Transcript Slide 1

The Impact of the ACA:
How Readmissions Penalties Will Affect
the Healthcare Executive’s Mission
Healthcare Leadership Network of the Delaware Valley
May 2, 2014
Paula A. Bussard
Senior Vice President, Policy & Regulatory Services
The Hospital & Healthsystem Association of Pennsylvania
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Preventable Readmissions
• 1 in every 5 Medicare patients are
readmitted within one month of discharge.
• More than 2,000 hospitals affected by
readmission penalties.
• About $270 million in Medicare funds.
 PA FFY 2013 - $12 million—PA ranked 32nd
 PA FFY 2014 - $9 million—PA ranked 31st
• Increase in penalty to max of 3%.
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Preventable Readmissions
Readmission rates for 2010, as
reported by Pennsylvania Health
Care Cost Containment Council
(PHC4):
 Total readmission rate was 13.5%
(2 out of every 15 hospital stays
had a readmission within 30 days).
 CHF readmission rate was 24.3%.
 Septicemia readmission rate was
21.0%.
 COPD readmission rate was
20.2%.
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Pennsylvania Hospital Engagement Network
 HAP—one of 26 hospital engagement networks nationwide
 60 Pennsylvania hospitals participating in the HEN collaborative
project:
• 15 hospitals participated in one year BOOST project (Better
Outcomes for Older adults through Safe Transitions)
• 45 hospitals in PA-HEN collaborative
 Tracking readmission data for all Pennsylvania PA-HEN participating
hospitals
 PA-HEN has offered:
• Regional networking sessions (including post-acute providers);
webinars; one-on-one coaching calls; and site visits
• Priorities:
 Health literacy training
 Post discharge best practices (appointments/phone calls)
 Medication reconciliation
 Patient education
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PA-HEN Readmission Progress
PA-HEN Wide Readmission Results (Rate of 30 day readmissions, all-cause, CHF and COPD)
30%
25%
Reflects a 24%
reduction from
baseline
20%
Rate
G
O
A
L
15%
10%
5%
0%
2010
n=118
2011
n=118
Q1 2012 Q2 2012 Q3 2012 Q4 2012 Q1 2013 Q2 2013
(Dec-Feb) (Mar-May) (Jun-Aug) (Sep-Nov) (Dec-Feb) (Mar-May)
n=118
118
n=118
n=117
n=118
n=118
CHF Rate
COPD Rate
All Cause Rate
55
Current Priorities
• Immersion project model
• Health Literacy
• Community Cross Continuum Teams
– Removal of silos
– Collaboration with stakeholders
– Regional events including health care and community
partners
– Encourage education sharing
– Encourage patient participation
• Paradigm shift from ‘doing to patients’
to ‘doing with 6patients’
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Health Literacy
Average adult reads 3-5 grade levels below
highest grade completed.
Therefore, up to ½ of US population may be
at risk for:
– Medical misunderstandings
– Mistakes
– Excess hospitalizations
– Poor health outcomes
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Cross Continuum Teams
Primary care
Personal care
Specialists
Area Agencies on
Care management Aging
Long-term care
Health plans
Home health
Durable medical
Hospice
equipment
Pharmacy
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Lessons Learned—Challenges
 Patient and family educational needs
 EHR—helps, but can be burdensome
 Regional differences:
• Urban—higher indigent population, language
and cultural barriers more prevalent
• Rural—can have limited community services
 Behavioral health care needs
 Regulatory and payment differences between
levels of care
 Loss of revenue
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Lessons Learned—Opportunities
 Effective communication.
 Information sharing – health record exchange.
 Management of care:
• Transition of care.
• Better outcomes.
• Engagement of patient and families.
• Better planning for chronic and end of life care.
• Use of innovative delivery models, including care in place
and effective use of advanced practice professionals.
 Measurement/performance indicators that are relevant across
the continuum of care.
 Understanding of financial performance and implications.
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Leadership Strategies to Sustain Quality
Improvement and Prevention of Harm
 Connecting quality and cost
•
Align with overall organizational goals and financial incentives
 Define clear, measurable aims for improvement
•
Report out to organization and community, if appropriate
 Plan, do, study, act
•
•
Multi-disciplinary team
Commit to data collection and reporting
 Accountability and transparency
•
•
Community regularly with administrative and clinical leadership and
governing body
Show results (good and not-so-good)
 Leadership must champion
 Hardwire the improvements into every day practice
•
Everyone held to same standard
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Engaging Patients and Families
Health care consumers:
 Expect care to be high quality.
 Approach care with a deep sense of
uncertainty and vulnerability.
 Experience with care is very personal and
granular.
 See insurance companies as setting the rules.
 Want hospitals to see them as people.
 Want care to be respectful, professional,
and quick.
PA ranked 40th in HCHAPS
scores
 Want hospitals to be empathetic and to stand up for them.
Source: Findings from HAP Focus Groups – conducted March 2014
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Using Financing to Reshape the Organization and
Outcomes of Care
Accountable Care Organizations
Post Acute Care (PAC) Episode Bundling
Acute Care Episode with PAC Bundling
Primary
Care
Physicians
Specialty
Care
Physicians
Outpatient
Hospital
Care and
ASCs
Inpatient
Hospital
Acute
Care
Long Term
Acute
Hospital
Care
Inpatient
Rehab
Hospital
Care
Skilled
Nursing
Facility
Care
Home
Health
Care
Acute Care Bundling
Medical Home
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Questions
The Hospital & Healthsystem Association of Pennsylvania
May 2014