Preventing Avoidable Readmissions: Collaborative Measurement July 24, 2013
Collaborative Goals Reduce readmission rates by 20% Increase the number of patients in the pilot unit or population who undergo assessment for risk of readmission to 95%. Increase the number of patients in the pilot unit or population who are assessed to be at high risk of readmission whose primary care physician is informed of their hospitalization within 48 hours of admission to 80%. Increase number of patients in the pilot unit or population who are assessed to be at high risk of readmission who are scheduled for a follow-up physician visit within 7 days of discharge from hospital to 80%. 10% improvement or national 25 th percentile in scores on four HCAHPS dimensions
Today s Objectives Put our readmission measure into context o Collab measure is not the same as CMS s Provide introduction to process measures for this year
Were you at the in-person session? Yes, I was at the in-person session. No, I was not at the in-person session.
Agenda Readmission rates o Overview of readmit rates o Readmission trend since 2010 New process measures for this year
More info? These slides will be distributed after this session Data manual will be posted in our online toolkit http://www.ncqualitycenter.org/engage-providers/henpartnership-for-patients-overview/nocvainitiatives/readmissions-nc/reducing-readmissionsnc-resources/
Readmission Rates Overview of different readmit rates Baseline, goals, and progress
There are lots of different readmit rates out there This collab uses all-cause, all-payer 1-30 day readmit rate (claims-based, not risk-adjusted). Others CMS HF/AMI/PN readmit rate CMS all-cause readmit rate, THA/TKA CCNC/Treo s Potentially Preventable (PPR) rates
What readmit rates are you using internally? CMS HF/AMI/PN CMS all-cause CCNC s PPR measure Other please type in
Readmit rates can really change depending on the metric Rankings really change!
Does this mean readmission rates are baloney? No. Different rates reflect very real, large policy differences about what to focus on.
Collab Measure 1 2 3 4 5 Day 0 Day 5 Day 7 Day 10 Day 13 Day 15 Day 17 Day 35 Day 37 4 readmissions/5 discharges=80% Every patient, every payer, every reason, every time
CMS Index Index Day 0 Day 5 Day 7 Day 10 Day 13 Day 15 Day 17 Day 35 Day 37 All-or-none: Yes, this patient was readmitted within 30 days. 1 readmission/2 index discharges=50% 30 days since d/c
CMS HF CMS all-cause NCQC Collab CCNC Timeframe? 0-30 0-30 1-30 (same day excluded) Other hospitals? Yes Yes No Yes 0-30 Risk-adjustment? Yes Yes No Yes Payer? Medicare Medicare Every payer Medicaid Clinical condition (first visit)? Includes HF only Excludes psych, rehab, and cancer pts Includes every condition Excludes about 40% of patients Clinical reason (readmit dx or procedure) Excludes planned (used to exclude nothing) Excludes planned Includes every readmit Only includes clinically related readmits Frequent fliers? Only 1 readmit counted per 30 day window Multiple readmits within 30 days are possible Multiple readmits within 30 days are possible Only 1 readmit counted per chain of clinically related discharges
Bottom line Worry less about comparing your starting rate to other hospitals o The rate you start at depends a LOT on the measure definition Instead, focus on whether you can CHANGE your rate at your hospital! Regardless of the exact definition, a great QI intervention will lower your readmission rate
Readmission Rates Our collab s readmit rate: The simplest one you can think of o Every patient, every time, every reason but no risk-adjustment and back to your hospital only. How much progress can I hope to see in my hospital?
Progress we ve seen to date 12.0% Readmit Rates for original 27 collab participants (2010Q1-2012Q4 partial) 10.0% 8.0% 6.0% 4.0% 2.0% 0.0% 2010Q1 2010Q2 2010Q3 2010Q4 2011Q1 2011Q2 2011Q3 2011Q4 2012Q1 2012Q2 2012Q3 2012Q4- Partial Rate (Collab) 10.3% 10.6% 10.5% 10.2% 10.6% 10.3% 10.2% 10.4% 10.3% 9.7% 9.6% 9.6% Goal=8.3% 8.3% 8.3% 8.3% 8.3% 8.3% 8.3% 8.3% 8.3% 8.3% 8.3% 8.3% 8.3%
Bottom Line: What does it all mean? Collab (n=27) 2010 Rate 10.4% 2012 Q2 Rate (partial) 9.6% Readmits in 2010 28,876 Projected readmits based on 2012 Q3-4 rate 26,703 Projected readmits avoided 2,173 Projected cost reduction $20,732,971
Does anything about this data surprise you? Yes No
New Process Measures
New Process Measures Percent of patients given an assessment for high risk of readmission Calculate percent out of all patients in your pilot unit. Goal is 100%. Percent of high-risk patients where PCP informed of hospitalization w/in 48 hrs Calculate % for high-risk patients in pilot unit. Inform PCP or appropriate clinician within 48 hours of admission. Follow-up visit scheduled within 7 days Calculate % for high-risk patients in pilot unit. Hospital does not need to track whether patient attends visit.
What the data entry looks like Percent of patients given an assessment for high risk of readmission Percent of high-risk patients whose care provider is informed within 48 hours Percent of high-risk patients who have a follow-up visit scheduled within 7 days
Let s take a deeper dive into these process measures First data due: August 20 th
Numerator ( Case ) Definition Denominator Population Timeframes & Collection Schedule Comments Percent of patients given assessment for high risk of readmission Number of patients discharged from pilot unit who have been assessed for risk of readmissions All patients discharged from pilot unit Hospital submits monthly numerator/den ominator to QDS. Rates are submitted monthly on the 20 th day of the following month (Example: August data is submitted by September 20.) Hospitals may select from among several methods for assessing patient risk of readmission. All patients in the pilot unit or population are to be assessed. Sampling, if necessary, should be discussed with NCQC.
Questions on screening tools All collaborative hospitals will need to have a screening tool for high risk of readmission. o Some hospitals will revise or develop new tools (July 31 webinar will provide tools and resources) o Send your screening tool to NCQC (dhiggins@ncha.org) for shared learning Some hospitals will need to report zeros until the screening tool is developed.
Poll Do you have a screening tool to identify high risk of readmits? o Yes o No Who completes it? Are you considering revising it? Is it used faithfully? Chat in your answer.
What do I do if my hospital doesn t have a screening tool yet? Hospitals should report all three process measures, even if they don t have a screening tool yet. o Many hospitals are in this boat! How to report? o Patients assessed at high risk of readmission. Numerator=Number of patients assessed at high risk=0 Denominator=All patients on unit o Other two process measures: Zero out of Zero Numerator=Zero Denominator=Zero
How to enter data if a hospital does NOT have a screening tool Percent of patients given an assessment for high risk of readmission Percent of high-risk patients whose care provider is informed within 48 hours Percent of high-risk patients who have a follow-up visit scheduled within 7 days
Numerator ( Case ) Definition Denominator Population Timeframes & Collection Schedule Comments Informing primary care physician of patient admission for patients assessed at high risk of readmission Patients in the pilot unit or population who are assessed to be at high risk of readmission and whose primary care physician is informed of their hospitalization within 48 hours of admission. Number of patients in the pilot unit or population who are assessed to be at high risk for readmission Hospital submits monthly numerator/den ominator to QDS. Rates are submitted monthly on the 20 th day of the following month. Method of communication & documentation (e.g., phone, email, fax) is up to the hospital and its community. Project team should consult with community PCPs and other providers.
Poll Are you already tracking high risk patients whose provider is informed of their admission within 48 hours? Yes No How are you tracking it? Chat in your answer.
Numerator ( Case ) Definition Denominator Population Timeframes & Collection Schedule Comments Follow-up physician visit within 7 days for patients assessed at high risk for readmission Patients in the pilot unit or population who are assessed to be at high risk of readmission and who are scheduled for a follow-up physician visit within 7 days of discharge from hospital. Number of patients in the pilot unit or population who are assessed to be at high risk for readmission. Hospital submits monthly numerator/ denominator to QDS. Rates are submitted monthly on the 20 th day of the following month. 7 days of discharge should be interpreted as 7 calendar days.
FAQs PCP informed of hospitalization w/in 48 hours o Does it have to be by phone? Answer: Up to you & your community. Project team should consult with community & decide email/phone/etc. Follow-up visit scheduled within 7 days o 7 calendar days or business days? Answer: Calendar days. What if the patient doesn t have a PCP? o Notify appropriate clinical specialist (whoever the patient should see for f/u) Send additional questions to Dean Higgins dhiggins@ncha.org and we will post answers on our website.
Poll Are you already tracking high risk patients whose follow up appt is scheduled within 7 days of discharge? Yes No How are you tracking it? Chat in your answer.
All Patients on your pilot What to Remember unit/population What % of these patients are assessed to determine whether they are high risk? Should be 100%. Submit this as first process measure. Some patients are high risk Some patients are not high risk. What percent of these patients have their care provider contacted within 48 hours? What percent of these patients have a follow-up appt made within 7 days?
Two different denominators You have 100 patients on your unit/population. This is the denominator for process measures #1 (% of patients who are assessed to determine if they are high risk) You have 20 high risk patients. This is denominator for process measure #2 and #3, i.e. contact w/care provider & f/u within 7 days)
Two different denominator populations Percent of patients given an assessment for high risk of readmission Percent of high-risk patients whose care provider is informed within 48 hours Percent of high-risk patients who have a follow-up visit scheduled within 7 days
How to enter data Step 1: Log in
Step 2: Click on the readmissions module
Step 3: Click on Data Tab.
Step 4: Enter data Percent of patients given an assessment for high risk of readmission Percent of high-risk patients whose care provider is informed within 48 hours Percent of high-risk patients who have a follow-up visit scheduled within 7 days
Poll Regarding the process measures and how to enter them, indicate which best describes your position: o I've got it and fully understand o I still have questions o I am so confused!!!
Summary Background on readmit measure for this collab o Different from CMS; pay attention to *direction* of trend, not comparisons to other hospitals o Know what your collab goal is for this year For this year, three new process measures build on each other & focus on high risk patients Questions??
Next Steps Complete your action plan August 7 Submit process measures for July into QDS Webinar: Assessing Risk of Readmission Webinar: Connecting with Community Partners Webinar: Patient and Family Engagement Coaching Call August 20 July 31 from 1:30-2:30pm August 7 from 1:30-2:30pm August 14 from 1:30-2:30pm July - September
Contacts For more information, contact: Laura Maynard, Director of Collaborative Learning at: lmaynard@ncha.org or 919-677-4121 Dean Higgins, Project Manager at dhiggins@ncha.org or 919-677-4212 Erica Preston-Roedder, Director of Quality Measurement, at eroedder@ncha.org or 919-677-4125