Using Quality Data to Market to Referral Sources Kim Hicks
Change as a Matter of Survival BUSINESS OF HEALTHCARE 3
What s Happening here?
It costs Medicare about $26 billion a year, with about $17 billion stemming from potentially avoidable readmissions. Medicare is reducing reimbursement for 2,610 hospitals, including 126 in Pennsylvania, for high readmission rates. According to the Hospital & Healthsystem Association of Pennsylvania, 79 percent of Pennsylvania hospitals are expected to lose a little more than $21 million in Medicare fee-for-service payments during the federal fiscal year that began Oct. 1, based on the final readmission adjustment factors published by the Centers for Medicare and Medicaid Services. Readmissions cost Geisinger $1 million in in Medicare funds The Daily Item Among Philadelphia-area hospitals, both Pennsylvania Hospital in Philadelphia and Physician s Care Surgical Hospital in Royersford, Pa., were hit with 3 percent payment reductions the maximum penalty imposed under the program. Scranton s three hospitals face reductions Medicare Payments Thetimes-tribune.com 5
National Transformation of Healthcare the Affordable Care Act provides CMS the flexibility to implement a wide range of innovations designed to transform the delivery system by paying for value not volume Source: ASPE Issue Brief Growth In Medicare Spending Per Beneficiary Continues To Hit Historic Lows January 7, 2013 By: Richard Kronick and Rosa Po 6
Innovations include: Accountable Care Organizations Bundled Payment Value Based Purchasing Pay-for-Performance 7
Collaboration and coordination will be key in remaining a viable participant in the changing health care delivery model. Each level of care must coordinate with the next to prevent fragmented care. Collaboration 8
So, what does this mean to us? Hospitals and Managed Care are reducing the number of skilled nursing facilities that they partner with 9
CMS Definition of Choice Hospitals are still required to provide a list of appropriate facilities Preferred vendor lists are allowed 10
What is happening in the industry? Hospitals are demanding data driven, statistically based information Hospitals want validated outcomes Facilities that can t provide this info are in rouble 11
Nursing Homes that can t position themselves as an attractive option to the hospitals in their areas 12
Will find themselves on the outside looking in 13
WILL YOU WIN THE RACE TO BE A MODEL PARTNER? 14
Providers of care will be judged by quality metrics. Measurement and decisions based on data and outcomes will become the health care norm. Quality Metrics 15
Like what? Items they can verify from independent sources: 5 Star Survey Performance/QAPI Items they have or need from you: Hospital Readmission Rates Customer Satisfaction Data Patient Communication Strategy High-Level Clinical Outcomes 16
17
Source: Market Disruption- Translating Change into Action, Ellen Lukens, Avalere, 7-2014 18
They want the information But how do they want it? 19
20
21
22
How do you summarize your success? Demonstrate outcomes with data Leave them with information they can understand without you there to explain it Keep it as short and as simple as possible 23
5 STAR AND SURVEY PERFORMANCE 24
5 Star Health Inspection Rating includes your surveys for the last three years. Health Inspections have the heaviest weight. Look at NH Compare! 25
Accreditations and Awards AHCA/Baldridge Leading Age Providigm Joint Commission CARF 26
QAPI 27
Things are good now but will they be in the future? Consistent assessment of your quality Proactive identification of problems Identification of system issues Interventions before they become BIG problems 28
QAPI Hospitals have been utilizing QAPI practices for years- this is a concept they are familiar with Don t let this opportunity slide- there is a window where you can prove you know more than the rest 29
QAPI: The Five Elements of QAPI Create a structured, replicable process that identifies system problems 1. Design and Scope Prove you cover the whole regulation with data 5. Systematic Analysis and Systemic Action Conduct in-depth improvement projects using root cause analysis 4. Performance Improvement Projects (PIPs) The data that you use needs to come from multiple sourcesnot just MDS 2. Governance and Leadership Create a process that sustains through turnover 3. Feedback, Data Systems and Monitoring
31
How are you deciding if something is broken? What evidence are you using? 32
HOSPITAL READMISSION RATES 33
More hospitals than ever are receiving penalties. $428 Million to be fined this year 2,610 Hospitals- 433 more than last year More conditions apply 34
Hospital Readmission Rates You will need to be able to market yourself to hospitals and managed care partners and show: Your readmission rate What you are doing to track and reduce readmissions Be prepared to compete against other homes on this Copyright Providigm 2012 35
What should you be doing At the very least, know your raw rate of readmissions to the hospital But, realize that risk adjustment is necessary 36
Calculating a Raw Rate of Readmission Numerator Denominator Percentage of Readmissions 37
Calculating a Raw Rate of Readmission Numerator: Number of those admissions that returned to the hospital within 30 days of their admission date Denominator: Number of admissions that came to you from a hospital and have had at least 30 days since their admission date 38
Understand that Risk Adjustment is necessary 39
Understand that Risk Adjustment is necessary Rehab Younger Population Low Acuity, Low Risk Long Term Stay Specializes in Cardiac More Elderly, Frail Population High Acuity, High Risk 40
Understand that Risk Adjustment is necessary Rehab Younger Population Low Acuity, Low Risk Long Term Stay Specializes in Cardiac More Elderly, Frail Population High Acuity, High Risk 41
Understand that Risk Adjustment is necessary Worse than expected job managing readmissions considering who they care for Their risk adjusted rate would be HIGHER than their actual rate Better than expected job managing readmissions considering who they care for Their risk adjusted rate would be LOWER than their actual rate 42
Understand that Risk Adjustment is necessary Allows benchmarking and comparison in a way that is fair and accurate. Takes into account the types of acuity levels of the residents in a building, as well as their risk for readmission 43
44
SATISFACTION 45
Customer Satisfaction Resident and family satisfaction has always been important. Now, because of HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems), hospitals are even more concerned about your satisfaction scores. 46
HCAHPS Hospital s HCAHPS scores began to affect about 30% of their reimbursement in 2013 The HCAHPS measurement reports the quality of care in a hospital as perceived and reported by patients. Because HCAHPS includes questions about transition of care, your satisfaction rating can directly impact your hospital referral partners. 47
48
Employee Engagement High rates of employee engagement have been shown to reduce turnover and increase the consistency and quality of care. 49
COMMUNICATION STRATEGY 50
Communication: Patients as Partners Medicare beneficiaries will be partners in care in terms of decision making and health choices. Communication with and education of consumers improves outcomes for consumers and providers. 51
Be prepared to discuss communication strategy 52
Pre-Care Strategy Communication Advance Directives During Care/Participation in Care Plan Post-Care Strategy 53
CLINICAL OUTCOMES 54
Pressure Ulcers Falls Infections Clinical Outcomes UTIs, Vaccinations Community Discharge Length of Stay Information 55
QIs/QMs Fact Sheet of Outcomes Confirmation of data from other measureable data sources 56
57
What should you be doing? Put together your data based on parameters they have asked forchances are, this will come from multiple systems/places. No parameters? Play with them Tell your best story 58
Partner Report 59
BENEFITS OF BEING ON THAT LIST 60
Where the Rubber Hits the Road Conservative average per patient/ per day reimbursement is $391.78 Source: Centers for Medicare & Medicaid Services, Department of Health and Human Services. 2013. CMS 1446 F. Medicare Program; Prospective payment systems and consolidated billing for skilled nursing facilities for fiscal year 2014. Federal Register 78, no. 151 (August 6): 47936 44978. 61
If providing data to a partner would cause them to fill one more bed a year $391.78 X 365= $142,999.70 62
Questions? Call your Medline rep 1800 MEDLINE Kim Hicks khicks@providigm.com 63