Transcript Collaborative on Reducing Readmissions in Florida

Readmissions: The Final CMS
Rule, Community Engagement
Initiatives, and CMS Grants
Kim Streit, FACHE, MBA, MHS
VP/Healthcare Research and Information for FHA
Susan Stone, MSN, RN
Care Transitions Project Director for FMQAI
August 23, 2011
Objectives
• Describe the new financial incentive
systems designed to reduced avoidable
readmissions
• Learn about CMS programs that focus on
improving care transitions
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CMS Final Rule 2012
•
•
•
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Selection of applicable conditions
Definition of “readmission”
Measures for applicable conditions
Methodology for calculating the Excess
Readmission Ratio
• Public reporting of readmission data
• Definition of “applicable period”
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Applicable Conditions
• Acute Myocardial infarction
• Congestive Heart Failure
• Pneumonia
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Definition of “Readmission”
• “in the case of an individual who is
discharged from an applicable hospital,
the admission of the individual to the same
or another applicable hospital within a time
period specified by the Secretary (30
days) from the date of such discharge”
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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 (#0506)
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Exclusions
•
•
•
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Planned procedures following AMI
Transfers to another acute care hospital
Hospitalizations for in-hospital death
Not in Medicare FFS for at least 30 days
post-discharge
• Discharged AMA
• Under age 65
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Methodology
• Index hospitalization
– Identified based on the principal diagnosis &
the inclusion/exclusion criteria
• Risk Adjustment
– Age, sex, chronic medical conditions,
indicators of patient frailty for 12 months prior
• If no claim in prior 12 months, only comorbidities in
index admission included
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Example
Index
Discharged:
Admitted:
Admitted:
Admitted:
Jan 1
Jan 15
Jan 25
Feb 10
Readmission
Does not
count
Index
For Details on the Measures
• www.qualitynet.org
• 2011 Measures Maintenance Technical Report: Acute
Myocardial Infarction, Heart Failure, and Pneumonia 30Day Risk-Standardized Readmission Measures
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Applicable Period/Data for
Calculation
• Will use 3 years of data to calculate the
“Excess Readmission Ratios”
• July 1, 2008- June 30, 2011
• Minimum of 25 discharges
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Excess Readmission Ratio
Risk adjusted actual readmissions
Risk adjusted expected readmissions
P/E less than 1 =
P/E greater than 1 =
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Public Reporting of Readmission
data
• Required to calculate/publish readmission
rates for all patients for all hospitals
• Did not finalize – asked for suggestions
only
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CMS FY 2013 Rulemaking
• Payment adjustment
– Based DRG payment amount
– Policies for SCH & MDHs
– Adjustment factor (ratio & floor)
– Aggregate payments for excess readmissions
– Applicable hospital
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Payment Impact
• Beginning in FY2013, hospitals with higher than
expected risk-adjusted readmissions rates for 30-days
post-discharge will receive reduced Medicare
payments for every discharge (readmissions rate
based on prior year’s data)
• Maximum payment reduction for individual facilities:
1.0% in FY2013, increasing to 3.0% in FY2015 and
thereafter
• The Secretary is mandated to establish a quality
improvement program for hospitals with high severityadjusted readmissions rates to be carried out in
conjunction with Patient Safety Organizations
Community Engagement
The most effective interventions to reduce
avoidable readmissions will depend on
changes in the processes of care at a
community level and engage more than one
provider (including hospitals, home health
agencies, dialysis facilities, nursing homes,
and physician offices), as well as patients,
families, and community health care
stakeholders.
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QIO: Coalition Building to
Improve Care Transitions
• Expands the 2008-2011 Care Transitions Project from 14
states to a national program
• FMQAI is seeking to recruit 9+ communities to
participate in Florida’s Care Transitions initiatives
• Two types of communities:
– Did not apply for/not accepted into a Formal Care
Transitions Program (grant) – will receive
ongoing QIO technical assistance
– Accepted into a formal Care Transitions Program
(receives a grant) – will receive technical
assistance through another CMS contractor
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Community Criteria
•
Includes two-five participating hospitals that are
close in proximity
•
Collaborates with post-acute care settings,
physicians, and community organizations that can
impact readmissions
•
Target population – Medicare fee-for service
(including dual eligible)
•
Unit of measure – community (based on overlap of
hospitals’ discharges/beneficiary zip codes)
•
Goal – 20% relative improvement in 30-day
readmission rate over three years
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Provide Technical Assistance
for Communities (Non-Grant)
•
Support coalition building among providers,
stakeholders, and beneficiary advocacy and service
organizations
•
Conduct root-cause analysis and provide results for
each community
•
Work with providers to select evidence-based
interventions and develop the implementation plan
•
Continued ongoing assistance
– Measure development
– Monitor the effectiveness of the interventions
– Support ongoing root-cause analyses
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Data Support* (Non-Grant)
• Hospital- and communityspecific readmission rates
• Post-acute care setting
readmission rates
• Disease-specific
readmission rates
• Emergency department
rates
• Observational stay rates
• Mortality rates
*includes readmissions to all hospitals
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Provide Application Assistance
for Communities (Grant)
• Mandated by the Affordable Care Act (section 3026)
Community-based Care Transitions Program (CCTP)
http://www.cms.gov/DemoProjectsEvalRpts/MD/itemdetail.asp?itemID=CMS1239313
• $500 million available in grants
• Partnership between high readmission rate
(AMI/HF/PNE) hospitals and a community-based
organization (CBO) that provide care transitions
services
• CCTP application toolkit and assistance available
from FMQAI
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CCTP Grant Application
Getting Started
• Do your homework – review the facts and create
relationships
• Identify key stakeholders – Hospital CFO, CEO,
COO, VPN, Director of Case Management, etc.,
CBO, skilled nursing facilities, home health
agencies, and physician champions
• Create a Memorandum of Understanding –
delineates the role, responsibilities, etc.
• Complete a root-cause analysis and determine best
practice intervention(s)
• Define an operating and cost model (write proposal)22
Hospital Engagement Contract
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.
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10 Focus Areas of the Initiative
1.
Adverse drug events
2.
Catheter associated urinary tract infection
3.
Catheter associated bloodstream infections
4.
Injury from falls and immobility
5.
Obstetrical adverse events
6.
Pressure ulcers
7.
Surgical site infections
8.
Venous thromboembolism
9.
Ventilator associated pneumonia
10. Preventable readmissions
Statewide Quality Meetings
• Provide a mechanism for providers to participate
in a large scale improvement effort to reduce
readmissions in Florida
• Engage leaders around an action-based agenda
• Share relevant state data to determine areas for
rapid cycle improvement
• Identify additional affinity groups to address
special need areas
• Provide a forum to share successes and lessons
learned
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Florida Hospital Association
FMQAI
Kim Streit, FACHE, MBA, MHS
Email: [email protected]
Telephone: 407.841.6230
Susan Stone, MSN, RN
Email: [email protected]
Telephone: 813-865-3435
QUESTIONS
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