TRANSITIONS OF CARE & CARE COORDINATION Agenda Select Medical - - PowerPoint PPT Presentation

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TRANSITIONS OF CARE & CARE COORDINATION Agenda Select Medical - - PowerPoint PPT Presentation

Jan 20, 2024 226 likes •404 views

Select Medical TRANSITIONS OF CARE & CARE COORDINATION Agenda Select Medical Overview Transitions of Care Right Patient, Right Level of Care, Right Time Right Patient, Right Level of Care, Right Time Chronic Critical Illness

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TRANSITIONS OF CARE &

Select Medical

CARE COORDINATION

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Agenda

  • Select Medical Overview
  • Transitions of Care

– Right Patient, Right Level of Care, Right Time Right Patient, Right Level of Care, Right Time – Chronic Critical Illness Syndrome – Role of Long Term Acute Care Hospital (LTACH)

  • Care Coordination

– Pre‐care – Point of Care – Post‐care 2

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Select Medical Overview

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Select Medical’s National Footprint

2 1 4 1 2 12 5 3 4 2 8 11 7 17 2 1 24 2 4 3 11 1 11 5 45 3 15 11 1 58 9 49 2

131 148

8 2 44 4 1 3 153 23 1 1 1 1 17 17 10 1 12 3 3 2 18 3 7 13 3 8 13 4 2 8 1 4 14 3 2 3 17 16 2 15 2 20 1 2 2 3 20 66 35 17 3 21 3 2 1 21 32 43 3 1 3 2 5 5 13 15 2 6 1 2 1 12 17 2 6 10 11 4 6 7 2 8 2 4 6 1 9 7 94 6 2 6 1 24 17 1 2 2 5 3 1 97 56

As of 6/30/15

2 14 1 4 46

111 Long‐Term Acute Care Hospitals (LTACH) 17 Inpatient Rehabilitation Hospitals 1,028 Outpatient Rehabilitation Centers 427 Contract Therapy Locations 300 Concentra Centers

10 1 8 1

4

p ( ) (28 States) Hospitals (8 States) (31 States and D.C.) (28 States and D.C.) (38 States)

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SLIDE 5

5

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Transitions of Care

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Continuum of Care

Right Patient, Right Level of Care, Right Time

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Admission Scenarios – Study Example

8

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Chronic Critical Illness (CCI)

  • High acuity, medically complex with multi organ system failure
  • Frequently requires prolonged mechanical ventilation
  • Distinct clinical group of patients with distinct

pathophysiology and care needs when compared to acutely critically ill patients P I i C S d (PICS)

  • Post Intensive Care Syndrome (PICS)

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Chronic Co-Morbidities Acute Critical Illness Chronic Critical Illness Ventilator Dependence Medical Surgical Brain Dysfunction Neuromuscular Weakness Endocrinopathy Malnutrition Anasarca Skin Breakdown Symptom Distress Neurologic Cardiac Sepsis/Acute Co-Morbidities g

Am J Respir Crit Care Med Vol 182. pp 446–454, 2010

Older Age

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CCI Discharge Options: CHEST, 2005

Level of Care Acuity Level Advantage Disadvantage

Acute ICU Patient may be unstable Hi Tech interventions as well as full ICU care Cost Focused on acute needs as full ICU care (cardiac cath, Pulmonary Artery Cath, Full OR) Focused on acute needs Not skilled in CCIS Acute Step-down Lower cost Patients usually stable Hi tech interventions with transfer back to ICU Focused on short stays Not Skilled in CCIS LTACH Patients may be unstable as long as acute care interventions not needed Specialize in CCIS Clinical Team and Patient Focused Lower cost Some focused interventions available (GI procedures, debridements, Respiratory procedures, basic diagnostics) Physician Coverage Patient focused p g ) Sub-acute SNF Patients must be stable Cost Family access Patient focused No on-site interventions, clinical team not skilled in CCIS and ratios much lower Patient focused ratios much lower No daily physician coverage SNF Patients must be stable and recovering Cost Appropriate clinical services Staffing ratios No on-site interventions No daily physician coverage

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Acute Rehabilitation Must be stable and able to meet rehab criteria Rehab and mobility focused CCIS pt often not ready for this level

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Role of LTACH

  • Specialized ACUTE Care Environment

E id B d T t t d P t l – Evidence Based Treatments and Protocols

  • Interdisciplinary Team Focus and Intensity of Service

– Patient Centered

  • Serves a Critical Role in Facilitating Functional Outcomes

g

– Environment and Skillset for Early Mobilization of CCI Patients 12

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Care Coordination

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Care Coordination

Focus and Innovation

Pre‐Care Point of Care Post‐Care

  • Screening
  • Clinical Criteria
  • Preparation
  • Communication

F ili H d ff

  • Care Conference
  • IDT Meeting
  • DC Planning
  • DC Preparation

C i i

  • Level of Care
  • Clinical Capabilities
  • Communication
  • Patient Satisfaction
  • Facility Hand‐off
  • Patient/Family
  • Communication

Patient Engagement 14

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Point of Care ‐ Case Management/UR

Organized Interdisciplinary Workflow

  • Clinical Barrier Resolution
  • Treatment Plan
  • Discharge

Planning

Admitting Diagnosis

  • Nationalized

Patient/ Family

Physician Treatment Team Treatment Plan

  • Clinical Barrier Resolution
  • Interdisciplinary Approach

POC Progression

  • Community Barrier Resolution
  • Resource Barrier Resolution

Discharge Planning

DC LLOC REHAB SNF HOME

Nationalized LOS

  • UR/UM

Severity

  • f Illness

Case Manager

  • Utilization Review
  • Outlier Management

Resource and LOS Management

OTHER

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Key Points – Care Coordination

  • Appropriate Transitions of Care
  • Patient Centered Care Planning
  • Multi‐Discipline Team Focused Treatment Plans
  • Flow of Information and Education for Patients and Providers
  • Innovations in Care Delivery and Coordination of Care

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Thank you

For additional information or questions: David Key, SVP Operations Select Medical 4714 Gettysburg Rd Mechanicsburg, PA 17055 dkey@selectmedical com dkey@selectmedical.com (717) 730‐4231