Transcript Hospital Readmission for Private Duty

CCSC “Pathway to
Home” for Care
Transition Support
A Marketing Program to Create
Referral Opportunities
Session 1 of 3 part program
The Program
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“Pathways to Home” Care Transition
Support is a program “branded” to CCSC
and their affiliates
The program is designed to help members
capitalize on the increasing attention put on
patients being readmitted into a hospital
within 30 days after a prior stay
The program is designed to provide you
with the tools you need to be successful in
marketing this program
The program and training
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Three training sessions
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First : Definition of the problem, technical
information and background, starting your
initial research
Second: Program details
Third: Marketing the program…from A to Z
Tools
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Discharge guide for patients
Sales tools
So lets get started!
The “Readmission”
Opportunity
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Hospitals are being financially hit
starting very SOON by having patients
readmitted into the hospital 30 days
after they are discharged.
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Part of 2010 “Affordable Care Act”
This means that Hospitals are looking
at strategies to help patients stay out
of the hospital after they are
discharged.
 This offers an opportunity for your
agency!
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Step 1: Understand the terms
being used and what is occurring
2010 Affordable Care Act
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Here are some the concerns that the
Affordable Care Act is trying to
correct:
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Hospitalizations are costly, accounting
for 30% of total healthcare spend
• 37% of Medicare spend
18% of Medicare patients discharged
from hospitals are readmitted within
30 days of discharge.
 Associated Cost:$15-17 Billion per
year
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….and do understand that…
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Some Readmissions are planned!
Such as follow-up to surgery or
procedure
 And some unplanned readmissions
will always occur, not matter what the
efforts
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Hospital Readmissions
Reduction Program
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Part of CMS Inpatient Prospective Payment System
Will eventually reduce hospital’s Medicare
reimbursement by 2%
The Hospital Readmissions Reduction Program is
a penalty-only plan designed to retrieve payments
from hospitals that have received additional revenue
associated with readmitted patients.
 Unlike CMS’s other high-profile quality initiative,
the Hospital Inpatient Value-Based Purchasing
Program, which allows high-performing hospitals
to earn a bonus payment!
So…Here’s what is happening
now….
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Hospitals with higher-than-average 30day risk-adjusted readmission rates for
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heart failure
acute myocardial infarction
pneumonia cases
between July 1, 2008, and June 30,
2011, will receive reduced Medicare
payments starting in FY 2013, capped
at a maximum of 1% of inpatient
payments.
…and here is what will happen
in the future
The penalties will increase in
subsequent years to a maximum of
2% of inpatient payments in FY
2014 and 3% from FY 2015
onwards.
 Diseases they will be penalizing on
will also increase.
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What counts as a
readmission
Who will this affect and how
much?
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Approximately three quarters of all hospitals
are line for some penalty
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About 2300 of 3100 hospitals involved in this
program will see some penalty
Average penalty will be about 0.30% of
inpatient payments
60% of hospitals will see payment reductions
of $10,000 to $500,000
Average penalty in terms of dollars per
facility will be $88,000
The average Medicare payment for a
preventable readmission totaled
approximately $7,200
Step 2: Do your research on your
local hospitals
Researching Hospital
Readmission rates in your area
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Readmission rates are posted for hospitals on the
“Medicare Hospital Compare Quality of Care” website
www.hospitalcompare.hhs.gov
Search by your zip to see results of all the hospitals in
your area:
 Will let you compare 3 hospitals at a time
 You will want to click on “Outcomes of Care Measure”
 You will want to click on the “View Graphs”
THIS SITE WILL HELP YOU IDENTIFY HOSPITALS IN
YOUR AREA THAT ARE EXPERIENCING THE
MOST PAIN, BUT ALL HOSPITALS ARE PAYING
CLOSE ATTENTION TO THESE MEASURES.
The Hospital Compare
Website
Results of a search in my
area
After you have identified hospitals in your area….identify
who you will call on in your hospital
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Who will be most aware of readmission rates?
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Utilization Review and /or case management department head
CEO or C suite executives
Finance Related executives
• “Charge Description Manager”
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Vendor Compliance ( or even Purchasing)
Care Transition Coach
Performance Management Exec
“Pilot” projects or special projects on readmissions (Rns’)
Continuous quality improvement staff or Quality Improvement
Director
ACO contracting specialist
Hint: Go on Hospital Websites to see if they list “leadership” contacts.
Look to “news or press releases” on websites as ways to capture a
key contact name.
Step 3: Understand the reasons
for readmissions and the patients
that may be most involved with
unplanned readmissions
“Research shows a strong link between attention
to care transitions and lower readmission rates.
When patients move from the hospital to the next
site of care - be it their home or a nursing home,
rehabilitation facility, or a hospice, they benefit
from having a clear treatment plan they can
understand and follow, providers who are aware of
and are able to carry out the plan and access to
the right medications and support services. “
-”Reducing Hospital Admission: Lessons from Top Performing Hospitals”,
April 2011, Sharon Silow-Carroll, Jennifer N. Edwards and Aimee
Lashbrook, Health Management Associates
What factors affect readmission
rates
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Fragmented systems of care
Lack of PCP or Primary Care physician or a “medical
home”
Increases specialization prohibits providers ability to
treat and manage patients with multiple conditions
 Sometimes older adults will see as much as 16
physicians a year!
Increase of use of Hospitalists
Lack of understanding of discharge plans or inability to
appropriately self manage their care
No follow up care visits with PCP
Who are the patient’s with the
highest risk for readmission
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Patients with multiple conditions
Patients who are on multiple NEW
prescription medications
Patients who suffer from CHF
Patients who suffer from end stage renal
disease
Patients who suffer from Alzheimer’s or
other forms of dementia
Patients who lack appropriate family
support
Step 4: Understand the steps
some hospitals are taking now
to lower readmissions
Hospital activity
Looking at improving their discharge
planning
 Engaging in “predictive modeling”
activities to identify high risk patients
 Creating Care Transition Coaches
 Utilizing telemonitoring devices
 Developing more formal relationships
with PAC providers
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Getting ready to approach
hospitals
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Do your home work
Create a list of hospitals in your area
 Know where hospitals stand in
comparison to others in avoidable
readmissions
 Start to develop potential
contacts/departments within hospital
 Know the terms
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Hospitals Readmission Pain
Hospitals historically have not had to
be very concerned about what
happened to a patient once they left
the walls of their facility….now they
do!
 Hospitals will be looking to Home
Health Care and Home Care
Companies to provide ideas and
programs
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Questions?
Next session
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We will talk about “Pathways to
Home” features and how they connect
with issues hospitals are facing.