An Initiative of the Florida Hospital Association Hospital Improvement Innovation Network Pharmacy Roundtable: Reducing ADE, C. diff and Readmissions July 2017
Pharmacy Roundtable – Office Hour- Interactive Agenda Hosted by Mission To Care (MTC) FHA (Hospital Improvement Innovation Network) Facilitated by: Phyllis Byles-FHA Quality Improvement Advisor Scott King-PharmD-Orlando Health Dr. P. Phillips Hospital
Agenda • History of Partnership for Patients (PfP)/pharmacy roundtable • Successes-quality and financial • Status of work for HIIN • Dialogue or Next Steps-how do we move forward? • What can MTC do for you? • Survey
History for PfP • Provided by the legislation in ACA • Intent to reduce harm and cost in healthcare • Pharmacists were identified as key partners • Pharmacy roundtable initiated in 2013 • MTC advocates for all providers and needs pharmacists involved in key core measures • Supports peer learning and small tests of change
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) “America’s hospitals embrace the ambitious new goals CMS has proposed,” said Rick Pollack, president and CEO of the American Hospital Association (AHA). “The vast majority of the nation’s 5,000 hospitals were involved in the successful pursuit of the initial Partnership for Patients aims. Our goal is to get to zero incidents . AHA and our members intend to keep an unrelenting focus on providing better, safer care to our patients -- working in close partnership with the federal government and with each other.” AS WE MOVE FORWARD-- LET’S FOCUS ON WHAT’S GOING WELL FOR US!!!!!! partnershipforpatients.cms.gov
ADEs – Excessive Anticoagulation 4.50 4.00 3.50 3.00 Rate per 100 2.50 2.00 1.50 1.00 0.50 0.00 BL 10/16 11/16 12/16 01/17 02/17 03/17 04/17 FL Rate 3.72 2.40 2.07 3.08 2.71 2.80 2.69 2.31 HRET HIIN Rate 3.67 4.27 4.07 4.42 4.22 3.51 2.81 2.84 # FL Reporting 67 73 72 73 73 73 72 59 #HRET HIIN Reporting 1,148 1,214 1,218 1,215 1,238 1,235 1,165 971 Source: Comprehensive Data System, July 6, 2017
ADEs – Hypoglycemia 7.00 6.00 5.00 Rate per 100 4.00 3.00 2.00 1.00 0.00 BL 10/16 11/16 12/16 01/17 02/17 03/17 04/17 FL Rate 5.25 2.88 2.82 3.01 2.69 2.79 3.27 2.84 HRET HIIN Rate 4.07 3.73 3.70 3.59 3.84 4.05 4.25 4.07 # FL Reporting 60 63 62 63 62 62 60 52 #HRET HIIN Reporting 1,090 1,150 1,155 1,152 1,174 1,166 1,108 937 Source: Comprehensive Data System, July 6, 2017
ADEs – Opioids 0.80 0.60 Rate per 100 0.40 0.20 0.00 BL 10/16 11/16 12/16 01/17 02/17 03/17 04/17 FL Rate 0.52 0.45 0.48 0.46 0.45 0.45 0.48 0.47 HRET HIIN Rate 0.48 0.45 0.46 0.48 0.49 0.52 0.52 0.54 # FL Reporting 66 71 70 71 68 66 63 55 #HRET HIIN Reporting 1,124 1,168 1,173 1,168 1,187 1,178 1,113 949 Source: Comprehensive Data System, July 6, 2017
C. Difficile 8.00 7.00 6.00 Rate per 10,000 5.00 4.00 3.00 2.00 1.00 0.00 BL 10/16 11/16 12/16 01/17 02/17 03/17 04/17 FL Rate 6.95 5.05 5.43 5.15 5.03 5.05 4.67 4.32 HRET HIIN Rate 6.14 6.12 6.12 5.78 6.05 5.47 5.26 4.91 # FL Reporting 90 90 90 90 89 89 87 76 #HRET HIIN Reporting 1,506 1,552 1,551 1,554 1,530 1,525 1,471 1,186 Source: Comprehensive Data System, July 6, 2017
Falls 1.50 1.25 Rate per 1,000 1.00 0.75 0.50 0.25 0.00 BL 10/16 11/16 12/16 01/17 02/17 03/17 04/17 FL Rate 0.56 0.55 0.62 0.59 0.57 0.59 0.57 0.52 HRET HIIN Rate 0.66 0.75 0.75 0.81 0.83 0.84 0.84 1.00 # FL Reporting 87 83 84 84 85 84 83 70 #HRET HIIN Reporting 1,435 1,462 1,461 1,458 1,451 1,430 1,339 1,019 Source: Comprehensive Data System, July 6, 2017
Readmissions – 30 Days, All Cause 14.0 12.0 10.0 Rate per 100 8.0 6.0 4.0 2.0 0.0 BL 10/16 11/16 12/16 01/17 02/17 03/17 FL Rate 10.67 9.97 10.01 9.61 9.83 9.72 9.40 HRET HIIN Rate 8.77 7.70 7.74 7.61 8.44 8.13 8.05 # FL Reporting 86 82 82 82 83 83 81 #HRET HIIN Reporting 1,412 1,433 1,433 1,439 1,367 1,230 1,002 Source: Comprehensive Data System, July 6, 2017
Readmissions – Medicare, All Cause 16.0 14.0 12.0 Rate per 100 10.0 8.0 6.0 4.0 2.0 0.0 BL 10/16 11/16 12/16 01/17 02/17 03/17 FL Rate 13.43 12.33 12.33 11.35 12.09 12.00 11.60 HRET HIIN Rate 11.74 9.98 10.06 9.81 10.67 10.65 10.59 # FL Reporting 57 68 68 70 69 68 65 #HRET HIIN Reporting 1,054 1,267 1,265 1,276 1,199 1,064 852 Source: Comprehensive Data System, July 6, 2017
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 High Risk Medications (HRMs). That is almost 3 out of every 10 readmissions! 14
30-Day Readmissions Among Medicare FFS Beneficiaries on HRMs in Florida — 2015 30-Day All-Cause 19.6% Readmission Rate 30-Day HRM 23.7% Readmission Rate • Readmissions among beneficiaries on HRMs are much more frequent than the general population, suggesting ample opportunity for improvement. • Percent of 30-day readmits with an anticoagulant or diabetes agent ADE are much higher than the percent of readmits with an opioid ADE. 15
16 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 total $3.4 Trillion-in hospital care=$1.1 Trillion (2016)
2017 Legislative Session • Florida Medicaid hospital funding was reduced by $200 million in general revenue, which equals $521 million with the federal share. The reduction includes: – A $108.4 million reduction to the diagnosis related group (DRG) base rate. This 5-percent reduction is less than the 7-percent rate cut initially proposed. – A $412.6 million reduction in hospital rate enhancements, also known as “add - on” payments. This is less than the $499.5 million reduction initially proposed.
New Legislation Impacting Hospitals and Pharmacists • In 2017 legislation passed requiring hospital emergency departments to develop best practices around drug overdose prevention • FHA is working with FCEP to draft guidelines and documents that will meet the intent of the legislation • There is concern on the part of ED providers to support appropriate/adequate medical management treatment resources • Opioid management and drug addictions are primary issues and have wide ranging impact in our Florida communities • This is a place where the HIIN pharmacists can have a significant role and contribution!
Topics and Questions for participants: A. Is opioid safety a concern in your community? Do you have a best practice/policy in place for patients with addictions seen in your ED? B. What is your hand hygiene policy? Is it effective? C. Is data collection for hypoglycemia accurate? D. How is D/C med rec done in your facility? E. Is your hospital model of care inclusive of pharmacists? F. Are there barriers that MTC can help resolve? G. What can MTC offer to you specifically for your hospital needs?
More Discussion……. 1. Does your organization support/perform pharmacist-led med rec and med therapy review? 2. Do you have bedside delivery of meds prior to discharge? 3. Do you have pharmacist-led discharge med counseling? 4. Describe your hospital post-discharge follow up 5. Describe your medication therapy management model 6. How do you accomplish a comprehensive medication history? 7. Of utmost interest to MTC — how are transfers to ALF, SNFs different than discharges home? What is the pharmacist role?
Let’s Prioritize Next Steps • Results from chat box • MTC needs your help with guidelines for the ED best practices for overdose legislation • MTC wants to improve transfer documentation and communication. Who can help us?
Next Pharmacy Roundtable-August 9 th -1100 • Memorial Hospital Pembroke - Jon Carlo C. Francisco, Pharm.D., BCPS, Clinical Specialist – Infectious Disease, Antimicrobial Stewardship Pharmacist • Please plan to join us for this very interesting presentation
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