Readmissions Coordinating & Transforming Care August 23, 2012.
-
Upload
godfrey-tucker -
Category
Documents
-
view
219 -
download
5
Transcript of Readmissions Coordinating & Transforming Care August 23, 2012.
- Slide 1
- Readmissions Coordinating & Transforming Care August 23, 2012
- Slide 2
- Todays Agenda Issue overview Comparison Framework Cardiology Connection Next Steps 2
- Slide 3
- Source: Commonwealth Fund, 2010 Medicare Readmission Rates 2009 Medicare readmission data revealed that Illinois ranked #48 for Heart Failure, #47 for Heart Attack, and #43 for Pneumonia.
- Slide 4
- CMS Readmissions Independent payment reduction program Goal 20% reduction by 2014 Penalizes excess readmissions ACA: exclude unrelated, planned Uses AMI, CHF, Pneumonia diagnostic categories as index admissions (w/more to come) Imposes a 1% cap of total Medicare payments in 2013, 2% - 2014, 3% - 2015 & thereafter Select hospitals not yet CAH, LTC, Rehab or Childrens Excludes case volumes < 25 4
- Slide 5
- Illinois Readmission Activity Projected Medicare estimates: 2010 = $30.3 M 2011 = $25.3 M Improvement in 2012 - $20.2 M 128 Hospitals (CMS data 2008-11) 12.5% No Penalty 72.7% Some Penalty 14.8% Maximum Penalty Nationally: (34.5%) (57.4%) ( 8.3%)
- Slide 6
- Key Initiatives Improving transitions of care Developing & improving palliative care Redesigning hospital discharge processes Strengthening hospitalist programs Measuring reductions in readmissions using standardized metrics
- Slide 7
- Illinois Readmission Profile Activity across Illinois hospitals Unique Patient Identifier Hospital agreements & submission 3Ms APR-DRG software readmission chains for clinically-related causes All payer hospital-specific & aggregate reports
- Slide 8
- Illinois SMART ACT - Readmissions HFS Performance-based System for PPR HFS seeks a $40M savings in FY2013 Uses 3Ms PPR software & APR-DRGs as foundation Hospitals to be individually compared against a target PPR rate threshold using 2010 data Above threshold pymt w/hold Below threshold no pymt w/hold 8
- Slide 9
- Summary Comparison IHA HFS Medicare Primary Focus Quality Improvement $40 M Budget Savings Reimbursement Penalty for Non-compliance Patient Population All payers/Acute care inpatients; OBV, ED Medicaid beneficiaries - inpatients Medicare beneficiaries - inpatients Readmission criteria Clinically-related cause: 7 & 30 days Clinically-related cause: 30 days All cause for readm w/in 30 days of index d/c for AMI, CHF or Pneumonia Readmission Method Chain Yes/No Data Timeframe Starts w/2011 1 -3 Q and then quarterly FY 2010 CMS Hospital Compare - 3yrs rolling (7/1/08 - 6/30/11) 9
- Slide 10
- Medicare Patients Readmissions Rate (Hospital Compare *and IHA Readmissions Resource**) (All Cause)* (Clinically Related Causes)** (All Cause)* CMS
- Slide 11
- Using IL Resource for Quality Improvement & Culture Transformation 11
- Slide 12
- Potential Preventable Readmission (PPR) A readmission that is clinically related to the index hospitalization. 12
- Slide 13
- Readmission Chain A sequence of PPRs that are all clinically related to the index hospitalization. May contain an index hospitalization and 1 PPR (most common), or may contain index and multiple PPRs. 13
- Slide 14
- 3M Potential Preventable Readmissions (PPR) Methodology Exclude: Newborns Obstetrical Major metastatic malignancy Other malignancy HIV Trauma Burn Left against medical advice 14
- Slide 15
- Readmission Example #1 Patient admitted on 4/1 (Day 1), discharged on 4/5 (Day 5) w/diagnosis of CHF, subsequently readmitted with same diagnosis on 4/29 & d/c on 5/8 15 IHAHFSCMS Index d/c date D/C diagnosis 4/5 CHF 4/5 CHF 4/5 CHF Readmission CHF Yes - Clinically related Yes -within 30 days of index d/c w/CHF Equals1 Chain 1 Readmission Paymt PenaltyN/AApplies
- Slide 16
- Readmission Example #2 Patient admitted on 4/1 (Day 1), discharged on 4/5 (Day 5) w/diagnosis of Pneum, subsequently readmitted with Hip Replacement on 4/29 & d/c on 5/3 16 IHAHFSCMS Index d/c date D/C diagnosis 4/5 Pneu 4/5 Pneu 4/5 Pneu Readmission Hip Replacement No - Not Clinically related Yes - index d/c re: Pneu and readm within 30 days Equals0 Chain 1 Readmission Paymt PenaltyN/ANoneApplies
- Slide 17
- Readmission Example #3 Patient admitted on 4/1 (Day 1), discharged on 4/5 (Day 5) w/diagnosis of Hip Replacement, subsequently readmitted with CHF on 4/29 & d/c on 5/8 17 IHAHFSCMS Index d/c date D/C diagnosis 4/5 Hip Replacement 4/5 Hip Replacement 4/5 Hip Replacement ReadmissionNo - Not Clinically related No - index d/c not 1 of 3 diagnosis Equals0 Chain 0 Readmission Paymt PenaltyN/ANone
- Slide 18
- Readmission Example #4 Patient admitted on 4/1 (Day 1), discharged on 4/5 (Day 5) w/diagnosis of Hip Replacement, subsequently readmitted with CHF on 4/29 & d/c on 5/8 & readmitted w/CHF on 5/15, d/c on 5/28 18 IHAHFSCMS Index d/c date D/C diagnosis 4/5 Hip Replacement 4/5 Hip Replacement 4/5 Hip Replacement Readmission (CHF) 5/15 No unrelated Yes No unrelated Yes No not 1/3 cond Yes for cause 30 days re: CHF index Equals 0 Chain/ 1 Chain 0 Chain/ 1 Chain1 Readmission Paymt PenaltyN/ANone/Applies
- Slide 19
- Key Considerations IHA/HFS What is d/c date? What is d/c diagnosis? Any readmission activity w/in 30 days of d/c? Is readmission diagnosis clinically related? If so, a chain begins and WILL continue unless broken by: Any non-related readmission within 30 days Time interval > than 30 days Any PPR exclusion activity 19
- Slide 20
- Key Considerations CMS What is d/c date? What is d/c diagnosis? Is the d/c diagnosis 1 of 3 AMI, CHF or Pneumonia? AND Any readmission activity w/in 30 days of d/c? If so, then meets YES criteria Readmission penalty will be applied 20
- Slide 21
- Illinois Readmission Reports Hospital Level Reports (9) Service line Index APR DRG Point of Origin Discharge status Principal Payer Top readmission APR DRGs Claim level ED/OC Encounters 21
- Slide 22
- 22 Heart Failure CMS National - 24.70% Illinois - 25.60% Cardiology Connection
- Slide 23
- 23
- Slide 24
- 24
- Slide 25
- 25
- Slide 26
- 26
- Slide 27
- 27
- Slide 28
- 28
- Slide 29
- 29
- Slide 30
- 30
- Slide 31
- 31
- Slide 32
- Next Steps Cultural Opportunities Assessment Communication CMS/IHA; HFS; Patient & Family Advisory; Committees: Quality/Medical Records/Medical Staff/Nurse Staff/Senior Leadership External partners Education & Training: Training recorded, future webinars, site visits Initial Target & Proposed Action Plan 32
- Slide 33
- Future Institute Activities Suggested topics Specialty Hospitals Across Hospital Activity Provider Possibilities Enhancing Cultural Gains 33
- Slide 34
- Additional Support Contact COMPDATACOMPDATA Includes recorded webinar training Email: [email protected]@ihastaff.org Phone: 866/262-6222 HFS Medicaid Readmission PolicyReadmission SAVE the DATE: October 3 (Wed) 12 1pm 34
- Slide 35
- 35