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HOME I S T HE HUB 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

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  1. HOME I S T HE HUB 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

  2. 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

  3. 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

  4. 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.

  5. 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 o ta l hip/ T o 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

  6. 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 • oc us o n PAC, HU, T HR/ T K R in pa ra lle l F • E ng a g e with pa rtne rs in PAC • E ng a g e with VHQC fo r c r oss- 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

  7. Planne d Ac tivitie s for L e ar ning & Ac tion June 16 th* Hig h L e ve ra g e Stra te g ie s Aug ust 17 th* Da ta / Me a sure me nt Se pte mb e r 8 th* Re duc ing PAC Re a dmissio ns Oc to b e r 20 th* I mpro ving Ca re fo r Hig h Utilize rs 15 th Nove mbe r 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

  8. 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)

  9. 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

  10. 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

  11. 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

  12. PORT F OL I O OF ST RAT E GI E S Impro ve pro c e sse s & pra c tic e s fo r SNF pa tie nts Re duc e PAC Re a dmissio ns 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 All Ca use Re duc e HU All Pa ye r “Who le -pe rso n” c a re te a ms, Re a dmissio ns Re a dmissio ns b y c a re pla ns 20% b y 2020 Re duc e T o ta l Impro ve pre -o p, pe ri-o p, Hip/ K ne e po st-o p a nd re ha b pra c tic e s Re pla c e me nt & pro c e sse s Re a dmissio ns Re duc e Co a c hing a nd L inka g e to Re a dmissio ns fro m Se rvic e s (AAA/ SI M) Ho me

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

  14. RE ADMI SSI ONS BY DI SCHARGE DI SPOSI T I ON I N VI RGI NI A Medicare FFS Readmission Rates, by Discharge Setting: Home, SNF, HH 22 20% PAC 20 18.6% Average 18 Axis Title 15% Home 16 14 12 10 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 So urc e : 2015 VA Me dic a re F F S da ta , c o urte sy o f VHQC

  15. K E Y ST AT I ST I CS T O K NOW Me dic a re Me dic a re to PAC • ~275k Me dic a re disc ha rg e s • ~110k Me dic a re disc ha rg e s to PAC • ~50k Me dic a re re a dmissio ns • ~22k re a dmissio ns “fro m” PAC • ~18% Me dic a re re a dmissio n ra te • ~20% re a dmissio n ra te ~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% *PAC = Ho me He a lth o r SNF

  16. 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 or mula E xample T o ta l ho spita l* disc ha rg e s A 1000 T o ta l ho spita l re a dmissio ns B 150 Ho spita l re a dmissio n ra te = B/ A 15% T o ta l PAC** disc ha rg e s (40% o f to ta l) C = .4A 400 T o 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

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

  18. 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

  19. 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

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

  21. 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 o ve tr ansitio n fr o m SNF to ho me ” T o le s e t al JAGS 2014

  22. 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

  23. 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

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