ACHIEVE QUALITY IMPROVEMENT BY USING THE REHOSPITALIZATION...
Transcript of ACHIEVE QUALITY IMPROVEMENT BY USING THE REHOSPITALIZATION...
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ACHIEVE QUALITY IMPROVEMENT BY USING THE REHOSPITALIZATION MEASURE
in LTC Trend Tracker and PointRight® Pro 30™
Your Speakers Today
David GiffordSR VP for Quality & Regulatory Affairs
AHCA
Steven LittlehaleExecutive Vice President and
Chief Clinical OfficerPointRight
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Objectives
Understand the Policies that Make the Standardized
Rehospitalization Measurement Important
Learn How Providers Are Succeeding and How To Access Your Data in LTC
Trend Tracker and PointRIght Pro 30
Learn How to Use Your Rehospitalization Data to
Position Your Organization with Payer Groups like MCOs and
ACOs
Learn How to Use the Measure in Quality
Improvement Programs
UNDERSTAND THE POLICIES THAT MAKE THE STANDARDIZED REHOSPITALIZATION MEASUREMENT IMPORTANT
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…all policy changes involve rehospitalizations
All roads lead to Rome…
National Policies Impacting SNFs
HHS plan to link quality with payment
Protecting Access to Medicare Act of 2014 (PAMA) requires CMS to implements a 2% withhold of SNF Part A payments that can be returned based on your rehospitalization rates
IMPACT act of 2014 requires CMS to measure and publicly report collection of PAC quality measures
President’s Executive Action to revise Five Star
ACO and MCO contracts with CMS only work by lowering rehospitalization rates
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HHS Payment Reform• HHS announced targets to increase the number of
payments that are linked to quality outcomes by 2018• “We are setting clear goals – and establishing a clear timeline --for moving
from volume to value in Medicare payments”
• “Our first goal is for 30% of all Medicare provider payments to be in
alternative payment models that are tied to how well providers care for their
patients, instead of how much care they provide – and to do it by 2016. Our
goal would then be to get to 50% by 2018”
• “Our second goal is for virtually all Medicare fee-for-service payments to be
tied to quality and value; at least 85% in 2016 and 90% in 2018”
- HHS Secretary Burwell Jan 26, 2015
President’s 2016 Budget
Implement value-based purchasing for PAC providers , including home health, SNFs, ambulatory surgical centers and hospital outpatient departments beginning in 2017. • At least 2% of payments must be tied to the quality
and efficiency of care in the first two years of implementation, and at least 5% beginning in 2019.
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PAMA of 2014 has SNF VBP section
Passed in 2014 as part of SGR fix, PAMA links SNF rehospitalization to SNF Medicare Part A
paymentsUses a with-hold approach• 2% “mathematical” withhold to create incentive pool• Incentive pool is 50-70% of the withhold
Incentive pool is “returned” to facilities based on their rehospitalization performance score
First adjustment to a SNF’s market basket will be in Oct 2018 based on performance likely starting in late 2015 or early 2016
Estimated Timeline for SNF VBP Implementation
Withhold Starts
Analyze Data
Baseline Measurement Period
SNF Comments
Post withhold in Proposed Rule
Oct 2018
Collect Data
July 2016
Oct 2016
Oct 2017
Oct 2019
Oct 2015
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SNF National Rehospitalization Rates
At risk for • 2% payment penalty; • Dropped from MCO/ACO
Networks
“IMPACT ACT OF 2014” Legislation has five parts : • Incorporate standardized clinical assessments• Public reporting of common quality
measures• Provide quality measures to consumers
when transitioning to a PAC provider• Interoperability of information at transfer• HHS and MedPAC to conduct several studies
Discuss today
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“IMPACT ACT OF 2014” Part 2
Publicly report quality measures across settings• Rehospitalizations• Discharge to community• Pressure ulcers• Medication reconciliation • Incidence of major falls• Patient preferences • Efficiency measure(s): Avg Total Medicare Spend per
Beneficiary• Plus any other measures Secretary wants
Measures to be approved by National Quality Forum (NQF)
“IMPACT ACT OF 2014” Part 3
Hospitals and PAC providers must provide quality and efficiency measures to beneficiaries to help them with their PAC decision making• Modify conditions of participation to
incorporate QMs into the discharge planning process
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President’s Executive ActionFive Star Directs CMS
• Add quality measures to Five-Star• Rehospitalizations
• Discharge back to community
• Antipsychotic use
• Staff turnover & retention
• Expand auditing of MDS data from 5 states to all states effective 01/01/15
• Collect payroll data pilot test in 2015 and begin in 2016
LEARN HOW PROVIDERS ARE SUCCEEDING AND HOW TO ACCESS YOUR DATA IN LTC TREND TRACKER AND POINTRIGHT PRO 30
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AHCA Developed PAC Measures
PointRight Pro 30 Rehospitalization• Now available
Discharge Back to the Community• Now available
Length of Stay• Now available
Improvement in Functional Status*• Available Oct 2015
Customer Satisfaction**• Available spring 2015
* Requires use of CARE tool linked with MDS admission data** Requires use of AHCA CoreQ satisfaction questionnaire
Who is using PointRight® Pro 30TM
• PointRight® Pro 30 TM Rehospitalization measure approved by NQF in Dec 2014
• Available to all AHCA members in LTC Trend Tracker
• Organizations currently using this measure• 3 MA Pioneer ACOs • 1 MA dual-eligible MCO • 1 NJ ACO • 1 SC Care Management Co• 1 large national PAC management Co• 1 Large private investment management firm
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Where do I get
my data?
Your Member
Resource
Survey History
CMS Five Star Rating
Resident Characteristics
Staffing Information
AHCA Post-Acute Measures
www.ltctrendtracker.com
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LTC Trend Tracker Report
Actual rehospitalization
Expected Rehospitalization
Risk Adjusted Rehospitalization
Graphs in LTC Trend Tracker
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LEARN HOW TO USE YOUR REHOSPITALIZATION DATA TO POSITION YOUR ORGANIZATION WITH PAYER GROUPS LIKE MCOS AND ACOS
What’s your story?
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The Data the Differentiates
30 Day Rehospitalization rate, by diagnosis
Quality Measures LOS by diagnosis Types of patients you specialize in
Staffing ratios•RN to LPN•Nurse to resident
Retention Satisfaction Coverage (admissions) Five-Star Regulatory/Survey
“Fringe benefits” Staff competencies Med Director info Functional improvement Discharge Success
Med errors Strengths and Weaknesses
National PointRight Pro 30Adjusted Rehospitalization Rates
14% and below
14% to 16%
16% and above
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National PointRight Pro 30Adjusted Rehospitalization Rates
13% and below
13% to 16%
16% and above
*denotes combined survey districts
Five-Star Ratings & Rehospitalization Rates
Rating Jan-15Average Observed
Rehospitalization RateAverage Adjusted
Rehospitalization Rate
5 17.1 15.54 17.8 15.73 18.0 15.72 18.5 15.61 17.8 15.2
Rating Feb-15Average Observed
Rehospitalization RateAverage Adjusted
Rehospitalization Rate
5 16.3 15.14 17.4 15.63 17.7 15.62 18.3 15.91 19.1 16.3
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Average Length of Stay (ALOS)
Year of Entry Location Mean
2013 Nation 29.8
2012 Nation 30
2011 Nation 30.4
Year of
EntryLocation
Cognitive
ImpairmentMean
2013 Nation No 29.6
2013 Nation Yes 30.6
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Year of
EntryLocation Incontinent Mean
2013 Nation No 27.8
2013 Nation Yes 34.6
Year of
EntryLocation Pain Mean
2013 Nation No 29.4
2013 Nation Yes 32
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Year of
EntryLocation Depression Mean
2013 Nation No 29.6
2013 Nation Yes 33
LEARN HOW TO USE PRO 30 IN QUALITY IMPROVEMENT PROGRAMS
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Avedis Donabedian• Avedis Donabedian was a physician and
founder of the study of quality in health care and medical outcomes research, most famously as a creator of The Donabedian Model of care.
A Model that Bridges High Performance to Improvement
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Get a Framework!
Structure• Staff Ratios• RN vs LPN• Equipment
Available• Contracts in
place
“Rules of the Game”
Process• Medication
administration & errors
• Accuracy of assessments
• Hours to nurse evaluation
“Playing the Game”
Outcome• 30 Day Rehosp• Rehosp by
Diagnosis• Resident
satisfaction
“Who Won the Game”
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Entry Date
Length of Stay
DischargeDay
Unplanned MedicareAll
PayerCHF COPD CVA Diabetes Pneumonia
Tue 6 Mon Unplanned Y Y Y
Thu 4 Mon Unplanned Y Y Y
Fri 8 Thu Planned Y Y Y
Mon 6 Mon Unplanned Y Y Y Y Y Y Y
Thu 5 Tue Unplanned Y Y Y Y Y
Use Data To Pinpoint & Illustrate Your Competitive Advantage
What is one (or two) things
that you do better than
everyone else?
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Get a preview of what your rehospitalization rates are for your facility!
• Go to: pointright.com/ahcawebinarto request your free report.
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Contact InformationDavid Gifford MD MPH
SR VP for Quality & Regulatory Affairs
American Health Care Association
120 L St. NW
Washington DC 20005
202-898-3161
www.ahcancal.org
Steven LittlehaleMS, GCNS-BC
EVP & CCO
PointRight
150 CambridgePark DriveSuite 301
Cambridge, MA 02140
781-457-5910
pointright.com