient-centered care effectiveness and cost savings.

Transitional Care Clinic and post-discharge calls boost patient-centered care effectiveness and cost savings. CASE STUDY Transitional Care Clinic and post-discharge calls boost patient-centered care effectiveness and cost savings. OUR WORK WITH Via Christi Health nrchealth.com CASE STUDY Overview With its long-standing

More information

CPC+ CHANGE PACKAGE January 2017

CPC+ CHANGE PACKAGE January 2017 CPC+ CHANGE PACKAGE January 2017 Table of Contents CPC+ DRIVER DIAGRAM... 3 CPC+ CHANGE PACKAGE... 4 DRIVER 1: Five Comprehensive Primary Care Functions... 4 FUNCTION 1: Access and Continuity... 4 FUNCTION

More information

Describe the process for implementing an OP CDI program

Describe the process for implementing an OP CDI program 1 Outpatient CDI: The Marriage of MACRA and HCCs Marion Kruse, RN, MBA Founding Partner LYM Consulting Columbus, OH Learning Objectives At the completion of this educational activity, the learner will

More information

Population Health Management Tools and Strategies to Support Care Coordination An InfoMC White Paper April 2016

Population Health Management Tools and Strategies to Support Care Coordination An InfoMC White Paper April 2016 Population Health Management Tools and Strategies to Support Care Coordination An InfoMC White Paper April 2016 Norris, Susan, Ph.D., Chief Clinical Officer, InfoMC Daniels, Allen S., Ed.D., Clinical Director,

More information

Implementing Medicaid Value-Based Purchasing Initiatives with Federally Qualified Health Centers

Implementing Medicaid Value-Based Purchasing Initiatives with Federally Qualified Health Centers Implementing Medicaid Value-Based Purchasing Initiatives with Federally Qualified Health Centers Beth Waldman, JD, MPH June 14, 2016 Presentation Overview 1. Brief overview of payment reform strategies

More information

HIMSS Davies Award Enterprise Application. --- Cover Page --- IT Projects and Operations Consultant Submitter s Address: and whenever possible

HIMSS Davies Award Enterprise Application. --- Cover Page --- IT Projects and Operations Consultant Submitter s  Address: and whenever possible HIMSS Davies Award Enterprise Application --- Cover Page --- Name of Applicant Organization: Truman Medical Centers Organization s Address: 2301 Holmes Street, Kansas City, MO 64108 Submitter s Name: Angie

More information

Quality Based Impacts to Medicare Inpatient Payments

Quality 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 information

Health Information Technology

Health Information Technology ACO Congress Oct 25, 2010 Los Angeles, CA Patient Centered Medical Home and Accountable Care Organizations Health Information Technology David K. Nace MD, Medical Director, McKesson Corporation Co-Chair,

More information

SENTARA HEALTHCARE. Norfolk, VA

SENTARA HEALTHCARE. Norfolk, VA SENTARA HEALTHCARE Norfolk, VA 1 Sentara Healthcare Overview 11 Acute Care Hospitals in Virginia with a total of 2572 licensed beds 1E Extended dstay hospital 9 Ambulatory Care Campuses; 5 with freestanding

More information

Regulatory Advisor Volume Eight

Regulatory 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 information

Measurement Strategy Overview

Measurement Strategy Overview Mobile Integrated Healthcare Program 911 Nurse Triage Measurement Strategy Overview Aim A clearly articulated goal statement that describes how much improvement by when and links all the specific outcome

More information

THE NEW IMPERATIVE: WHY HEALTHCARE ORGANIZATIONS ARE SEEKING TRANSFORMATIONAL CHANGE AND HOW THEY CAN ACHIEVE IT

THE NEW IMPERATIVE: WHY HEALTHCARE ORGANIZATIONS ARE SEEKING TRANSFORMATIONAL CHANGE AND HOW THEY CAN ACHIEVE IT Today s challenges are not incremental, but transformational; across the country, many CEOs and executives in healthcare see the need not merely to improve traditional ways of doing business, but to map

More information

Leveraging Clinical Communications Technology to Prevent Missed Nursing Care

Leveraging Clinical Communications Technology to Prevent Missed Nursing Care Leveraging Clinical Communications Technology to Prevent Missed Nursing Care Maintaining a competitive edge in the value-based purchasing era Patricia Smith MBA, BSN, RN Preventing Missed Nursing Care

More information

Transitioning 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 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 information

PROVIDER. Newsletter BETTER QUALITY IS OUR GOAL IN THIS ISSUE MEDICARE 2015 ISSUE II

PROVIDER. Newsletter BETTER QUALITY IS OUR GOAL IN THIS ISSUE MEDICARE 2015 ISSUE II MEDICARE 2015 ISSUE II PROVIDER Newsletter BETTER QUALITY IS OUR GOAL Our Quality Improvement (QI) program is dedicated to finding ways to help deliver better care and service to our members, in collaboration

More information

AN OPPORTUNITY TO INTEGRATE NUTRITION SERVICES IN YOUR LOCAL HEALTHCARE SYSTEM

AN 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 information

Population Health Management Tools to Improve Care for Individuals and Populations of Patients

Population Health Management Tools to Improve Care for Individuals and Populations of Patients June 1, 2015 Population Health Management Tools to Improve Care for Individuals and Populations of Patients Joel Diamond, MD, FAAP Building Population Health Information-powered clinical decision-making

More information

The Community Care Navigator Program At Lawrence Memorial Hospital

The Community Care Navigator Program At Lawrence Memorial Hospital The Community Care Navigator Program At Lawrence Memorial Hospital Presented By: Linda Gall, MSN, RN, ACM Director of Care Coordination October 21, 2011 Learning Objectives: 1. Describe the vision and

More information

By Julie Berez Mentor: Matthew McHugh PhD JD, MPH, RN, CRNP

By Julie Berez Mentor: Matthew McHugh PhD JD, MPH, RN, CRNP Can Nurse Staffing Levels Improve Hospital Readmissions Performance? By Julie Berez Mentor: Matthew McHugh PhD JD, MPH, RN, CRNP Presentation Outline Overview of Readmissions Reduction Program Study Significance

More information

Care Transitions in Behavioral Health

Care Transitions in Behavioral Health Janssen Pharmaceuticals, Inc. Presents: Care Transitions in Behavioral Health Chuck Ingoglia, MSW Senior Vice President, Policy and Practice Improvement, National Council for Behavioral Health Nina Marshall,

More information

1/14/2013. Emerging Healthcare Issues: How Will They Impact Hospital Reimbursement? EMERGING HEALTHCARE TOPICS FOR DISCUSSION

1/14/2013. Emerging Healthcare Issues: How Will They Impact Hospital Reimbursement? EMERGING HEALTHCARE TOPICS FOR DISCUSSION 2013 University of California Compliance & Audit Symposium Lori Laubach, Partner Sharon Hartzel, Director Health Care Consulting Moss Adams LLP Emerging Healthcare Issues: How Will They Impact Hospital

More information

CAMDEN CLARK MEDICAL CENTER:

CAMDEN CLARK MEDICAL CENTER: INSIGHT DRIVEN HEALTH CAMDEN CLARK MEDICAL CENTER: CARE MANAGEMENT TRANSFORMATION GENERATES SAVINGS AND ENHANCES CARE OVERVIEW Accenture helped Camden Clark Medical Center, (CCMC), a West Virginia-based

More information

Case managers are consummate team players, working with. IssueBrief

Case managers are consummate team players, working with. IssueBrief IssueBrief May 2016 Making hospital care management an organizational priority: Dartmouth-Hitchcock deploys case managers so patients are at the right place at the right time Case managers are consummate

More information

Healthgrades 2016 Report to the Nation

Healthgrades 2016 Report to the Nation Healthgrades 2016 Report to the Nation Local Differences in Patient Outcomes Reinforce the Need for Transparency Healthgrades 999 18 th Street Denver, CO 80202 855.665.9276 www.healthgrades.com/hospitals

More information

SIMPLE SOLUTIONS. BIG IMPACT.

SIMPLE SOLUTIONS. BIG IMPACT. SIMPLE SOLUTIONS. BIG IMPACT. SIMPLE SOLUTIONS. BIG IMPACT. QUALITY IMPROVEMENT FOR INSTITUTIONS combines the American College of Cardiology s (ACC) proven quality improvement service solutions and its

More information

Understanding Patient Choice Insights Patient Choice Insights Network

Understanding Patient Choice Insights Patient Choice Insights Network Quality health plans & benefits Healthier living Financial well-being Intelligent solutions Understanding Patient Choice Insights Patient Choice Insights Network SM www.aetna.com Helping consumers gain

More information

2013 Health Care Regulatory Update. January 8, 2013

2013 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 information

Hot Spotter Report User Guide

Hot Spotter Report User Guide PATIENT-CENTERED CARE Hot Spotter Report User Guide Overview The Hot Spotter Report is designed to give providers and care team members a heads up when their attributed patients appear to be at risk for

More information

Population Health. Collaborative Care. One interoperable platform. NextGen Care

Population Health. Collaborative Care. One interoperable platform. NextGen Care Population Health. Collaborative Care. One interoperable platform. NextGen Care We ve become very proactive in identifying at-risk patients and getting them in our door before they get sick. Our physicians

More information

RPM: Is It All It Is Cracked Up to Be?

RPM: Is It All It Is Cracked Up to Be? RPM: Is It All It Is Cracked Up to Be? Session 192, February 22, 2017 Hank Fanberg, Director of Innovation, Christus Health System Gregg Malkary, Managing Director, Spyglass Consulting Group 1 Speaker

More information

Select the correct response and jot down your rationale for choosing the answer.

Select the correct response and jot down your rationale for choosing the answer. UNC2 Practice Test 2 Select the correct response and jot down your rationale for choosing the answer. 1. If data are plotted over time, the resulting chart will be a (A) Run chart (B) Histogram (C) Pareto

More information

Plan for investment of retained marginal rate payment for emergency admissions in Gloucestershire

Plan for investment of retained marginal rate payment for emergency admissions in Gloucestershire Plan for investment of retained marginal rate payment for emergency admissions in Gloucestershire 1. Purpose of document This document summarises and explains how Gloucestershire CCG has used the funds

More information

Keenan Pharmacy Care Management (KPCM)

Keenan Pharmacy Care Management (KPCM) Keenan Pharmacy Care Management (KPCM) This program is an exclusive to KPS clients as an additional layer of pharmacy benefit management by engaging physicians and members directly to ensure that the best

More information

Coastal Medical, Inc.

Coastal Medical, Inc. A Culture of Collaboration The Organization Physician-owned group Currently 19 offices across the state of Rhode Island and growing 85 physicians, 101 care providers The Challenge Implement a single, unified

More information

Winning at Care Coordination Using Data-Driven Partnerships

Winning at Care Coordination Using Data-Driven Partnerships Idriz Limaj, LNHA, RN Chief Operating Officer Winning at Care Coordination Using Data-Driven Partnerships Session #166, February 22, 2017 1 Steven Littlehale, MS, GCNS-BC EVP & Chief Clinical Officer Speaker

More information

Retrospective Bundles

Retrospective Bundles Bundled Payment for Care Improvement (BPCI) Overview Shawn Matheson MBA, LNHA, FACHCA Market Manager Idaho Health Care Association Annual Convention Boise, ID July 13, 2017 Retrospective Bundles Surgeon

More information

Core Item: Hospital. Cover Page. Admissions and Readmissions. Executive Summary

Core Item: Hospital. Cover Page. Admissions and Readmissions. Executive Summary Cover Page Core Item: Hospital Admissions and Readmissions Name of Applicant Organization: Horizon Family Medical Group Organization s Address: 4 Coates Drive, Goshen NY 10924 Submitter s Name: Rinku Singh

More information

USING ACUTE CARE PLANS TO IMPROVE COORDINATION AMONG ED HIGH UTILIZER PATIENTS MASSACHUSETTS GENERAL HOSPITAL Publication Year: 2014

USING ACUTE CARE PLANS TO IMPROVE COORDINATION AMONG ED HIGH UTILIZER PATIENTS MASSACHUSETTS GENERAL HOSPITAL Publication Year: 2014 USING ACUTE CARE PLANS TO IMPROVE COORDINATION AMONG ED HIGH UTILIZER PATIENTS MASSACHUSETTS GENERAL HOSPITAL Publication Year: 2014 SUMMARY: High utilizer patients often get a full work-up every time

More information

CLINICAL INTEGRATION DRIVERS, IMPACT, AND OPTIONS JOBY KOLSUN, D.O. MEDICAL DIRECTOR CLINICAL INTEGRATION LEE PHO

CLINICAL INTEGRATION DRIVERS, IMPACT, AND OPTIONS JOBY KOLSUN, D.O. MEDICAL DIRECTOR CLINICAL INTEGRATION LEE PHO CLINICAL INTEGRATION DRIVERS, IMPACT, AND OPTIONS JOBY KOLSUN, D.O. MEDICAL DIRECTOR CLINICAL INTEGRATION LEE PHO Disclaimers My current position I am not offering advice on clinical integration Items

More information

Creating Care Pathways Committees

Creating Care Pathways Committees Presentation Creating Care Title Pathways Committees December 12, 2012 December 12, 2012 Creating Care Pathways Committees LeadingAge Indiana Integrated Care & Payment Executive Series 1 2012 Health Dimensions

More information

LESSONS LEARNED IN LENGTH OF STAY (LOS)

LESSONS LEARNED IN LENGTH OF STAY (LOS) FEBRUARY 2014 LESSONS LEARNED IN LENGTH OF STAY (LOS) USING ANALYTICS & KEY BEST PRACTICES TO DRIVE IMPROVEMENT Overview Healthcare systems will greatly enhance their financial status with a renewed focus

More information

The influx of newly insured Californians through

The influx of newly insured Californians through January 2016 Managing Cost of Care: Lessons from Successful Organizations Issue Brief The influx of newly insured Californians through the public exchange and Medicaid expansion has renewed efforts by

More information

The Future of Healthcare Credit Analysis - Seven Emerging Ratios

The Future of Healthcare Credit Analysis - Seven Emerging Ratios The Future of Healthcare Credit Analysis - Seven Emerging Ratios Kevin F. Fitch Director, Strategic Financial Planning & Analysis Adam D. Lynch Vice President Robert A. Henley Director, Analytics Learning

More information

paymentbasics The IPPS payment rates are intended to cover the costs that reasonably efficient providers would incur in furnishing highquality

paymentbasics The IPPS payment rates are intended to cover the costs that reasonably efficient providers would incur in furnishing highquality Hospital ACUTE inpatient services system basics Revised: October 2015 This document does not reflect proposed legislation or regulatory actions. 425 I Street, NW Suite 701 Washington, DC 20001 ph: 202-220-3700

More information

Designing & Delivering Whole-Person Transitional Care Coordinating care across settings and over time to drive outcomes

Designing & Delivering Whole-Person Transitional Care Coordinating care across settings and over time to drive outcomes Designing & Delivering Whole-Person Transitional Care Coordinating care across settings and over time to drive outcomes Amy E. Boutwell, MD, MPP CNYCC Annual Meeting November 6, 2017 Agenda Design data,

More information

WHITE PAPER. The Shift to Value-Based Care: 9 Steps to Readiness.

WHITE PAPER. The Shift to Value-Based Care: 9 Steps to Readiness. The Shift to Value-Based Care: Table of Contents Overview 1 Value Based Care Is it here to stay? 1 1. Determine your risk tolerance 2 2. Know your cost structure 3 3. Establish your care delivery network

More information

Creating the New Care Design L2. George Kerwin, CEO Patient of Bellin Health Bellin Health Team. Objectives

Creating the New Care Design L2. George Kerwin, CEO Patient of Bellin Health Bellin Health Team. Objectives Creating the New Care Design L2 George Kerwin, CEO Patient of Bellin Health Bellin Health Team Objectives Identify the five views of the Production System necessary to Create a Connected Personal Experience

More information

ACO Practice Transformation Program

ACO Practice Transformation Program ACO Overview ACO Practice Transformation Program PROGRAM OVERVIEW As healthcare rapidly transforms to new value-based payment systems, your level of success will dramatically improve by participation in

More information

improvement program to Electronic Health variety of reasons, experts suggest that up to

improvement program to Electronic Health variety of reasons, experts suggest that up to Reducing Hospital Readmissions March/2017 The readmission rate for patients discharged to a skilled nursing facility is 25% within 30 days1. What can senior care providers do to reduce these hospital readmissions?

More information

From EHR Implementation to Attestation: Auditing and Monitoring Meaningful Use

From EHR Implementation to Attestation: Auditing and Monitoring Meaningful Use From EHR Implementation to Attestation: Auditing and Monitoring Meaningful Use Donna M. Abbondandolo, MBA, CHC, CPHQ, RHIA, CCS, CPC AVP of Compliance Laura Massa, RHIA, CCS, CTR Compliance Data Specialist

More information

Managing Congestive Heart Failure as a Business September 13, 2010 Session M30 Society for Healthcare Strategy and Market Development annual meeting

Managing Congestive Heart Failure as a Business September 13, 2010 Session M30 Society for Healthcare Strategy and Market Development annual meeting Managing Congestive Heart Failure as a Business September 13, 2010 Session M30 Society for Healthcare Strategy and Market Development annual meeting Chris Kane SVP, Strategic Business Development WellStar

More information

Clinical Operations. Kelvin A. Baggett, M.D., M.P.H., M.B.A. SVP, Clinical Operations & Chief Medical Officer December 10, 2012

Clinical Operations. Kelvin A. Baggett, M.D., M.P.H., M.B.A. SVP, Clinical Operations & Chief Medical Officer December 10, 2012 Clinical Operations Kelvin A. Baggett, M.D., M.P.H., M.B.A. SVP, Clinical Operations & Chief Medical Officer December 10, 2012 Forward-looking Statements Certain statements contained in this presentation

More information

A Systematic Approach to Performance Improvement Under MACRA s Quality Performance Program

A Systematic Approach to Performance Improvement Under MACRA s Quality Performance Program A Systematic Approach to Performance Improvement Under MACRA s Quality Performance Program White Paper ELLIS MAC KNIGHT, MD, MBA Senior Vice President/CMO May 2017 CONTACT For further information about

More information

OMC Strategic Plan Final Draft. Dear Community, Working together to provide excellence in health care.

OMC Strategic Plan Final Draft. Dear Community, Working together to provide excellence in health care. Dear Community, Working together to provide excellence in health care. This mission statement, established nearly two decades ago, continues to be fulfilled by our employees and medical staff. This mission

More information

Midmark White Paper The Connected Point of Care Ecosystem: A Solid Foundation for Value-Based Care

Midmark White Paper The Connected Point of Care Ecosystem: A Solid Foundation for Value-Based Care Midmark White Paper The Connected Point of Care Ecosystem: A Solid Foundation for Value-Based Care Introduction This white paper examines how new technologies are creating a fully connected point of care

More information

Innovating Predictive Analytics Strengthening Data and Transfer Information at Point of Care to Improve Care Coordination

Innovating Predictive Analytics Strengthening Data and Transfer Information at Point of Care to Improve Care Coordination Innovating Predictive Analytics Strengthening Data and Transfer Information at Point of Care to Improve Care Coordination November 15, 2017 RRHA Healthcare Innovations Conference Agenda Arnot Health Overview

More information

Launching an Enterprise Data Warehouse to Rapidly Reduce Waste in Asthma Care

Launching an Enterprise Data Warehouse to Rapidly Reduce Waste in Asthma Care Success Story Launching an Enterprise Data Warehouse to Rapidly Reduce Waste in Asthma Care HEALTHCARE ORGANIZATION Children s Hospital TOP RESULTS Decreased average length of stay by 11 hours Achieved

More information

Referrals, Prior Authorizations, Medical Management, and Appeals

Referrals, Prior Authorizations, Medical Management, and Appeals Referrals, Prior Authorizations, Medical Management, and Appeals 1 An Independent Licensee of the Blue Cross Blue Shield Association 044506 (12-21-2017) 2017 Premera. Proprietary and Confidential. Referrals

More information

The creative sourcing solution that finds, tracks, and manages talent to keep you ahead of the game.

The creative sourcing solution that finds, tracks, and manages talent to keep you ahead of the game. Jobvite Engage: Advertising & Marketing The creative sourcing solution that finds, tracks, and manages talent to keep you ahead of the game. As any recruiter in Advertising & Marketing can tell you, today

More information

How Allina Saved $13 Million By Optimizing Length of Stay

How Allina Saved $13 Million By Optimizing Length of Stay Success Story How Allina Saved $13 Million By Optimizing Length of Stay EXECUTIVE SUMMARY Like most large healthcare systems throughout the country, Allina Health s financial health improves dramatically

More information

HOSPITAL QUALITY MEASURES. Overview of QM s

HOSPITAL 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 information

Strategy Guide Specialty Care Practice Assessment

Strategy Guide Specialty Care Practice Assessment Practice Transformation Network Strategy Guide Specialty Care Practice Assessment 1/20/2017 1 Strategy Guide: Specialty Care PAT 2.2 Contents: Demographics Tab: 3 Question 1: Aims... 3 Question 2: Aims...

More information

PRISM Collaborative: Transforming the Future of Pharmacy PeRformance Improvement for Safe Medication Management

PRISM Collaborative: Transforming the Future of Pharmacy PeRformance Improvement for Safe Medication Management PRISM Collaborative: Transforming the Future of Pharmacy PeRformance Improvement for Safe Medication Management Mission: To improve the health of the people of Connecticut through safe and effective medication

More information

The Connected Point of Care Ecosystem: A Solid Foundation for Value-Based Care

The Connected Point of Care Ecosystem: A Solid Foundation for Value-Based Care Includes Suggestions for Leveraging Improved BP Measurements to Achieve Quality Metrics Midmark White Paper The Connected Point of Care Ecosystem: A Solid Foundation for Value-Based Care Introduction This

More information

Jumpstarting population health management

Jumpstarting population health management Jumpstarting population health management Issue Brief April 2016 kpmg.com Table of contents Taking small, tangible steps towards PHM for scalable achievements 2 The power of PHM: Five steps 3 Case study

More information

Making the Case for Change Without a Burning Platform

Making the Case for Change Without a Burning Platform Making the Case for Change Without a Burning Platform Presented By: Rex P. Budde, CPA, MBA President and CEO Southern Illinois Healthcare, Carbondale, IL Region s second largest employer 3,700 total employees

More information

WHITE PAPER. Transforming the Healthcare Organization through Process Improvement

WHITE PAPER. Transforming the Healthcare Organization through Process Improvement WHITE PAPER Transforming the Healthcare Organization through Process Improvement The movement towards value-based purchasing models has made the concept of process improvement and its methodologies an

More information

U.S. Healthcare Problem

U.S. Healthcare Problem U.S. Healthcare Problem U.S. Federal Spending GDP (%) Source: Congressional Budget Office This graph shows that government has to spend a lot of more money in healthcare in the future and it is growing

More information

Clinical Program Cost Leadership Improvement

Clinical Program Cost Leadership Improvement Clinical Program Cost Leadership Improvement December 2017 Presbyterian recently developed a rapid-cycle process for integrating sustainable cost and quality improvements within clinical programs. Population

More information

Managing Patients with Multiple Chronic Conditions

Managing Patients with Multiple Chronic Conditions Best Practices Managing Patients with Multiple Chronic Conditions Dartmouth-Hitchcock Physicians Case Study Organization Profile Headquartered in Bedford, New Hampshire, Dartmouth-Hitchcock is a large

More information

Rebekah Gardner, MD Senior Medical Scientist, Healthcentric Advisors Assistant Professor of Medicine, Brown University

Rebekah Gardner, MD Senior Medical Scientist, Healthcentric Advisors Assistant Professor of Medicine, Brown University Improving the Safety of Care Transitions through Best Practices and Community Collaboration The Rhode Island Experience Rebekah Gardner, MD Senior Medical Scientist, Healthcentric Advisors Assistant Professor

More information

POPULATION HEALTH PLAYBOOK. Mark Wendling, MD Executive Director LVPHO/Valley Preferred 1

POPULATION HEALTH PLAYBOOK. Mark Wendling, MD Executive Director LVPHO/Valley Preferred   1 POPULATION HEALTH PLAYBOOK Mark Wendling, MD Executive Director LVPHO/Valley Preferred www.populytics.com 1 Today s Agenda Outline LVHN, LVPHO and Populytics Overview Population Health Approach Population

More information