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An I nitia tive to Ac c e le ra te Pro g re ss to Re duc e Re a dmissio ns in Virg inia We b ina r # 3 – Po st-Ac ute Ca re Re a dmissio ns Se pte mb e r 8, 2016

HOUSE K E E PI NG

• Slide s we re se nt this mo rning
• We b ina r is b e ing re c o rde d
• Ple a se use the “te le pho ne ” o ptio n
• Audio pin pro mpt
• All pa rtic ipa nts a re mute d
• Ra ise yo ur ha nd
• Ask a q ue stio n
• Wa rm up

WE L COME AND OVE RVI E W

Abraham Segres VHHA

Vic e Pre side nt, Qua lity & Pa tie nt Sa fe ty

a se g re s@ vhha .c o m (804) 965-1214

VI RGI NI A HOSPI T AL & HE AL T HCARE ASSOCI AT I ON

An a sso c ia tio n o f 30 me mb e r he a lth syste ms re pre se nting 107 c o mmunity, psyc hia tric , re ha b ilita tio n a nd spe c ia lty ho spita ls thro ug ho ut Virg inia .

Visio n

T hro ug h the po we r o f c o lla b o ra tio n, the a sso c ia tio n will b e the re c o g nize d driving fo rc e b e hind ma king Virg inia the he a lthie st sta te in the na tio n b y 2020.

Missio n

Wo rking with o ur me mb e rs a nd o the r sta ke ho lde rs, the a sso c ia tio n will tra nsfo rm Virg inia ’ s he a lth c a re syste m to a c hie ve to p-tie r pe rfo rma nc e in sa fe ty, q ua lity, va lue , se rvic e a nd po pula tio n he a lth. T he a sso c ia tio n’ s le a de rship is fo c use d o n: princ iple d, inno va tive a nd e ffe c tive a dvo c a c y; pro mo ting initia tive s tha t impro ve he a lth c a re sa fe ty, q ua lity, va lue a nd se rvic e ; a nd a lig ning fo rc e s a mo ng he a lth c a re a nd b usine ss e ntitie s to a dva nc e he a lth a nd e c o no mic o ppo rtunity fo r a ll Virg inia ns.

VHHA 2015-2020 I MPROVE ME NT PRI ORI T I E S

• 1. Ho spita l re a dmissio ns

1a . Ho spita l-wide 1b . Post- ac ute tr

ansfe r s

1c . T

• ta l hip/ T
• ta l kne e Re pla c e me nt 30-da y re a dmissio ns
• 2. Clo stridium diffic ile – He a lthc a re -a c q uire d I

nfe c tio ns

• 3. Pa tie nt E

xpe rie nc e – HCAHPS

• 4. Se rio us Sa fe ty E

ve nts

State wide L e ar ning & Ac tion

• Sta te wide c o lla b o ra tive June 2016 to No ve mb e r 2018
• F
• c us o n PAC, HU, T

HR/ T K R in pa ra lle l

• E

ng a g e with pa rtne rs in PAC

• E

ng a g e with VHQC fo r c r

• ss- c ontinuum wo rk
• E

ng a g e with AAAs fo r c ommunity base d c a re / CT I

• Pro vide , use , inte rpre t data fro m VHHA & VHQC

Planne d Ac tivitie s for L e ar ning & Ac tion

June 16th* Hig h L e ve ra g e Stra te g ie s Aug ust 17th* Da ta / Me a sure me nt Se pte mb e r 8th* Re duc ing PAC Re a dmissio ns Oc to b e r 20th* I mpro ving Ca re fo r Hig h Utilize rs

Nove mbe r 15th In- Pe r son L e ar ning E ve nt 9- 3:30

*All we b inars will b e o ffe re d at 10am

A F E W OF OUR PART NE RS

• Vir

ginia He althc ar e Assoc iation (VHCA)

• Vir

ginia Assoc iation of Home Car e and Hospic e

• L

e adingAge Vir ginia

• VHQC
• Vir

ginia De par tme nt of Aging & Re habilitative Se r vic e s (DARS)

RE DUCI NG RE ADMI SSI ONS F ROM POST

• ACUT

E CARE

Amy Boutwell, MD, MPP Collaborative Healthcare Strategies

Pre side nt

a my@ c o lla b o ra tive he a lthc a re stra te g ie s.c o m

(617) 710-5785

AGE NDA

• Re a dmissio ns fro m po st-a c ute c a re in Virg inia
• I

de ntifying ro o t c a use s o f re a dmissio ns fro m po st-a c ute c a re

• De ve lo ping a multi-fa c e te d a ppro a c h to re duc ing re a dmissio ns fro m po st-a c ute c a re
• Spe c ific a c tio n ste ps

OBJE CT I VE S

1. De sc rib e c o mmo n ro o t c a use s o f re a dmissio ns fro m po st-a c ute c a re , a nd ide ntify pra c tic a l wa ys fo r ho spita ls a nd PAC pro vide rs to ide ntify the ir o wn ro o t c a use s; 2. De sc rib e 3 e ffe c tive stra te g ie s fo r re duc ing re a dmissio ns fo r pa tie nts disc ha rg e d to po st-a c ute c a re ; 3. Disc uss me tho ds use d to c o lla b o ra te with po st a c ute pro vide rs

PORT F OL I O OF ST RAT E GI E S

Re duc e All Ca use All Pa ye r Re a dmissio ns b y 20% b y 2020 Re duc e PAC Re a dmissio ns Impro ve pro c e sse s & pra c tic e s fo r SNF pa tie nts Impro ve pro c e sse s & pra c tic e s fo r Ho me He a lth pa tie nts Re duc e HU Re a dmissio ns “Who le -pe rso n” c a re te a ms, c a re pla ns Re duc e T

• ta l

Hip/ K ne e Re pla c e me nt Re a dmissio ns Impro ve pre -o p, pe ri-o p, po st-o p a nd re ha b pra c tic e s & pro c e sse s Re duc e Re a dmissio ns fro m Ho me Co a c hing a nd L inka g e to Se rvic e s (AAA/ SI M)

RE ADMI SSI ONS F ROM POST ACUT E CARE I N VI RGI NI A

RE ADMI SSI ONS BY DI SCHARGE DI SPOSI T I ON I N VI RGI NI A

Q1 Q2 Q3 Q4 Home 16.4 16.4 15.5 15.8 HHA 20.2 20 21.3 20.6 SNF 19.9 20.6 20.1 20 State Avg 18.6 18.5 18.7 18.6 10 12 14 16 18 20 22 Axis Title

Medicare FFS Readmission Rates, by Discharge Setting: Home, SNF, HH

20% PAC 15% Home

So urc e : 2015 VA Me dic a re F F S da ta , c o urte sy o f VHQC

18.6% Average

K E Y ST AT I ST I CS T O K NOW

Me dic a re

• ~275k Me dic a re disc ha rg e s
• ~50k Me dic a re re a dmissio ns
• ~18% Me dic a re re a dmissio n ra te

Me dic a re to PAC

• ~110k Me dic a re disc ha rg e s to PAC
• ~22k re a dmissio ns “fro m” PAC
• ~20% re a dmissio n ra te

*PAC = Ho me He a lth o r SNF

~40% o f disc ha rg e s a re to po st a c ute c a re A 20% re duc tio n wo uld a vo id 4,400 re a dmissio ns pe r ye a r in VA Re duc ing PAC re a dmissio ns wo uld re duc e the sta te -wide ra te fro m 18.2% to 16.6%

CAL CUL AT E T HE I MPACT OF RE DUCI NG PAC RE ADMI SSI ONS ON YOUR HOSPI T AL ’ S RE ADMI SSI ON RAT E

F

• r

mula E xample

T

• ta l ho spita l* disc ha rg e s

A 1000 T

• ta l ho spita l re a dmissio ns

B 150 Ho spita l re a dmissio n ra te = B/ A 15% T

• ta l PAC** disc ha rg e s (40% o f to ta l)

C = .4A 400 T

• ta l PAC re a dmissio ns (20% ra te )

D = .2C 80 Go a l: 20% re duc tio n PAC re a dmissio ns = .20 x D 16 Ne w ho spita l re a dmissio ns = B – (.2D) = E 150-16= 134 Ne w ho spita l re a dmissio n ra te = E / A 13.4%

*”ho spita l” = a dult, no n-OB **PAC = Ho me He a lth o r SNF

Calc ulate this fo r yo ur ho spital

E XAMI NE ROOT CAUSE S OF RE ADMI SSI ONS F ROM PAC

ROOT CAUSE S OF RE ADMI SSI ONS

• I

nc o mple te info rma tio n a b o ut c linic a l sta tus

• I

nc o mple te info rma tio n a b o ut func tio na l sta tus

• I

nc o mple te info rma tio n a b o ut b e ha vio ra l he a lth o r “sundo wning ”

• Missing ha rd c o pie s o f c o ntro lle d sub sta nc e pre sc riptio ns
• Missing do c ume nta tio n o f pla c e me nt o f tub e s o r line s (e g pic c line s)
• De la ys in o b ta ining (ra re , e xpe nsive ) me dic a tio ns
• Cha ng e in c linic a l sta tus re q uiring pro vide r e va lua tio n b ut no t e me rg e nc ie s
• Pa tie nt/ fa mily dissa tisfa c tio n with the fa c ility – se e king diffe re nt pla c e me nt
• Re a dmissio ns fo llo wing disc ha rg e fro m SNF

to ho me

READMISSION REVIEW TOOL

Purpose:

• To understand patient perspective
• To understand root causes
• To understand there are multiple factors
• To identify opportunities for improvement
• To develop a better plan for the patient
• To develop better services to offer

Recommendation:

• Conduct at least 5
• Best practice: review all readmissions

AHRQ Ho spita l Guid e to Re d uc ing Me d ic a id Re a d missio ns

Ava ila b le a t: www.inte ra c t2.ne t

RE ADMI SSI ONS AF T E R T RANSI T I ON F ROM SNF T O HOME

• 55,980 Me dic a re d/ c fro m 694 SNF

s

• 67% d/ c to ho me c a re a fte r SNF
• 12,350 (22%) re turne d to a c ute c a re <30d
• 15% re a dmitte d
• ~50% o f re turns <30d o c c urre d <10d!
• “indic ate s the ne e d fo r

inte r ve ntio ns to impr

• ve

tr ansitio n fr

• m SNF

to ho me ”

T

• le s e t al JAGS 2014

BE ST PRACT I CE S

• “I

nte rvie w” (re a dmissio n re vie w) pa tie nts while the y a re in the ho spita l

• L

iste n fo r “a ll” o f the fa c to rs tha t c o ntrib ute d to a re a dmissio n

• Ask the pe rso n who se nt the pa tie nt to the E

D to pro vide the ir pe rspe c tive

• Vie w a ll re a dmissio ns a s po te ntia lly a vo ida b le b y a sking “5 whys”
• Re a dmissio n re vie w a nd ro o t c a use a na lyse s is mo st pro duc tive whe n c o nduc te d in

the spirit o f o pe n inq uiry a nd se e king o ppo rtunitie s to impro ve

• Use re a dmissio n re vie ws a nd ro o t c a use a na lysis a s the b a sis fo r yo ur c o lla b o ra tive

wo rk with po st-a c ute pro vide rs

RE DUCI NG RE ADMI SSI ONS F ROM PAC: BE ST PRACT I CE S

Co llab o rate in manag ing c are ac ro ss se tting s and o ve r time : no t just a hando ff

PAC BE ST PRACT I CE # 1

SNF WARM HANDOF F S WI T H “CI RCL E BACK ”

Wa rm RN-RN Ha ndo ff to SNF Ho spita l c a lls b a c k SNF 3-24h a fte r d/ c to a sk 6 q ue stio ns 1. Did the pa tie nt a rrive sa fe ly? 2. Did yo u find a dmissio n pa c ke t in o rde r? 3. We re the me dic a tio n o rde rs c o rre c t? 4. Do e s the pa tie nt’ s pre se nta tio n re fle c t the info rma tio n yo u re c e ive d? 5. I s pa tie nt a nd/ o r fa mily sa tisfie d with the tra nsitio n fro m the ho spita l to yo ur fa c ility?

6. Have we pr

• vide d yo u e ve r

ything yo u ne e d to pr

• vide e xc e lle nt c ar

e to the patie nt?

So urc e : E mily Skinne r, Ca ro lina s He a lthc a re Syste m

PAC BE ST PRACT I CE # 2 ACUT E CARE MANAGE ME NT T E AM “WARM F OL L OW UP”

• ACO o r Bundle c linic a l c oor

dinator

• Air tra ffic c o ntro l (lists o f pa tie nts, c o o rdina te s virtua l c o -ma na g e me nt ro unds)
• Physic al ro unds in SNF
• Ac ute Ca re T

e a m se nds RN / NP to se e pa tie nt, disc uss pla n with SNF sta ff

• Re spo nd to c ha ng e s in c linic a l sta tus to ma na g e in se tting
• Vir

tual c a re ma na g e me nt ro unds with SNF

• We e kly te le pho nic ro unds ACO/ b undle c o o rdina to r a nd SNF
• L

OS, pro g re ss to wa rd disc ha rg e g o a ls, disc ha rg e pla nning

• T

e le - me dic ine c o nsults in SNF

• Dir

e c t admit to SNF

fro m ho me if ne e d e sc a la te d c a re

L E SSONS F ROM ACOS AND BUNDL E S

K e y le sso ns:

• T
• o k time to de ve lo p a c o lla b o ra tive ra ppo rt v. “ho spita l in-c ha rg e ”
• No sub stitute fo r ve rb a l c o mmunic a tio n a nd pro b le m so lving
• Ac tive c o -ma na g e me nt a nd c a re ma na g e me nt g e ts re sults

• Ha llma rk He a lth Syste m
• 2 ho spita l syste m, 20 E

D do c s, 17 PAs

• “Why a re a lmo st a ll SNF

pa tie nts a dmitte d? ”

• “Pa tie nts o nly se e n o nc e a mo nth”; “c a n’ t do I

Vs”, e tc

• “I

f the y se nd the m he re the y c a n’ t ta ke c a re o f the m”

• Ac tio ns:
• Aske d E

D c linic ia ns “5 whys”

• E

duc a tio n: po ste d I NT E RACT SNF c a pa c ity she e ts in E D

• Simplic ity : e sta b lish c o nta c ts, sta nda rd tra nsfe r info rma tio n
• Re sults: inc re a se in numb e r o f pa tie nts tra nsfe rre d fro m E

D to SNF

So urc e : Dr Ste ve n Sb arde lla, CMO and Chie f o f E D Hallmark He alth Syste m Me lro se , MA

PAC BE ST PRACT I CE # 3

HAL L MARK HE AL T H SYST E M T RE AT

• AND-RE

T URN T O SNF

10 20 30 40 1 2 3 4 5 6 7 8 9

# T r e at- and- Re tur n to SNF

PAC BE ST PRACT I CE # 4

SNF T RANSI T I ON T O HOME PROGRAM

• “Ho me a nd He a lthy Pro g ra m”
• Co mpre he nsive disc ha rg e pla nning : a ppo intme nts, se rvic e s ma de
• Re vie ws a ll info rma tio n with re side nt, fa mily, c a re g ive r
• Dire c t c o nta c t a fte r SNF

disc ha rg e

• Pho ne c a ll ne xt da y
• Onc e a we e k fo r a mo nth
• Onc e a mo nth fo r 3 mo nths

Co urte sy o f K e swic k Multi-Ca re , Ma ryla nd

I NT E RACT T OOL S T O RE DUCE POST

• ACUT

E HOSPI T AL I ZAT I ONS

Ho spitals ne e d to kno w the se to o ls in o rde r to mo re e ffe c tive ly c o llab o rate

I NT E RACT

(I NT E RVE NT I ONS T

O RE DUCE ACUT E CARE T RANSF E RS)

• Custo mize d Guide s fo r SNF

, Ho me He a lth a nd Assiste d L iving F a c ilitie s

• I

mple me nta tio n Guide

• Me a sure me nt a nd Ro o t Ca use Ana lyse s T
• o ls
• Cha ng e s in Clinic a l Sta tus T
• o ls
• Ho spita l Co mmunic a tio n T
• o ls
• Pa tie nt / F

a mily Co mmunic a tio n T

• o ls
• All a va ila b le fo r fre e to do wnlo a d a t www.inte ra c t2.ne t

Ava ila b le a t: www.inte ra c t2.ne t

Ava ila b le a t: www.inte ra c t2.ne t

Ava ila b le a t: www.inte ra c t2.ne t

Ava ila b le a t: www.inte ra c t2.ne t

Ava ila b le a t: www.inte ra c t2.ne t

Ava ila b le a t: www.inte ra c t2.ne t

Ava ila b le a t: www.inte ra c t2.ne t

COL L ABORAT I NG WI T H PAC PROVI DE RS T O RE DUCE RE ADMI SSI ONS

AHRQ Ho spita l Guide to Re duc ing Me dic a id Re a dmissio ns

AHRQ Ho spita l Guide to Re duc ing Me dic a id Re a dmissio ns

Ava ila b le a t: www.inte ra c t2.ne t

BE ST PRACT I CE S OF CROSS SE T T I NG COL L ABORAT I ON

• Sha re d unde rsta nding o f (b e st-a va ila b le ) da ta
• Sha re d unde rsta nding o f pa tie nts a nd c a re g ive rs’ pe rspe c tive
• Sha re d unde rsta nding o f “re c e ive rs” pe rspe c tive
• Cle a r a rtic ula tio n o f spe c ific , fe a sib le o ppo rtunitie s fo r impro ve me nt
• I

mpro ve me nts a re ma de & “ha rdwire d” into ne w sta nda rd pro c e sse s

• Re g ula r me e ting s, a c tive c o lla b o ra tio n a nd jo int pro b le m-so lving

OPPORT UNI T I E S AND RE COMME NDAT I ONS

VHQC CAN SUPPORT YOUR E F F ORT S T O WORK WI T H PAC PROVI DE RS

Contac t Car la T homas: c thomas@vhqc .or g

ADDI T I ONAL WE BI NAR T HI S WE E K

• Atte nd the na tio na l la unc h we b ina r fo r the Ag e nc y fo r He a lthc a re Re se a rc h a nd

Quality’ s Ho spital Guide to Re duc ing Me dic aid Re admissio ns

• T

his ne w g uide suppo rts ho spita ls in de ve lo ping a da ta -info rme d a nd who le -pe rso n a ppro a c h to re duc ing re a dmissio ns, using the “ASPI RE F ra me wo rk”

• T
• mo rro w: F

rida y Se pte mb e r 9 fro m 3-4:30

• No c o st to a tte nd
• Re g istra tio n link c a n b e fo und o n Amy Bo utwe ll’ s L

inke dI n pa g e

RE COMME NDAT I ONS

1. K no w yo ur da ta : ho w ma ny disc ha rg e s a nd re a dmissio ns fro m PAC? 2. Re vie w 5 re a dmissio ns fro m po st-a c ute c a re se tting s 3. Co nve ne a me e ting with a g ro up o f po st a c ute pro vide rs 4. I de ntify 3 wa ys the ho spita l c a n impro ve the tra nsitio n fro m ho spita l to PAC 5. I de ntify 3 wa ys the PAC pro vide r(s) c a n re duc e a c ute c a re tra nsfe rs

QUE ST I ONS?

T HANK YOU F OR YOUR COMMI T ME NT T O RE DUCI NG RE ADMI SSI ONS

Amy E . Bo utwe ll, MD, MPP Adviso r, VHHA Ce nte r fo r He althc are E xc e lle nc e Pre side nt, Co llab o rative He althc are Strate g ie s amy@ c o llab o rative he althc are strate g ie s.c o m