Adverse Drug Events Impact on Hospital Readmissions Co hosted by FHA - PowerPoint PPT Presentation

Adverse Drug Events Impact on Hospital Readmissions Co ‐ hosted by FHA HIIN and HSAG Facilitators Edna Clifton ‐ HSAG, Florida QIN ‐ QIO Phyllis Byles ‐ FHA Scott King, PharmD ‐ Orlando Health Dr. P. Phillips Hospital March 7, 2017

Agenda • Overview Mission to Care FHA HIIN ‐ goals • Data year to date for high risk medications (HRMs) • Overview hospital specific reports ‐ analysis of claims data for HRMs and hospital readmissions • Open Discussion – Q/A • Conclusions ‐ Next steps

HIIN Overview • “Mission to Care” HIIN • Accomplishments of HEN 1.0 & 2.0 • Core Topics and Data for HIIN • Resources ‐ HRET HIIN & FHA HIIN • Hospital Process and Expectations • Questions/Open Discussion

HIINs: Where are they? • 32 states ‐ 1600+ hospitals (largest HIIN collaborative nationally) FHA HEN: 94 Hospitals

HIINs: How are they related? CMS Partnership for Patients (PfP) 15 Other HIIN Entities AHA/HRET across the Nation FHA ‐ 31 other state organizations across Mission to the nation ‐ 1600+ Care 94 member hospitals

FHA HEN Results: 2012 ‐ 2016 Prevented 31,342 cases of harm Avoided $198 million in healthcare costs

Where We are Going ‐ HIIN GOALS: 20% Overall Reduction in Hospital Acquired Conditions (baseline 2014) 12% Reduction in 30 ‐ Day Readmissions (baseline 2014) 145 Harms/1,000 Discharges “America’s hospitals embrace the ambitious new 2010 goals CMS has proposed,” said Rick Pollack, 142 Harms/1,000 Discharges 2011 president and CEO of the American Hospital 132 Harms/1,000 Discharges Association (AHA). “The vast majority of the 2012 nation’s 5,000 hospitals were involved in the 121 Harms/1,000 Discharges successful pursuit of the initial Partnership for 2013 Patients aims. Our goal is to get to zero 121 Harms/1,000 Discharges 2014 incidents . AHA and our members intend to keep an unrelenting focus on providing better, safer New Goal care to our patients ‐‐ working in close partnership with the federal government and 97 Harms/1,000 Discharges 2019 with each other.” partnershipforpatients.cms.gov

Historical Comparison Original HEN HEN 2.0 HIIN Funding Source Affordable Care Act Affordable Care Act Medicare Trust Fund Project Timeline 2 base years; 1 optional 1 base year; no optional 2 base years; 1 optional year year year Project Aim 40% reduction in 40% reduction in 20% reduction in all preventable harm; 20% preventable harm; 20% cause harm; 12% reduction in reduction in reduction in readmissions readmissions readmissions Number of hospitals 1,378 1,497 ~1710 Number/Types of Topics 10 core harm topics plus 10 core harm topics plus 10 core harm topics plus readmissions readmissions readmissions ADE, CAUTI, CLABSI, ADE, CAUTI, CLABSI, ADE, CAUTI, CLABSI, C ‐ EED, Falls, OB Harm, EED, Falls, OB Harm, diff, Falls, Pressure Pressure Ulcers, SSI, Pressure Ulcers, SSI, Ulcers, Sepsis, SSI, VAE, VAP/VAE, VTE VAE, VTE VTE Number of Primes 26 17 16 Data Submission 2010 2010 2014 Baseline Data Measures Mix of national, state, Nationally defined Nationally defined and organizationally (standardized) outcome (standardized) outcome defined measures measures measures

Financial Incentives for Strong Quality Processes 0% ‐ 1% ‐ 2.00% ‐ 2.00% ‐ 2.00% ‐ 2.00% ‐ 2.00% ‐ 2.00% ‐ 2.00% ‐ 2.00% ‐ 2% PERCENT PAYMENT REDUCTION ‐ 1.00% ‐ 1.25% ‐ 1.50% ‐ 1.75% ‐ 3% ‐ 2.00% ‐ 2.00% ‐ 1.00% ‐ 4% ‐ 2.00% ‐ 5% ‐ 3.00% ‐ 3.00% ‐ 3.00% ‐ 3.00% ‐ 6% ‐ 7% ‐ 1.00% ‐ 1.00% ‐ 1.00% ‐ 1.00% ‐ 8% ‐ 9% 2011 2012 2013 2014 2015 2016 2017 2018 IQR VBP Readmission Reduction HACS National health expenditures=$3.4 Trillion ‐ in hospitals=$1.1 Trillion (2016)

Readmissions 12.0 Florida HEN 2.0 Baseline: 10.0 (74 hospitals) Florida HEN 2.0 Apr ‐ June 2016: 9.5 (73 hospitals) 10.0 8.0 Rate per 100 6.0 4.0 2.0 0.0 Baseline Oct ‐ 16 Nov ‐ 16 Dec ‐ 16 FL Rate 10.8 10.1 10.3 8.4 HRET HIIN Rate 9.0 8.4 8.6 7.4 # FL Reporting 76 56 46 22 #HRET HIIN Reporting 1,274 591 551 439 Source: HRET Comprehensive Data System, February 21, 2017

Readmissions ‐ Medicare 15.0 12.0 Rate per 100 9.0 6.0 3.0 0.0 Baseline Oct ‐ 16 Nov ‐ 16 Dec ‐ 16 FL Rate 13.7 12.5 12.4 7.6 HRET HIIN Rate 11.9 10.5 10.8 9.0 # FL Reporting 40 40 36 20 #HRET HIIN Reporting 838 447 423 350 Source: HRET Comprehensive Data System, February 21, 2017

ADEs ‐ opioids 0.8 Florida HEN 2.0 Baseline: 0.6 (54 hospitals) 0.6 Rate per 100 0.4 Florida HEN 2.0 Apr ‐ June 2016: 0.4 (54 hospitals) 0.2 0.0 Baseline Oct ‐ 16 Nov ‐ 16 Dec ‐ 16 FL Rate 0.6 0.5 0.5 0.4 HRET HIIN Rate 0.5 0.4 0.4 0.4 # FL Reporting 57 46 45 37 #HRET HIIN Reporting 1,040 627 608 555 Source: HRET Comprehensive Data System, February 21, 2017

ADEs ‐ hypoglycemia 8.0 Florida HEN 2.0 Baseline: 7.5 (53 hospitals) 7.0 Florida HEN 2.0 Apr ‐ June 2016: 5.7 (54 hospitals) 6.0 Rate per 100 5.0 4.0 3.0 2.0 1.0 0.0 Baseline Oct ‐ 16 Nov ‐ 16 Dec ‐ 16 FL Rate 6.8 3.6 3.5 3.0 HRET HIIN Rate 3.9 4.3 4.5 4.5 # FL Reporting 48 35 31 31 #HRET HIIN Reporting 1,010 626 605 567 Source: HRET Comprehensive Data System, February 21, 2017

ADEs ‐ excessive anticoagulation 4.0 Florida HEN 2.0 Baseline: 3.4 (48 hospitals) 3.5 3.0 Rate per 100 2.5 2.0 1.5 Florida HEN 2.0 Apr ‐ June 2016: 1.8 (59 hospitals) 1.0 0.5 0.0 Baseline Oct ‐ 16 Nov ‐ 16 Dec ‐ 16 FL Rate 2.5 2.0 2.3 2.2 HRET HIIN Rate 3.4 3.3 3.1 3.1 # FL Reporting 52 46 45 43 #HRET HIIN Reporting 1,066 659 636 590 Source: HRET Comprehensive Data System, February 21, 2017

Reducing Adverse Drug Events Edna Clifton Associate Director Care Coordination Health Services Advisory Group (HSAG) March 7, 2017

Overview HSAG is contracted by the Centers for Medicare & Medicaid Services (CMS) to work with healthcare providers to: • Improve coordination of care • Reduce hospital readmissions • Improve medication safety by reducing adverse drug events (ADEs) for patients in the community 17

Readmissions and Medication Safety HSAG works with hospitals to reduce ADEs. • ADEs contribute to readmissions and are the leading cause of preventable patient harm. 1 • The Department of Health and Human Services (HHS) identified the following medication classes as high priority medication targets for the National Action Plan for Adverse Drug Event Prevention 2 (common, preventable, and measurable ADEs): – Anticoagulants – Diabetic agents – Opioids 1. Gurwitz JH, Field TS, Harrold LR, et al. Incidence and preventability of adverse drug events among older persons in the ambulatory setting. JAMA. 2003;289(9):1107–16. 18 2. U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. (2014). National Action Plan for Adverse Drug Event Prevention. Washington, DC: Author.

ADEs Contribute to Increased Costs and Negatively Impact Patient Care ADEs Add an additional $3.5 billion in healthcare costs; of this, up to $3.5 $5.6 million per U.S. hospital. 3 BILLION Prolong hospital stays by 1.7 to 4.6 days. 2 Account for 1/3 of adverse events encountered in hospitals. 4 2. U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. (2014). National Action Plan for Adverse Drug Event Prevention. Washington, DC: Author. 3. Institute of Medicine. Committee on Identifying and Preventing Medication Errors. Preventing Medication Errors, Washington, DC: The National Academies Press 2006. 19 4. U.S. Department of Health and Human Services Office of Inspector General (OIG). Adverse Events in Hospitals: National Incidence Among Medicare Beneficiaries. Washington, DC. 2010 November. Report No.: OEI-06-09-00090.

Emergency Department (ED) Visits for ADEs 17.6% of the visits, with Associated with anticoagulants 48.8% of cases resulting in hospitalization. 5 13.3% of the visits, with Associated with diabetic agents 38.5% resulting in hospitalization. 5 6.8% of the visits, with Associated with opioids 24.6% resulting in hospitalization. 5 5. Shehab N, Lovegrove MC, Geller AI, Rose KO, Weidle NJ, Budnitz DS. US Emergency Department Visits for Outpatient Adverse Drug Events, 2013-2014. JAMA. 20 2016;316(20):2115-2125. doi: 10.1001/jama.2016.16201.

Engaging With Hospitals to Create and Implement ADE Interventions • Data reveal that many facilities rank above the state average for high ‐ risk readmission rates related to one or more of the three high ‐ risk medication (HRM) classes: anticoagulants diabetic agents opioids • A hospital’s ADE rate is measured by counting the number of hospital admissions and ED visits related to an ADE from one of the three HRMs. 21

Florida Medicare Readmissions Within 30 Days Calendar Year 2015 16,246 148,154 54,512 7 ‐ Day Readmissions Readmissions Readmissions Within 30 Days Within 7 Days Were on HRMs 22

Florida Medicare Readmissions Within 30 Days—2015 (cont.) Of the 54,512 readmissions within 7 days, 16,246 (29.8%) readmissions were for beneficiaries who were on HRMs. That is almost 3 out of every 10 readmissions! 23