HOME I S T HE HUB An I nitia tive to Ac c e le ra te Pro g - PowerPoint PPT Presentation

HOME I S T HE HUB An I nitia tive to Ac c e le ra te Pro g re ss to Re duc e Re a dmissio ns in Virg inia

HOUSE K E E PI NG • Slide s we re se nt this mo rning • We b ina r is b e ing re c o rde d • Ple a se use the “te le pho ne ” o ptio n • Audio pin pro mpt • All pa rtic ipa nts a re mute d • Ra ise yo ur ha nd • Ask a q ue stio n • Wa rm up

WE L COME AND OVE RVI E W Abraham Segres VHHA Vic e Pre side nt, Qua lity & Pa tie nt Sa fe ty a se g re s@ vhha .c o m (804) 965-1214

VI RGI NI A HOSPI T AL & HE AL T HCARE ASSOCI AT I ON An a sso c ia tio n o f 30 me mb e r he a lth syste ms re pre se nting 107 c o mmunity, psyc hia tric , re ha b ilita tio n a nd spe c ia lty ho spita ls thro ug ho ut Virg inia . Visio n T hro ug h the po we r o f c o lla b o ra tio n, the a sso c ia tio n will b e the re c o g nize d driving fo rc e b e hind ma king Virg inia the he a lthie st sta te in the na tio n b y 2020. Missio n Wo rking with o ur me mb e rs a nd o the r sta ke ho lde rs, the a sso c ia tio n will tra nsfo rm Virg inia ’ s he a lth c a re syste m to a c hie ve to p-tie r pe rfo rma nc e in sa fe ty, q ua lity, va lue , se rvic e a nd po pula tio n he a lth. T he a sso c ia tio n’ s le a de rship is fo c use d o n: princ iple d, inno va tive a nd e ffe c tive a dvo c a c y; pro mo ting initia tive s tha t impro ve he a lth c a re sa fe ty, q ua lity, va lue a nd se rvic e ; a nd a lig ning fo rc e s a mo ng he a lth c a re a nd b usine ss e ntitie s to a dva nc e he a lth a nd e c o no mic o ppo rtunity fo r a ll Virg inia ns.

VHHA 2015-2020 I MPROVE ME NT PRI ORI T I E S 1. Ho spita l re a dmissio ns 1a . Ho spita l-wide 1b . Po st-a c ute tra nsfe rs 1c . T o ta l hip/ T o ta l kne e Re pla c e me nt 30-da y re a dmissio ns 2. Clo stridium diffic ile – He a lthc a re -a c q uire d I nfe c tio ns 3. Pa tie nt E xpe rie nc e – HCAHPS 4. Se rio us Sa fe ty E ve nts

SCHE DUL E OF E VE NT S June 16 - Ove rvie w of Virg inia Sta te wide Re a dmission Re duc tion Hig h L e ve ra g e Stra te g ie s Aug ust 16 - Da ta & Ana lytic s to Support Re a dmissions Re duc tion E fforts Se pte mbe r 8 - Post- Ac ute Re a dmissions Re duc tion Stra te g ie s Oc tobe r 19 - Hig h- Utilize r Re a dmissions Re duc tion Stra te g ie s Nove mbe r T BD- In- Pe rson Workshop with Dr. Boutwe ll * All we binar s be gin at 10am

DAT A AND ANAL YT I CS T O SUPPORT RE DUCI NG AL L PAYE R RE ADMI SSI ONS Amy Boutwell, MD, MPP Collaborative Healthcare Strategies Pre side nt a my@ c o lla b o ra tive he a lthc a re stra te g ie s.c o m (617) 710-5785

AGE NDA 1. De sc rib e the hig h-le ve ra g e ta rg e t po pula tio ns 2. Disc uss me a sure me nt spe c ific a tio ns fo r the ta rg e t po pula tio ns 3. Pre se nt a na lyse s o f VA da ta fo r the ta rg e t po pula tio ns 4. L e a rn a b o ut VHHA a na lytic s suppo rt se rvic e s

OBJE CT I VE S • He lp re a dmissio n re duc tio n te a ms kno w ho w to de fine the “hig h le ve ra g e ” re a dmissio n re duc tio n ta rg e t po pula tio ns: • All pa ye r • Po st-a c ute c a re • Hig h utilize r • E nc o ura g e re a dmissio n re duc tio n te a ms to e xa mine the ir o wn da ta • Ca lc ula te the g o a l: ho w ma ny is a 20% re duc tio n in re a dmissio ns • Wha t’ is the impa c t o f re duc ing re a dmissio ns fo r hig h-le ve ra g e g ro ups?

NOT E S • T he se de finitio ns a re re c o mme nda tio ns • Re fle c t fe asible me a sure s fo r ho spita l te a ms • Re fle c t ge ne r al alignme nt with VHHA (a ll pa ye r), VHQC (Me dic a re ) me tho ds • Ho spita l te a ms ma y ha ve pre fe re nc e s fo r o the r c o nve ntio ns, whic h is fine • Our o b je c tive s a re to e nsure yo u ha ve the da ta yo u ne e d to suppo rt yo ur e ffo rts to re duc e ho spita l-wide re a dmissio ns b y 20% b y 2020 • T he se de finitio ns suppo rt q ua lity impro ve me nt • T he y a re no t inte nde d to re plic a te me tho ds use d b y “pe na lty” pro g ra ms • T he mo st impo rta nt thing is to pic k a de finitio n, unde rsta nd it, a nd tre nd o ve r time to de mo nstra te impa c t o f yo ur e ffo rts

DAT A-I NF ORME D ST RAT E GI C F OCUS ARE AS E xpanding o ur fo c us to re duc e re admissio ns b y 20% b y 2020

RE ADMI SSI ONS I N VI RGI NI A • Virg inia ra nke d # 46 in US fo r a ve ra g e re a dmissio n pe na ltie s in 2015 • F Y 2016, the re we re $21M in re a dmissio ns pe na ltie s sta te -wide • E xpa nsio n o f pe na lty c o nditio ns to COPD, T HR/ T K R sub sta ntia lly inc re a se d impa c t o f pe na ltie s fo r VA ho spita ls • $11M o f the $21M in pe na ltie s we re due to T HR/ T K R • VA ra nke d # 49 fo r T HR/ T K R re a dmissio n ra te s

GOAL I n re spo nse to the se re a dmissio n sta tistic s, the VHHA Bo a rd ha s se t a g o a l: Re duc e all-paye r r e admissio ns by 20% by 2020 K e y e le me nts o f this g o a l: • All-paye r : pre pa ring ho spita ls b y lo o king fo rwa rd to the future ma rke t re a litie s • All-c ondition: fo rwa rd-lo o king to risk-b a se d c o ntra c ting a nd a lte rna tive pa yme nts • De dic ate d fo c us ar e as : T HR/ T K R, po st-a c ute , a nd ho spita l-wide re a dmissio ns

AL L CAUSE RE ADMI SSI ONS T op 10 diagnose s only   ac c ount for ~25% of all r e admissions… …   missing 75% of oppor tunity by c ase finding for  diagnose s So urc e : VA Me dic a re F F S da ta , c o urte sy o f VHQC

RE ADMI SSI ONS BY DI SCHARGE DI SPOSI T I ON Medicare FFS Readmission Rates, by Discharge Setting: Home, SNF, HH 22 20% PAC 20 18 Axis Title 15% HOME 16 14 12 10 Q1 Q2 Q3 Q4 Home 16.4 16.4 15.5 15.8 HHA 20.2 20 21.3 20.6 SNF 19.9 20.6 20.1 20 State Avg 18.6 18.5 18.7 18.6 So urc e : VA Me dic a re F F S da ta , c o urte sy o f VHQC

Re admission r ate HU: 36% Re admission r ate non- HU: 8% So urc e : 2016 MA All Pa ye r Sta te -wide Re a dmissio n Ana lysis HU Re a dmissio n Ra te = 40% No n-HU Re a dmissio n Ra te = 8%

HOW DO WE DE F I NE AND ME ASURE

15-pa rt a ll pa ye r a nd pa ye r-spe c ific re a dmissio n a na lysis. F o r mo re info rma tio n se e AHRQ Ho spital Guide to Re duc ing Me dic aid Re admissio ns (Da ta a na lysis to o l in Ve rsio n 2 to b e re le a se d Se pte mb e r 9 2016)

DE F I NI T I ON: AL L CAUSE AL L PAYE R RE ADMI SSI ONS • All c a use , a ll pa ye r re a dmissio ns • Adult 18+ • T o da te , the fo c us ha s b e e n o n re duc ing a dult re a dmissio ns • Pe dia tric re a dmissio n ra te s a re lo w a nd dilute a n “a dult me d/ surg ” re a dmissio n ra te • Childre n’ s ho spita ls wo uld o f c o urse no t use this de finitio n • No n-o b ste tric (e xc lude c hildb irth re la te d DRGs) • Co nsiste nt with the Ya le / CMS “ho spita l wide re a dmissio n” me a sure • Vo lume is so hig h a nd re a dmissio ns so lo w, inc luding OB disto rts the me a sure • E xc lusio ns: disc ha rg e s de c e a se d, tra nsfe rs to a c ute inpa tie nt, a c ute re ha b • Mig ht a lso e xc lude disc ha rg e s AMA (~1% disc ha rg e s)

DE F I NI T I ON: AL L CAUSE AL L PAYE R RE ADMI SSI ONS • “All pa ye r” • All pa ye rs • Also e xa mine “pa ye r spe c ific ” • “Me dic a re ” • “Me dic a id” • “Co mme rc ia l” • “Othe r”

DE F I NI T I ON: AL L CAUSE AL L PAYE R RE ADMI SSI ONS • Re a dmissio n • Admissio n fo r a ny re a so n fo llo wing inpa tie nt disc ha rg e within 30 da ys • E ve ry disc ha rg e c a n b e fo llo we d b y a re a dmissio n • A pa tie nt c a n b e re a dmitte d mo re tha n o nc e in a mo nth • De no mina to r • All disc ha rg e s in the c a le nda r mo nth (le ss e xc lusio ns) • Nume ra to r • All a dmissio ns tha t o c c urre d within 30 da ys o f a disc ha rg e in the de no mina to r • No t limite d to a c a le nda r mo nth

DE F I NI T I ON: RE ADMI SSI ONS BY DI SCHARGE DI SPOSI T I ON • Disc ha rg e dispo sitio n • T ypic a lly ho spita ls c a n’ t me a sure re a dmissio ns fro m po st a c ute c a re • But we c a n me a sure re a dmissio ns fo llo wing a disc harg e to po st a c ute c a re • T he pa tie nt may o r may no t ha ve b e e n re c e iving po st a c ute c a re whe n the y we re re a dmitte d (ma y ha ve re fuse d ho me he a lth, o r le ft the SNF ) • Re a dmissio n ra te fo r this sub g ro up is ~20% • De no mina to r • Disc ha rg e s to skille d nursing , ho me he a lth, o the rs a s de sire d (e g ho spic e , L T AC) • Nume ra to r • Admissio n tha t o c c urre d with 30 da ys o f a disc ha rg e to skille d nursing , ho me he a lth

VA ST AT E -WI DE AL L PAYE R DI SCHARGE DI SPOSI T I ON, 2015 Disc har ge Disposition Numbe r of Disc har ge s % of Disc har ge s Ho me 264, 289 57% Ho me He a lth 99.135 22% Skille d Nursing F a c ility 76,137 17% Othe r 20,105 4% So urc e : VHHA a na lysis