Beyond the Hospital Walls: Impact of a SNFist Practice Model Aaron Snyder, MD Vice President, US Acute Care Solutions Kim Repac Chief Financial Officer, WMHS
Aging Population 50 Million
Distribution of RSRRs Among SNFs with at least 25 Index Stays 2011
Initial Focus Focus on identifying opportunities to reduce potentially avoidable utilization Opportunity for collaboration w/nursing homes and providers to improve care to reduce medically unnecessary utilization Potential for reduction of potentially avoidable admissions, readmissions, Emergency room visits and OBS in NHs
Potentially Avoidable Services A report for CMS prepared by RTI International in 2010 identified potentially avoidable diagnoses Based on a comprehensive list of conditions associated with potentially avoidable hospitalizations for residents of nursing facilities based on input from experts in geriatrics, ambulatory care sensitive conditions and other quality measures. Found 39% of all admissions may have been avoidable; Five conditions (pneumonia, congestive heart failure, urinary tract infections, dehydration, and chronic obstructive pulmonary disease/asthma) were responsible for 78% of all of the potentially avoidable hospitalizations
The Opportunity Improve care in nursing homes to: Recognize and treat conditions early to avoid increased patient acuity requiring hospital care Manage some conditions in the nursing home (e.g., dehydration, UTI) Expedite transfer of patients who do require hospitalbased evaluation and management Improve advance care planning and the use of palliative care plans when appropriate and adopted by the patient/family Align financial incentives through bundled payments or pay for performance programs
Readmission Penalties Maryland Waiver Total Patient Revenue Global Budget Revenue
WHY Are We Where We Are?
The Elephant in the Room
SNFist Care - 2015 SNFist Director Services Available Medical Director with Full Time Practice Medical Director Patient Visits After-Hours Care Weekend Care Weekend Admits
The Pilot A Joint Venture Between the Health System and Physicians
SNFist US Acute Care Solutions SNF Services US Acute Care Solutions Available 24/7 Model On-Site Providers / 7 Days a Week / 12 Hours a Day On Call Program Integrated EMR Collaboration SNFist/ED Physicians
Our New SNFist Model SNF US Acute Care Solutions Goals Results Better Outcomes Clinically Decreased Readmissions Decreased Admits Increased Weekend Placements in SNF Decreased LOS of Hospital Patients SNF-ED Coordination (Increased chances patient discharged back to SNF)
1365 1420 1839 1772 2159 Patient Encounters 2320 2424 2400 3000 Total SNFist Patient Encounters 2015 & 2016 2500 2000 1500 1000 500 0 Q1 Q2 Q3 Q4 2015 2016
Readmit % SNFist Readmit Rates Per Quarter 30% 25% 20% 15% 10% 5% 0% 2014 Q4 2015 Q1 2015 Q2 2015 Q3 2015 Q4 2016 Q1 2016 Q2 2016 Q3 2016 Q4 Devlin Allegehny
Weekend Admission Rates Pre-SNFist Program Weekend Admissions < 5%
Weekend Admission Rates with SNFist Program SNFist Program Weekend Admissions Rate 18.12%
Weekend Admission Rates Each Weekend Admission SAVES 1.5 Bed Day LOS
287 270 Transfers SNF to ED 418 450 Annual SNF to ED Transfers 400 350 300 250 200 150 100 50 0 2014 2015 2016
Summary of SNFist Results Improved Patient Care Reduced 30 Day Readmits Reduced Transfers from SNFist to ED Increased Weekend Admissions to SNF Decreased weekend holds in hospital, thus saving significant bed days annualized
Population Analysis Analyzed data for the unique patients transferred from the three SNFist nursing facilities to the hospital These patients had 547 inpatient admissions, 96 observation stays and 284 ER visits generating $10M in hospital charges. Total Inpatient Observation ER Total SNF # $ # $ # $ # $ Nursing Home A 314 $ 5,630,752 66 $ 218,375 159 $ 140,264 539 $ 5,989,390 Nursing Home B 138 $ 2,483,841 15 $ 83,653 68 $ 71,807 221 $ 2,639,301 Nursing Home C 95 $ 1,238,729 15 $ 47,957 57 $ 53,953 167 $ 1,340,639 TOTAL 547 $ 9,353,321 96 $ 349,985 284 $ 266,024 927 $ 9,969,330 ANNUALIZED 597 $ 10,203,623 105 $ 381,802 310 $ 290,208 1,011 $10, 875,632 ANNUALIZED DIRECT COST $ 6,122,174 $ 229,081 $ 174,125 $ 6,525,379 Conducted additional analysis to identify potentially avoidable services based on the primary diagnosis code (reason for visit or stay)
Analysis of Potentially Avoidable Services
Observation Pre SNFist Program Limited ability for weekend admissions to nursing homes Readmission rates amongst SNFist facilities and non-snfist facilities were similar 14.4% The three SNFist facilities received approximately 32.4% of the hospital nursing home discharges and accounted for approximately 32.3% of the total readmissions
Observation Post SNFist Program Readmission Rates Improved for SNFist Facilities, got worse for non-snfist Facilities 26% difference Increased patient placement to SNFist Facilities SNFist Facilities readmission rates decreased while casemix increased ED visits not resulting in admission decreased 35% at SNFist facilities and 24% overall Observation patients decreased 6% overall.
Results Pre SNFist Program Nursing Home Readmission rate 14.4% SNFist facilities Readmission rate 14.4% Non SNFist facilities readmission rate 14.4% SNFist NH % of Discharges 32.4% SNFist NH % of readmissions 32.3% Post SNFist Program Overall NH readmission Rate 15.6% SNFist NH readmission rate 13.6% Non SNFist NH readmission rate 16.6% SNFist % of Discharges to NH 33.2% SNFist NH% of readmissions 28.8%
Benefit to Participating Facility Access to dedicated coverage Increase in reimbursement due to increase in case mix III Increased admissions Medical Director in facility more frequently
Beyond the Hospital Walls: Impact of a SNFist Practice Model Aaron Snyder, MD Vice President, US Acute Care Solutions Kim Repac Chief Financial Officer, WMHS