In Pursuit of Coordinated Care Delivery Part I_Webcast.pptx - HubSpot PDF
Preview In Pursuit of Coordinated Care Delivery Part I_Webcast.pptx - HubSpot
Reinvigorating Inpatient Care Coordination Infrastructure Presented by: Sruti Nataraja, MPH, The Advisory Board Company Webinar Start Time: 1 p.m. Central Audio Dial-In Number: 800-735-5968 Slide Handout: Ensocare.com/connect-education/ Technical difficulties? 800-843-9166 or [email protected] © 2011 The Advisory Board Company – 22421B Reinvigora*ng Inpa*ent Care Coordina*on Infrastructure Sru; Nataraja, MPH Prac;ce Manager The Advisory Board Company [email protected] © 2011 The Advisory Board Company – 22421B 3 Road Map for Discussion Na;onal Call to Ac;on on Care I Coordina;on II Best Prac;ces for Hardwiring Inpa;ent Care Communica;on Best Prac;ces for Migra;ng Toward a III Transi;on Mentality © 2011 The Advisory Board Company – 22421B 4 Na;onal Call to Ac;on on Care Coordina;on © 2011 The Advisory Board Company – 22421B 5 Care Coordina;on Rising to Top of Execu;ve Agenda Leaders Cite as Key Priority for 2011 Top Priori*es Iden*fied by Hospital Leaders1 Priority 2010 Rank Priority 2011 Rank Quality/pa;ent safety 1 Cost reduc;on 1 Physician recruitment/reten;on 2 Quality/pa;ent safety 2 Cost reduc;on 3 Reimbursement 3 Pa;ent experience/pa;ent sa;sfac;on 4 Pa;ent experience/pa;ent sa;sfac;on 4 Reimbursement 5 Developing an accountable care organiza;on 5 Construc;on/capital improvements 6 Care coordina*on 6 Physician staff ventures/realignment 7 Physician recruitment and reten;on 7 Technology system/equipment 8 Technology system/equipment 8 Employee sa;sfac;on 9 Construc;on/capital improvements 9 Care coordina*on 10 Physician staff ventures/realignment 10 Leadership development 11 Dealing with uncompensated care 11 Revenue cycle 12 Revenue cycle 12 1 Based on response to survey ques;on: “Rank your Source: “HealthLeaders Media Industry Survey 2011,” HealthLeaders Media, organiza;on’s top 3 priori;es for the next 3 years.” hSp://www.healthleadersmedia.com/pdf/survey_project/2011/ © 2011 The Advisory Board Company – 22421B Leadership_press.pdf; Clinical Advisory Board interviews and analysis. 6 Seemingly An Area of High Performance Hospital Leaders Give High Marks to Care Coordina=on How Would You Rate the Current Status of Care Coordina*on At Your Organiza*on? n=487 Weak/Very Weak 14% 64% Very Strong/Strong Neutral 22% Source: “HealthLeaders Media Industry Survey 2011,” HealthLeaders Media, hSp://www.healthleadersmedia.com/pdf/survey_project/2011/ © 2011 The Advisory Board Company – 22421B Leadership_press.pdf; Clinical Advisory Board interviews and analysis. 7 Consumer View Less Rosy Mismatch Between Hospital Percep=on and Pa=ent Reality Consumer Views of Care Coordina*on1 n=1,238 Major Problem Roughly 4 of 10 consumers report 17% problems with care coordina;on Not a Problem at all 52% 27% Minor Problem 3% Don’t Know/Refused 1 Based on response to survey ques;on: “In general, do you think that Source: “The Public and the Health Care Delivery System,” NPR/ coordina;on among all of the different health professionals that you Kaiser Family Founda=on/Harvard School of Public Health, April see is a major problem, a minor problem, or not a problem at all?” 2009, hSp://www.kff.org/kaiserpolls/upload/7887.pdf; Clinical © 2011 The Advisory Board Company – 22421B Advisory Board interviews and analysis. 8 Academic Research Also Illumina;ng Problems Over 700 Ar=cles on Coordina=on Published in Last Two Years Rehospitalizations Eo ffne Hctos sopfi Ctaalirzea Ctioonor, dQinuaatliitoyn Among Patients in the of Care, and Health Care Medicare Fee-‐‑For-‐‑Service Expenditures Among Ar;cles Published on Program Medicare Beneficiaries 711 Care Coordina;on 2009 -‐ 2011 Thirty-‐‑Day Readmission Hospital Readmission as Rates for Medicare an Accountability Beneficiaries by Race and Measure Site of Care Research Methodology in Brief • Searched PubMed for ar;cles published between January 1, 2009 and March 7, 2011 in English with the words “care coordina;on” or “readmissions” appearing in the ;tle or abstract • A total of 711 ar;cles were published within ;me frame Source: Ar;cles listed above; Clinical Advisory © 2011 The Advisory Board Company – 22421B Board interviews and analysis. 9 Fragmenta;on Garnering the ASen;on of Regulators Medpac Explains Perils of Coordina=on in US System A Fragmented System “Providers need to increase care coordina*on and be jointly accountable for quality and resource use…There is no incen;ve for providers to coordinate care. Each provider may treat one aspect of a pa;ent’s care without regard to what other providers are doing. There is a focus on procedures and services rather than on the beneficiary’s total needs. This becomes a par;cular problem for beneficiaries with several chronic condi;ons and for those transi;oning between care providers, such as at hospital discharge. Poorly coordinated care may result in pa;ent confusion, over-‐treatment, duplica;ve service use, higher spending, and lower quality of care.” -‐ Medpac Report to the Congress: Reforming the Delivery System Source: Report to the Congress: Reforming the Delivery System, September 16, 2008, Statement of Mark Miller, Execu;ve Director, Medicare Payment Advisory Commission, to U.S. Senate Finance CommiSee, hSp://www.medpac.gov/documents/20080916_Sen%20Fin_tes;mony%20final.pdf; Clinical © 2011 The Advisory Board Company – 22421B Advisory Board interviews and analysis. 10 P4P Already a Reality Accountability Measures Transcend Hospital Walls Targe=ng Hospitals for System Performance Emerging Scope of Hospital Accountability Pre-‐Admit Care Hospital-‐Based Care Post-‐Acute Care CMS Measures Requiring Coordina*on R 30-‐day AMI1 R 30-‐day AMI readmission rate mortality rate R 30-‐day heart failure R 30-‐day heart failure readmission rate mortality rate R 30-‐day pneumonia R 30-‐day pneumonia readmission rate mortality rate Accountable En*ty Hospitals increasingly penalized for subpar care outcomes despite diffuse responsibility Source: U.S. Department of Health and Human Services, “Hospital Compare,” available at: 1 Acute Myocardial Infarc;on. hSp://www.hospitalcompare.hhs.gov, accessed March 10, 2011; Clinical Advisory Board © 2011 The Advisory Board Company – 22421B interviews and analysis. 11 New Payment Models Extend Realm of Responsibility Reimbursement Increasingly Spanning Con=nuum of Care Con*nuum of Care Pre-‐Acute Inpa*ent Acute Post-‐Acute Readmissions Penal;es Inpa;ent Bundling (ACE Demonstra;on) Episodic Bundles (Na;onal Pilot Program on Payment Bundling) Shared Savings (Medicare Shared Savings Program) © 2011 The Advisory Board Company – 22421B Source: Clinical Advisory Board interviews and analysis. 12 Rethinking Our Rela;onships Across the Con;nuum Hospitals Must Partner with Previously Siloed Stakeholders Con*nuum of Care Pre-‐Acute Inpa*ent Acute Post-‐Acute Stakeholders involved: PCP Pa*ent Specialists Hospitalists Nurses Home Health SNF Medical Home Case Manager Pa*ent Allied Health PCP Pa*ent Specialists Care q Adequate q Length of stay management q Partner with post-‐acute coordina*on preventa;ve care q Inpa;ent u;liza;on providers impera*ves: q Disease preven;on management q Standardize care site q Reduce readmissions transi;ons q Reduce readmissions © 2011 The Advisory Board Company – 22421B Source: Clinical Advisory Board interviews and analysis. 13 One Thing We Can All Agree On Readmissions the Star;ng Point Carrots and S=cks to Improve Transi=ons HR 3590 Sec*on 3025 Sec*on 399KK Sec*on 3026 Readmissions Quality Improvement Community-‐Based Care Reduc*on Program Program Transi*ons Program • Star;ng in October 2012, • Establishment of a quality • Beginning in 2011, program will hospitals will face penal;es for improvement program for receive mandatory 30-‐day all-‐cause readmissions hospitals with high readmission appropria;ons of $500 million for three condi;ons (AMI, HF, rates within two years of bill over 5 years pneumonia) passage • Funding for en;;es that provide • Possible expansion to COPD1, • Hospitals will work with pa;ent care transi;on services for high CABG2, PTCA3, other vascular safety organiza;ons to reduce risk Medicare beneficiaries condi;ons readmissions 1 Chronic Obstruc;ve Pulmonary Disease. 2 Coronary Artery Bypass Gras. 3 Percutanueous Transluminal Coronary Angioplasty. Source: HR 3590 Pa;ent Protec;on and Affordability Act; © 2011 The Advisory Board Company – 22421B Clinical Advisory Board interviews and analysis. 14 Penal;es Adding Urgency Excess Payment Calcula*on Adjustment Based on Maximum Penalty2 Number % Higher Average Excessive Total Opera*ng Payments: Condi*on of Than Pa*ents Reimbursement Expected1 Payment $50 million HF 450 $5,000 15% $337,500 Excess payment of Maximum AMI 300 $4,500 5% $67,500 $625,000 as percentage percentage allowed of total opera=ng in FY 2013=1.0% payments=1.25% Pneumonia 250 $4,000 22% $220,000 Total Excess Payment $625,000 Actual Penalty=$500,000 Customized Readmissions Assessment • As a special service to our members, the Clinical Advisory Board is offering a customized assessment of es;mated readmissions penal;es • If interested in obtaining an assessment for your hospital, e-‐mail [email protected] 1 Published rate on Hospital Compare divided by Na;onal Average. 2 Adjustment factor calculated as percentage of revenue paid for excessive readmissions divided by total revenue, with a maximum of 1% of total DRG payments in 2013, 2% in 2014, and 3% in 2015. © 2011 The Advisory Board Company – 22421B Source: Clinical Advisory Board interviews and analysis. 15 Readmissions Not the Only Metric Worth Considering Experts Ques=on Value as an Accountability Measure Recommended Process Measures Related to Care Coordina*on High-‐quality medica;on reconcilia;on Telephone follow-‐up “Acco untability measures should have a strong evidence base f or their validity, should accurately measure whether Use of nurse-‐directed high-‐quality care has been provided, and should have a low case management risk for unintended consequences…although hospital readmissions have become the gold standard for assess ing the effec*veness of hospital discharge proce sses, this outcome measure remains a surrogate for Health and quality of the re al outcomes of interest—health, quality of life, and life aser discharge value. ” Source: Axon, R. and M. Williams, "Hospital Readmission as an Accountability Measure," JAMA, February 2, 2011, 305(5); © 2011 The Advisory Board Company – 22421B Clinical Advisory Board interviews and analysis. Promp;ng the Need for a Broader Framework for 16 Care Transi;ons Domain Measure Source Pa;ents discharged from an inpa;ent facility to home or any other site of care, or their ABIM; ACP; PCPI; caregiver(s), who received a transi;on record (and with whom a review of informa;on SHM was documented) at the ;me of discharge Pa*ent and Family Pa;ents discharged from ED to ambulatory care or home health care who received a ABIM; ACP; PCPI; Informa*on transi;on record at the ;me of ED discharge* SHM at Discharge Pa;ents discharged from an inpa;ent facility to home or any other site of care, or their ABIM; ACP; PCPI; caregiver(s), who received a reconciled medica;on list at the ;me of discharge* SHM 3-‐Item Care Transi;on Measure (CTM-‐3)* NQF Pa;ents discharged from an inpa;ent facility to home or any other site of care for whom a ABIM; ACP; PCPI; Informa*on transi;on record was transmiSed to the facility or PCP or other health care professional SHM Transfer to designated for follow-‐up care within 24 hours of discharge* other Sites of Care No;fica;on to PCP that pa;ent was admiSed to an acute inpa;ent facility within 24 hours Observed prac;ce of admission Pa;ents discharged with a follow-‐up appointment scheduled within 5 days of discharge Observed prac;ce Follow-‐Up Care Pa;ent compliance rate with showing up at first follow-‐up appointment Observed prac;ce Follow-‐up phone calls conducted for high-‐risk pa;ents within 48 hours of discharge Observed prac;ce Discharge Percentage of admissions where pa;ents and family caregiver are included in assessing IHI Planning post-‐discharge needs Source: Na;onal Quality Forum (NQF), Preferred Prac;ces and Performance Measures for Measuring and Repor;ng Care Coordina;on: A Consensus Report, 2010; AHRQ, Care Coordina;on *Endorsed by the Na;onal Quality Forum. Measures Atlas, January 2011, available at: hSp://www.ahrq.gov/qual/careatlas/, accessed March © 2011 The Advisory Board Company – 22421B 6, 2011; Clinical Advisory Board interviews and analysis. 17 Defining Care Coordina;on Resul;ng in All-‐Encompassing Defini;ons… “Care coordina*on is the deliberate organiza;on of pa;ent “Coordina*ng Care to Improve Health Outcomes for care ac;vi;es between two or more par;cipants (including Pa;ents: Developing new models that make it easier for the pa;ent) involved in a pa;ent’s care to facilitate the doctors and clinicians in different care sewngs to work appropriate delivery of health care services. Organizing care together to care for a pa;ent. Examples include iden;fying involves the marshalling of personnel and other resources and widely deploying the best advanced primary care and needed to carry out all required pa;ent care ac;vi;es, and is health home models, and suppor;ng innova;ons in osen managed by the exchange of informa;on among accountable care organiza;ons.” par;cipants responsible for different aspects of care.” AHRQ in conjunc*on with Stanford-‐UCSF Center for Medicare and Medicaid Innova*on Evidence-‐based Prac*ce Center (Innova*on Center) “N3C defines care coordina*on as a client-‐centered, “Care coordina*on is a func;on that supports informa;on-‐ assessment-‐based interdisciplinary approach to integra;ng sharing across providers, pa;ents, types and levels of service, health care and social support services in which a care sites and ;me frames. The goal of coordina;on is to ensure coordinator manages and monitors an individual’s needs and that pa;ents’ needs and preferences are achieved and that preferences based on a comprehensive care plan.” care is efficient and of high quality.” The Na*onal Coali*on on Care Na*onal Commihee for Quality Coordina*on (N3C) Assurance (NCQA) Source: AHRQ at www.ahrq.gov; Center for Medicare and Medicaid Innova;on at hSp://innova;ons.cms.gov/; Na;onal Coali;on on Care Coordina;on at: hSp://otrans.3cdn.net/9f87d9634b2a786e51_f6m6iyik5.pdf; NCQA © 2011 The Advisory Board Company – 22421B at www.ncqa.org; Clinical Advisory Board interviews and analysis. 18 …And Infinite Areas of Explora;on A Thousand-‐Foot View of Care Coordina=on BCaosemdm Seurnviticye-‐s Care Transi;ons Programs Chronic Disease Access to Care Disease Management DRuepdliuccai;nogn Care Plans Medical Home TeInchfonromloag;yo (nIT ) Preven;ng Readmissions Care Coordina*on Pa;ent-‐Centered Care Case Management Inpa;ent Handoffs Health Coaches Geriatrics Discharge Planning © 2011 The Advisory Board Company – 22421B Source: Clinical Advisory Board interviews and analysis. 19 Our Perspec;ve Placing Acute Care at the Center Mul=ple Entry Points to Health Care System SNF Specialist Home ED Medical Home Hospital Pharmacy Community Agency Home Health LTAC Primary Care © 2011 The Advisory Board Company – 22421B Source: Clinical Advisory Board interviews and analysis. 20 Arriving at a Workable Scope for Care Coordina;on Defining the Focus for Today’s Presenta=on Three Screens for Other Advisory Board Research Study Inclusion on Care Coordina*on Preven*ng Unnecessary Criteria Descrip*on Readmissions: Transcending the Hospital’s Four Walls for Topic is largely within the control of Collabora0ve Care Coordina0on Controllability the hospital and could be inflected by CAB (2010) hospital staff Next Genera*on Capacity Implementa;on of best prac;ces Impact on Management Vol 2: Best within category would posi;vely Quality Prac0ce for Collabora0ng to impact clinical quality outcomes CAB Drive Toward Discharge Strategy and terrain not covered at (2009) length by past research within the Originality Clinical Advisory Board program or Medical Home Project: external research www.advisory.com/hcab/ medicalhome HCAB Fron*er Strategies for Care Management Whitepaper (Coming Soon in 2011) CAB © 2011 The Advisory Board Company – 22421B Source: Clinical Advisory Board interviews and analysis.
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