Transcript Collaborative on Reducing Readmissions in Florida

Collaborative on
Reducing Readmissions
in Florida
May 2011
Overview of Call
1. Overview of Readmission Trends
2. Update on Collaborative Projects
3. CMS Readmission Reduction
Program
4. Partnership for Patients
5. Next Steps
Congestive Heart Failure
Goal <8.0%
Readmissions within 15 Days ~ All Readmissions
3
Acute Myocardial Infarction
Goal <6.5%
Readmissions within 15 Days ~ All Readmissions
4
Pneumonia
Goal <4.0%
Readmissions within 15 Days ~ All Readmissions
5
CABG
Goal <8.0%
Readmissions within 15 Days ~ All Readmissions
6
Hip Replacement
Goal <2.5%
Readmissions within 15 Days ~ All Readmissions
7
Update on Projects:
Standardized Discharge Form
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Working with FADONA, FMDA, AHCA, CARES
3 rounds of testing
7th version of form
Two pages, designed to capture critical
information about patient
• Finalizing instructions and roll-out approach
• Statewide testing next
• Will replace 3008
FOS-FHA Hip Readmission
Project
• Began Sept 2010
• Improving understanding of why hip
replacement patients are readmitted
– AHCA data
– Case reviews
• Explore statewide initiatives
Hospital-Health Plan Initiatives
• Aetna, AvMed, BCBSFL, CIGNA, Health First,
Humana & United
• Agreement on standard measure(s) and risk
adjustment
• Sharing information on at risk patients
• Hospital-Health Plan case manager outreach
• Inventory of readmission programs underway at
hospital and health plans
PPACA Directives Related to
Readmissions
• Reduce payments for hospitals with high
readmission rates
• High volume/expenditure, endorsed by an entity
under contract with CMS, excludes readmissions
unrelated to the prior discharge
• FY 2013 payments, 3 conditions, expand
following year
• Include an all-condition measure
• Time frame consistent with endorsed measure
• Public reporting of rates
• All patient readmission rates
FY 2012 IPPS/LTCH PPS Proposed
Rule
• Selection of applicable conditions
• Definition of readmission
• Measures and Methodology for calculating
excess readmission
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Index hospitalization
Risk adjustment
Risk standardized readmission rate
Data sources
Exclusion of certain readmissions
• Public reporting of readmissions
• Applicable period
FY2013 IPPS/LTCH PPS Proposed
Rule
• Base operating DRG payment
amount
• Adjustment factor (ratio & floor)
• Aggregate payments for excess
readmissions
• Applicable hospital
General
• Definition: “a readmission is when a patient is
discharged from the applicable hospital to a nonacute
setting and then is readmitted to the same or another acute
care hospital within a specified time period from the time of
discharge from the index hospitalization”
• Counts as one readmission regardless of how many
readmissions within the period
• Time period: 30 days after discharge from
index admission
• Data Source: Medicare FFS data, minimum
of 25 cases
Selection of
Conditions/Measures
• AMI, heart failure, pneumonia
– High volume, high expenditure criteria
– Endorsed by an entity under contract
– Exclusions for readmissions unrelated to prior discharge
• Measures
– AMI 30-day Risk Standardized Readmission Measure
(NQF # 0505)
– Heart Failure 30-day Risk Standardized Readmission
Measure (NQF# 0330)
– Pneumonia 30-day Risk Standardized Readmission
Measure (NQF#0506)
Exclusions for Unrelated
Readmissions
• General
– Transfers to another acute care hospital
– In-hospital deaths
– Patients leaving Medicare FFS within 30 days postdischarge
– Discharged against medical advice
• AMI
– Excludes those readmissions when PTCA or CABG
unless principal dx for readmission is Heart failure, AMI,
Unstable angina, Arrhythmia, Cardiac arrest
• Heart Failure/Pneumonia
– None
Measures
• Except with AMI, includes
readmissions for all causes, without
regard to the principal dx of the
readmission
– Patient perspective
– Prevents gaming
– No clinically sound strategies for identifying
readmissions unrelated to hospital quality based on
document cause of readmission
Risk adjustment
• Patient risk factors (patient demographics, coexisting medical conditions, indicators of patient
frailty) identified from inpatient & outpatient
claims for 12 months prior to hospitalization
• Calculates a hospital risk standardized
readmission ratio
• If no claims in prior 12 months, only comorbidities from the index admission will be used
Time Window
• 30 days
– Clinically meaningful to collaborate with
medical communities to reduce readmission
risk
– Accepted standard in research &
measurement
– Motivates hospital & community partners to
work together
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Ready to be discharge
Improves communication across providers
Reduces risk of infection
Educating patients on symptoms to monitor
Where to seek follo up care
Applicable Time Period
• Hospital Compare uses 3 years of
data
• Proposing to use July 1, 2008
through June 30, 2011 to calculate
excess readmission rates
• Conducting analyses to look at using
longer or shorter data periods
Other Provisions
• Must publicly report the hospital specific data
from the readmission reduction program
• Calculation of all patient readmission rate
– Hospitals or state or other entity will have to submit the
data
• Excess readmission methodology
Risk adjusted actual readmissions
Risk adjusted expected readmissions
Medicare Spending Per
Beneficiary
• CMS required to include “efficiency” measure in
VBP for FY 2014
• Hospital specific measure
• Part A & Part B spending
• 3 days before admission – 90 days post
discharge
• Baseline period: May 15, 2010 though Feb 14,
2011
• Measure: May 15, 2012 – Feb 14, 2013
CMS Partnership for Patients
1. Reduce harm caused to patients in
hospitals. By end of 2013, reduce
preventable HACs by 40% from 2010.
2. Improve care transitions. By end of
2013, decrease preventable complications
during a transition from one care setting to
another, resulting in a 20% reduction in
readmissions.
Community-Based Care
Transition Program
• $500 million
• Accepting applications
– Hospitals with high readmission rates, partnering with
CBO
– CBOs providing care transition services
– Must demonstrate reduced 30 day all-cause
readmission rates
• 10th Scope of Work
– Assistance from QIO
• www.healthcare.gov/center/programs/partnership
/join/index.html
Discussion
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8.
Have you reviewed the NQF measures for readmission?
Do you believe they adequately exclude for planned or
unrelated readmissions?
What time window do you think is appropriate to measure
the hospital’s performance on reducing readmissions?
Time period for measurement: how much data do you
think is adequate to measure readmission rates?
Where should CMS get all payer data?
Are you interested in applying for a Care Transitions
grant?
How actively are you following the IPPS rule?
Is your hospital assessing the proposed rule and
incorporating estimated impacts into the budget?
Next Steps
• Workgroups will continue
• Statewide partnership on
Readmissions
• Monthly calls/meetings to share best
practices