Reducing 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 and its impact on the industry. 2. Discuss and analyze the types of data necessary to appropriately measure hospital readmission rates. 3. Describe potential solutions within your facility that will positively affect clinical outcomes. 4. Describe how progress is measured after implementation. 5. Discuss measures to ensure continuous quality improvement.

The Affordable Care Act This Act has brought about many challenges but at the same time it has opened opportunities for Skilled Nursing Facilities to set themselves apart from their competitors.

Why The Focus The Patient Protection and Affordable Care Act (March 23, 2010) has several provisions to reduce hospital readmissions Medicare is offering financial incentives to reduce potentially avoidable hospital transfers through payfor-performance, bundled payments, ACOs and other strategies CMS implemented financial penalties for hospitals with high 30 day readmission rates for the following diagnoses: CHF, Pneumonia, Acute Myocardial Infarction, COPD and elective Hip & Knee Replacements.

What is an ACO? Groups of volunteer doctors, hospitals, nurses and other care providers who offer coordinated quality care to a specific population of patients. How are ACOs paid? Providing treatment in the most cost effective environment.

ACOs Potential Impact on SNF Quality American HealthTech www.healthtech.net

Bundled Payments

http://innovation.cms.gov/initiatives/map/index.html

Medicare Readmission Penalties by State State Total Hospitals Eligible for Penalty # of Hospitals Penalized Average Penalty for Eligible Hospitals Ohio 137 96 0.36% Kentucky 65 57 0.66% Indiana 89 42 0.32% Michigan 95 55 0.39% Pennsylvania 156 110 0.39% West Virginia 30 27 0.46% http://www.kaiserhealthnews.org/stories/2013/august/02/readmission-penaltiesby-state-year-two.aspx

Readmission Penalties by Hospital *Provided by Kaiser Health News; http://capsules.kaiserhealthnews.org/wpcontent/uploads/2013/08/readmissions-year-2-data.pdf

How Did Medicare Decide On Penalties? Policy developed by CMS endorsed by the National Quality Forum (NQF) for heart attack, heart failure and pneumonia Three years of discharge data and minimum of 25 cases for each condition were used to develop these ratios Adjustment for factors that are clinically relevant including patient demographic characteristics, comorbidities and patient frailty *Provided by Kaiser Health News; http://www.kaiserhealthnews.org

30 Day, All-Condition Medicare Readmission Rates http://cmsgovblog.files.wordpress.com/2013/12/30day.jpg

Post-Acute Care Reform SNF Readmission Penalties Oct 1 st 2016-CMS will share with you how you are preforming as far as readmissions Oct 1 st 2017-Rates will be shared with the public on Nursing Home Compare Oct 1 st 2018-Rates will be cut 2%; based on your performance with readmissions you could get 98% of your rate or greater than 100% http://waysandmeans.gov/uploadedfiles/pac_reform_fact_sheet.pdf

Potential Complications with Hospital Admissions Transfer Trauma Delirium Immobility/Deconditioning Falls Weight Loss Incontinence and Foley Catheters Hospital Acquired Infections Wounds Polypharmacy

Factors Influencing Hospital Readmissions Geography Liability & Regulatory Concerns Hospitalizations Demographics Patient/Family Requests Co-morbidities

Factors Influencing Higher Readmission Rates Unsatisfactory Discharge Planning Access to PCP Noncompliance Medication Errors Family/Caregiver Competency Clinical Condition

Strategies for Success Decrease Unnecessary Readmissions Communication & Collaboration Resident/Family Satisfaction Success Preferred Provider Advanced Directives Quality Care

Advanced Data Collection Analysis Tracking Log

Discharges Tracking Log Considerations Physician/Staff Discharging Time of discharge Education Advanced Directives Palliative Care/Hospice Interact Tools

Tracking Log Considerations Percentage of residents that are readmitted within the first 30 days for MI, Pneumonia or Heart Failure? Then include all diagnosis. Did we fully implement the cardiac program? Joint Replacement Program? Pulmonary Program? Who is referring to you? What type of residents are you admitting?

How to Measure Rehospitalization Rates Based on claims (hospital & SNF Part A) Does not include ER visits and observation stays Excludes Medicare Advantage and private insurance %= numerator denominator %= # of persons sent to hospital # of persons admitted to SNF Brown University: http://ltcfocus.org/ SNF rehosp rates

Great Emphasis On Quality Assuring and/or improving quality requires documenting valid metrics and proactively implementing & monitoring systems How are we being graded? CMS Five Star Report Nursing Home Compare Quality Measures Facility Satisfaction Survey QIS/Traditional Surveys State - Resident Satisfaction Survey State - Family Satisfaction Survey

TriHealth Metrics

Metrics

Who s Watching Hospitals Survey Agencies ACOs MCOs

Managed Care of America

Humana SNF Scorecard Provider demographics and Services Available

Anthem Scorecard

Anthem-CareMore

Becoming the Preferred Provider What is your niche or area of expertise? Pick one or two specialties Develop a unique program Market the outcomes.

HCMG s Collaborative Objectives Reduce hospital readmissions Improve patient outcomes with minimal cost Improve the transition process from the hospital to SNF to home Become the local hospital s preferred provider

Cardiac Cardiac Recovery Program

SBAR Charting S= Situation B= Background A= Assessment R= Recommendation Improves the quality of information that is communicated to the physician resulting in an accurate diagnosis and treatment. http://interact2.net/docs/communication%20tools/sbar%20updated%20february%202011.pdf

Evaluation of Resident s Knowledge Teach Back Method What is the name of the diuretic or water pill you take? What amount of weekly weight gain should you report to your doctor? Share with me what a low-sodium diet entails? Why is it important to take your water pill every day? How will you remember to check for symptoms of heart failure every day?

Stop & Watch Tool Guides frontline staff through brief review of early, often subtle indicators of change in condition Improves communication between frontline staff and the nurse in charge http://interact2.net/docs/communication%20tools/early_warning_tool_(stopwatch)c.pdf

Electronic Medical Records Electronic Medical Records (EMRs) with complete, accurate and solid data. Software integration with partners to round out EMRs, e.g., labs, pharmacies, EKG reports, etc. Specialization programs that focus on reducing length-of-stay and improve the quality of care. Outcomes reports showing positive trends for lowering costs, boosting quality and reducing readmissions.

Orthopedic Programs YOUR RECOVERY The primary goal of your stay is for you to safely recover from surgery, participate in therapy, and to put you on the road to recovery. If there is anything we can do to enhance your stay and rehabilitation, please feel free to ask. Knee Replacement Hip Replacement

Wound Program Wound specialist of Greater Cincinnati Dr. Arti Masturzo Mist Therapy Negative Pressure Therapy Lymphedema Treatment Comprehensive Wound Care

The i-stat System An advanced handheld diagnostic tool that provides real-time, lab-quality results within minutes. Used for the Cardiac and Pulmonary Programs Comprehensive Point-of-Care Testing Diagnostic Testing (results ranging from 2 min to 17 min) Electrolytes and Hematology Blood Gas Chemistry Cardiac Markers Coagulation www.abbottpointofcare.com

(CORE) Readmission Risk Calculator www.readmissionscore.org

LACE Scores & Readmissions Lace Index Scores L- Length of stay A- Acuity of the admission C- Co-morbidities E- Emergency department visits in the last 6 months Scores range from 1-19 and is helpful in predicting the 30 day readmission rate. http://www.iha.org/pdfs_documents/news_events/breakout%20session %202B%20-%20Richard%20Fraioli,%20John%20Muir.pdf

Physician and NP/PA Expectations Required presence in facility Rounding with nursing staff Quarterly Meeting Involvement Offer education and In-Services for staff/families New admissions seen in a timely manner Available for family conferences Facility leadership involvement Supportive of programs to reduce readmissions

Care Coordinator

Symptom Management Nurse Practitioner

Home Health Agency

How Often Home Health Patients had to be Admitted to the Hospital Unplanned Hospital Readmission Average (%) National Average 16% Pennsylvania Average 17% Home Health Compare Website: http://www.medicare.gov/homehealthcompare/search.html#

HCMG All Cause/All Payer 30 Day Readmission Rate

LTC Trend Tracker

Becoming the Preferred Provider Design Unique Programs that are appealing to your local hospital and document outcomes for marketing. SNF provider Invest in staff training and education Invest in equipment Implement a system for calculating data Identify a champion within your organization to train, monitor and evaluate programs. Collect valid data which will allow you to present measureable outcomes.

Becoming the Preferred Provider Collaborate Monitor your readmission rates and be prepared to present yourself as a solution to the hospital s problem. Consider a Care Coordinator role within your organization and develop partnerships with like-minded companies to ensure a smooth transition of care.

Bridging Connections Local Hospitals

Marketing Points Improved medical care R/T early identification of change of conditions Capitalize on the program s uniqueness Better nursing assessment skills Better clinical outcomes Reduction in rehospitalizations Positive reputation among hospitals, MCOs and the community at large Improved Customer/Family Satisfaction

Everything Included

Prepare Your Staff

Questions Kim Barrows RN BSN kbarrows@hcmg.com

These materials and the intellectual property contained therein are Copyright 2012 and are the exclusive property of The Health Care Management Group. Any use, reproduction, publication, transfer, display, distribution, copying, dissemination, display, or adoption of these materials in other works without the express written permission of The Health Care Management Group is strictly prohibited and may give rise to criminal and civil penalties under the federal Copyright Act. All rights reserved by The Health Care Management Group.