Transcript Q42012-Q32015 - Care Transitions Improvement Coalition

CTIC of Southeast
Michigan
Feb. 17, 2016
Gloria Pizzo, R.N., BSN
Senior clinical quality consultant,
MPRO
What We know: A Review of
the Data
Medicare Readmission Penalties
• Year 4: Oct. 1, 2015 – Sept. 30, 2016
• Up to 3 percent reduction in all Medicare
payments for hospitals with high 30-day
readmissions for AMI, HF, PNA, COPD and
hip/knee replacement
• 2,592 hospitals penalized; losing $420 MILLION
http://khn.org/news/half-of-nations-hospitals-fail-again-to-escapemedicares-readmission-penalties/
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SNF Utilization Patterns Are
Increasingly Visible
SNF hospitalizations cost more than average
• Hospitalization of patients from SNF/LTC
averages $11,255
• Average Medicare hospitalization cost is
$8,447
• 33% higher
OIG November 2013
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Why Is This Important?
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CMS has data on all SNF readmissions reported quarterly for U.S. and state-by-state
CMS defined a SNF 30-day all cause
readmission measure Oct. 2015
Public reporting of SNF readmissions (Oct.
2017)
2% withhold of SNF payments (Oct. 2018)
Projected penalties to total $2.2 billion over 10
years
Office of the Inspector General’s Nov. 2013 report analyzed hospitalizations from SNFs; SNF by SNF
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“Potential for Efficiency
Improvements in Post Acute
Care Utilization...”
“Conditions for which post acute care accounts
for a large percent of episode payments provide
hospitals with a stronger incentive to efficiently
manage post acute services.”
CMS technical guidance on MSPB
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Top Diagnoses Leading to
Hospitalization from SNF
OIG November 2013
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Cost of Hospitalization
From SNF
Reason for Hospitalization
Sepsis
Pneumonia
CHF
Asp. Pneumonia
Complications
Total Cost
$3 billion
$850 million
$640 million
$618 million
$450 million
$/Hospitalization
$17,430
$9,500
$8,700
$12,200
$14,600
OIG November 2013
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It’s Time To Get Serious…
6 very important messages
1.
2.
3.
4.
5.
6.
Readmission reduction “pays” – at least inaction hurts
Hospitals must update & standardize transitional care
processes
Reducing readmissions is a cross-continuum effort
Attend to non-clinical needs for post-hospital supports &
services
Start working on all best ideas
Reducing readmissions requires better data
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Know Your Data
Using data to dispel assumptions, expand
opportunities for focus.
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CTIC Community
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CTIC Acute Care Providers
Beaumont Health Farmington Hills
Beaumont Health Dearborn
Beaumont Health Taylor
Beaumont Health Trenton
Beaumont Health Wayne
Garden City Hospital
St. Mary’s Hospital of Livonia
St. Joseph Mercy Hospital Ann Arbor
Henry Ford Hospital Wyandotte
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CTIC All-Cause 30 Day
Readmission Rates
(Q42012-Q32015)
Readmission Rates Per 1000 Medicare Fee-for-Service (FFS) Beneficiaries
by Quarter
CTIC
Oct. 1, 2012 - Sep. 30, 2015
25.00
20.00
15.00
10.00
5.00
0.00
Q4 2012
Q1 2013
Q2 2013
Q3 2013
Q4 2013
Q1 2014
Q2 2014
CTIC of Southeast Michigan
Q3 2014
Q4 2014
Q1 2015
Q2 2015
Q3 2015
MI Statewide
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CTIC All-Cause 30 Day
Readmission Rates
(Q42012-Q32015)
Time Period
Rate of Readmissions per 1,000 Benes
CTIC of Southeast Michigan
MI Statewide
Q4 2012
20.39
15.41
Q1 2013
21.16
16.17
Q2 2013
19.97
15.43
Q3 2013
18.60
14.67
Q4 2013
18.36
14.27
Q1 2014
19.91
14.97
Q2 2014
20.03
15.37
Q3 2014
20.46
15.24
Q4 2014
20.36
15.27
Q1 2015
20.65
15.51
Q2 2015
20.70
15.42
Q3 2015
17.38
13.67
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CTIC Admissions
(Q42012-Q32015)
Admission Rates Per 1000 Medicare Fee-for-Service (FFS) Beneficiaries
by Quarter
CTIC
Oct. 1, 2012 - Sep. 30, 2015
120.00
100.00
80.00
60.00
40.00
20.00
0.00
Q4 2012 Q1 2013 Q2 2013 Q3 2013 Q4 2013 Q1 2014 Q2 2014 Q3 2014 Q4 2014 Q1 2015 Q2 2015 Q3 2015
CTIC of Southeast Michigan
MI Statewide
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CTIC Admissions
(Q42012-Q32015)
Time Period
Rate of Admissions per 1,000 Benes
CTIC of Southeast Michigan
MI Statewide
Q4 2012
96.44
82.19
Q1 2013
101.35
86.73
Q2 2013
95.21
82.37
Q3 2013
91.38
78.43
Q4 2013
89.99
77.42
Q1 2014
94.08
79.86
Q2 2014
96.86
80.76
Q3 2014
92.18
78.02
Q4 2014
94.72
80.73
Q1 2015
97.53
82.70
Q2 2015
95.80
81.36
Q3 2015
89.76
75.61
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All-Cause 30 Day
SNF Readmissions
(Q42012-Q32015)
All-Cause 30-Day Post Acute Care Readmission Rates Compared Among Health
System and Michigan Rates by Quarters
Skilled Nursing Facilities (SNF)
CTIC
Oct. 1, 2012 - Sep. 30, 2015
30
25
20
15
10
5
0
Q4 2012 Q1 2013 Q2 2013 Q3 2013 Q4 2013 Q1 2014 Q2 2014 Q3 2014 Q4 2014 Q1 2015 Q2 2015 Q3 2015
CTIC of Southeast Michigan
MI Statewide
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All-Cause 30 Day
SNF Readmissions
(Q42012-Q32015)
Time Period
30-Day SNF Readmission Rates
CTIC of Southeast Michigan
MI Statewide
Q4 2012
27.4
23.00
Q1 2013
27.29
22.87
Q2 2013
26.02
22.81
Q3 2013
23.7
21.80
Q4 2013
26.6
22.13
Q1 2014
24.94
22.42
Q2 2014
24.45
21.99
Q3 2014
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22.10
Q4 2014
26.77
22.03
Q1 2015
25.44
21.98
Q2 2015
25.37
22.13
Q3 2015
23.07
20.21
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CTIC All-Cause 30 Day
HHA Readmissions
(Q42012-Q32015)
Graph 3: All-Cause 30-Day Post Acute Care Readmission Rates Compared
Among Health System and Michigan Rates by Quarters
Home Health Agencies (HHA)
CTIC
Oct. 1, 2012 - Sep. 30, 2015
30
25
20
15
10
5
0
Q4 2012 Q1 2013 Q2 2013 Q3 2013 Q4 2013 Q1 2014 Q2 2014 Q3 2014 Q4 2014 Q1 2015 Q2 2015 Q3 2015
CTIC of Southeast Michigan
MI Statewide
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CTIC All-Cause 30 Day
HHA Readmissions
(Q42012-Q32015)
Time Period
30-Day HHA Readmission Rates
CTIC of Southeast Michigan
MI Statewide
Q4 2012
26.23
22.69
Q1 2013
25.14
22.58
Q2 2013
25.67
23.06
Q3 2013
24.37
23.03
Q4 2013
24.76
22.29
Q1 2014
25.49
22.48
Q2 2014
24.88
23.25
Q3 2014
26.85
24.36
Q4 2014
25.45
22.95
Q1 2015
25.9
22.89
Q2 2015
25.87
22.93
Q3 2015
24.43
22.51
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All-Cause Readmission Within 30 Days of
Index Discharge by Top 10 Diagnosis Related
Group (DRG) Oct. 1, 2014 - Sep. 30, 2015
A
Title
B
C
% of
Total
DRG
No. of
Discharges
No.30D
Readmits
to Any
Hospital
D
E
% 30D
No. 30D
Readmits Readmits
to Any
to Same
Hospital
Hospital
F
G
% 30D
No. 30D
Readmits Readmits
to Same
to Other
Hospital
Hospital
H
% 30D
Readmits
to Other
Hospital
Rank
DRG
1
871
SEPTICEMIA OR
SEVERE SEPSIS W/O
MV 96+ HOURS W MCC
4.71
5,093
1,259
24.72
937
18.40
322
6.32
2
291
HEART FAILURE &
SHOCK W MCC
2.92
3,157
1,007
31.90
786
24.90
221
7.00
3
392
ESOPHAGITIS,
GASTROENT & MISC
DIGEST DISORDERS
W/O MCC
2.78
3,008
605
20.11
463
15.39
142
4.72
4
292
HEART FAILURE &
SHOCK W CC
2.07
2,242
632
28.19
458
20.43
174
7.76
5
378
G.I. HEMORRHAGE W
CC
1.84
1,987
414
20.84
318
16.00
96
4.83
6
683
RENAL FAILURE W CC
1.80
1,948
471
24.18
352
18.07
119
6.11
7
190
CHRONIC
OBSTRUCTIVE
PULMONARY DISEASE
W MCC
1.66
1,797
515
28.66
385
21.42
130
7.23
8
690
KIDNEY & URINARY
TRACT INFECTIONS
W/O MCC
1.63
1,762
338
19.18
266
15.10
72
4.09
9
682
RENAL FAILURE W
MCC
1.60
1,725
540
31.30
409
23.71
131
7.59
10
191
CHRONIC
OBSTRUCTIVE
PULMONARY DISEASE
W CC
1.54
1,666
394
23.65
299
17.95
95
5.70
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Factors Contributing to All-cause
30-day Readmissions A structured case
series across 18 hospitals
• 250 (47 percent) deemed potentially preventable
• Found an average of nine factors contributed to each
readmission
• Assessed factors related to five domains
• 73% - Care transitions planning & care coordination
• 80% - Clinical care
• 49% - Logistics of follow up care
• 41% - Advanced care planning & end of life
• 28% - Medications
• 250 readmissions identified 1,867 factors!
There is never one reason for readmission…
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Feingenbaum et al Medical Care 50(7): July 2012 from Kaiser Permanente
Develop A Multifaceted
Portfolio of Efforts
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Improve facility-based care processes for all patients
Collaborate with cross-setting partners, including payers
Provide enhanced services
Use data, analytics, flags, workflow prompts, automation
Dashboards to support continuous improvement, ensure
reliability, drive to results
There is no single bullet; we are engaged in
system transformation.
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Improve Standard Care for
All: Standard Discharge
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8.
Have a process
Know your data: Track rates & review readmissions
Assess & reassess patients for post-hospital needs
Engage patients and caregivers
Teach self-care to patients & caregivers
Provide a written discharge plan for all inpatients
Communicate effectively with “receiving” providers
Know the capabilities of area providers, including support
services
9. Arrange for post-acute services, including support services
http://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Downloads/Surveyand-Cert-Letter-13-32.pdf
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Effect of Hospital-SNF
Referral Linkages on
Readmission
MI Tri-County SNF Collaborative efforts are
working!
• “Stronger hospital-SNF linkages were found to reduce
readmission rates”
• “The greater proportion of discharges a hospital sends to a
single SNF, the lower the rate of readmission”
• Specifically lower rates of immediate bounce-backs (days 0-3)
• Effect of hospital-SNF referral linkages on readmission
Rahman et al, December 2013
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INTERACT II
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“Interventions to Reduce Acute Care Transfers”
Developed by Dr. Joe Ouslander & colleagues
Quality improvement approach & tools
Focused on identifying changes early & providing staff tools to act
on those observations
Provides protocols for managing common issues on-site
Supports improved communication between SNF-ED
Increase hospital awareness of SNF capabilities
Advanced care planning
Adaptations to assisted living & home health care settings
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SNF Circle Back–Warm
Handoffs
SNF Circle Back Questions (hospital calls back
SNF 3-24h after d/c)
1.Did the patient arrive safely?
2.Did you find admission packet in order?
3.Were the medication orders correct?
4.Does the patient’s presentation reflect the information you
received?
5.Is patient and/or family satisfied with the transition from the hospital
to your facility?
6.Have we provided you everything you need to provide excellent
care to the patient?
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Getting Back Home Program
Comprehensive discharge planning:
appointments, medication management, services
made
• Review all information with resident, family,
caregiver
Direct contact after SNF discharge
• Follow–up phone call next day
• Once a week for a month
• Once a month for three months
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Patient Engagement and
Activation
Ask Your Patients “Why”
Understand the “story behind the chief complaint”
• Interview patients, caregivers for the “story”
• Ask patients & support persons why they returned, if readmitted
• Ask patient & support persons what help they need; share with
them their needs/risk assessment
• Use teach-back, target the appropriate “learner”
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Save the Date
MPRO’s 2016 Care Coordination Summit
A Focused Approach: Hypertension and Diabetes
Crystal Gardens Banquet Center, Howell, MI
June 2, 2016
More information to come
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Follow us online @LakeSuperiorQIN
MPRO represents Michigan in the Lake Superior Quality Innovation Network.
This material was prepared by the Lake Superior Quality Innovation Network, under contract with the Centers for Medicare & Medicaid Services30
(CMS), an
agency of the U.S. Department of Health and Human Services. The materials do not necessarily reflect CMS policy. 11SOW-MI-C3-16-34 02161