janna barnes, msn manager of healthcare initiatives foundations case study session janna barnes, msn...

Foundations Case Study Session

Janna Barnes, MSNManager of Healthcare Initiatives

This presentation was presented at the Thoratec Corporation Economic Summit held September 30-October 2, 2015. Please note that this presentation represents the ideas and opinions of the presenters, who are solely responsible for such content, and notnecessarily those of Thoratec Corporation. ©2015 Thoratec Corporation. All rights reserved. US-HM2-11150393

Foundations For Success

Program Quality

FinancialViability OutcomesResources

& Growth

A Program to assist in establishing VAD Program Value

This reimbursement information is being provided to help the healthcare professional understand and comply with billing andreimbursement requirements that may apply to products. Use ofcodes identified here does not guarantee coverage or payment atany specific level. Reimbursement policies vary widely from insurerto insurer and will reflect different patient conditions. You shouldcheck the insurer’s policies to confirm coding or billing requirements.The health care professional is responsible for completing claimsforms using codes that accurately reflect the patient’s condition,procedures performed, and products used.

Case Study Agenda• Opening 15 min• Review of Foundations Tool 20 min• Case Study 1

– 10 min Present case study demographic and detail– 15 min analyze in small groups– 10 min discussion with main group– 10 min review top ideas and slides

• Case Study 2: – 10 min present case study demographic and detail– 15 min analyze in small groups– 10 min discussion with main group– 10 min review top ideas and slides

• Closing & Break Details 10 min

Foundations for MCS Program Success

• Created out of a need for a national process improvement plan for MCS programs

• Actual options for collection derived from center suggestions, available benchmarks, and expert best practices

• Constructed of 4 pillars– Program Quality– Financial Viability– Resources and Growth– Outcomes

Program Quality Pillar Reviews programmatic logistics and overall function• Program Utilization of Facility Resources• Program Opportunities• Certification Requirements

Sources:• Best practices and VAD Community Consensus• INTERMACS data & Published Materials• The Joint Commission & Centers for Medicare and

Medicaid Services (CMS)

Financial PillarDetails key metrics for a financially viable program• Proper Billing Practices• Coding Accuracy• Reimbursement Best Practices

Sources:• Over 4,000 bill reviews with over 1,700 payment histories• The Advisory Board• Becker’s Healthcare • Centers for Medicare and Medicaid Services (CMS)• American Medical Association (AMA)

Resources & Growth Pillar

Reviews the best utilization of existing resources, discovering new resources, and templates on how to grow a program

Sources:• Data derived from community Cardiology Survey

– 109 community cardiology providers (MDs and NP/PAs)

• Results available as a roadmap for improvement

Outcomes PillarTool to assess a programs adverse event profile compared to data benchmarks• 3 options for the Outcomes Pillar

– INTERMACS Data– DT Trial Data– BTT Trial Data

• Sources– INTERMACS Data pathway is based off of specifically all HMII

data from all programs submitting 10 or more HMII pumps into the registry for the entire duration of INTERMACS

– DT Trial data source: Park, Milano, Tatooles, et al. Circulation Heart Failure. 2012; 5:241-248.

– BTT Trial data source: John R, et al. Ann Thorac Surg. 2011; 92: 1406–13.

Accessing the Foundations Calculatorwww.thoratec.com/medicalprofessionals/reimbursement

Foundations Landing Page

Outcomes Pillar Options

Percentages vs EPPY

Entering Data

Accessing the Benchmark

Finished Scorecard Example

Listing – what do the colors mean?

• Gold - top 20%• Green – top 50%• Yellow – 40-50%• Red – below 40%• Gold star listing is accomplished by:

– Notifying your Thoratec Field and REHI team– Send the following information to the Thoratec team

• Contact person• Center name• Method of contacting (phone, email….)

• Listing will be good for two years

Utilizing the Process Improvement Plan

• Within the Calculator:– Collection spreadsheets– Definitions guideline– Benchmark & Resources pdf

• Center determines how they want to collect and assign collection tasks

• Data collected and entered into online program• Save PDF file of results• Presents at team meeting and develops action plans as

process improvement• Re-collect data and input into calculator

– Compare to prior report card to assess if action plan was a success

Recap of Foundations 4.0

• Framework for program analysis• Method of testing action items• Creates accountability• Benchmarks are updated twice a year• Tool is updated annually• If only doing one pillar, consider completing other

data topics and start process again• Coordinate with the Thoratec team for additional

resources

Getting Registered

Case Studies

• Use printed Dashboard Scorecards and Account Demographics

• 20 minutes to discuss within small groups• Assess and Cross compare across all 4 PillarsGoals:• Top 2 concerns from the scorecard data• Top 2 action items you would take based on your

assessment• Share top takeaways with the larger group

Case Study #1 Detail

• Large urban academic/transplant hospital• Get the “sickest of the sick”• Implant approximately 50 durable devices/year• Administration and executive team supports the

VAD program• Unsure if they are financially viable….they think so• Surgically run program• 2 VAD Coordinators, 1 data analyst, biomed

involvement (inpatient only)• Center feels outcomes are “pretty good

Program Quality Scorecard

Financial Scorecard

Discussion in Small Groups

• Work in Small groups to analyze the 4 Pillars in front of you

• What stood out from each Pillar?• What were the top 3 concerns you see from the 4

completed Pillars?

Program Quality Pillar Key Findings

Quality Pillar Key Findings

• Total LOS at 35 days• VAD 30 day readmission rate all cause = 35 days• VAD 30 day readmission rate after HF admission = 32

• What do you think about this?

Financial Pillar key findings

Financial Pillar Key Findings

• Minimal private pay and supplemental insurance• VAD accessories and supplies capture• % over cost charges• Lower professional fees for commercial payers

• Significant Concerns?

Resources and Growth Key Findings

• No outreach• Minimal to no communication with referrers

– Pre implant– Post implant

• No shared care or community provider education• No patient take backs• Referrers not sending less sick patients

• How could this affect the other Pillars of the Program?

Outcome Pillar Key Findings

• High rates for:– Returning to OR for bleeding– RV Failure– 30 day mortality

• Higher post-op LOS• Functional Capacity via 6 minute walk not as high as

published literature

• Why?

Case Study 1 Assessment

1. What stood out from the 4 Pillars?

2. Anything surprising?

3. What were the top 2 concerns you saw from the 4 completed scorecards?

What top 2 concerns did you see?

1. Poor referral quality1. Sicker patients being implanted2. IM 1-2

2. Reduced Outcomes1. LOS2. Readmissions3. Bleeding

What top 2 actions would you take based on what you see?

1. Increase referral and community activities to improve quality of referrals1. Thoratec MDM resources

2. Implement an action plan to reduce LOS1. Thoratec territory and clinical resources2. Compare pre-op LOS to post-op LOS

3. Action Plan to reduce bleeding and RV failure1. Could correlate to late referrals & inability to optimize prior to

implantation4. Action Plan to reduce readmissions5. Continue to assess financial viability

1. Implement chiefs report to highlight positive financial gain to executive level

Case Studies Goals – Case Study 2

• Use printed Dashboard Scorecards and Account Demographics

• 20 minutes to discuss within small groups• Assess and Cross compare across all 4 PillarsGoals:• Top 3 concerns from the scorecard data• Top 2 action items you would take based on your

assessment• Share top takeaways with the larger group

Case Study #2 Detail

• Medium Transplant/MCS program in smaller urban area

• Involved HF Clinic• Good partnership between CVS & HFC• Implant approximately 25-30 durable devices/year• Executive team somewhat aware of VAD program• VAD team is told they “are always in the red”• 2 VAD Coordinators who are responsible for all MCS

activities

Program Quality Scorecard

Financial Scorecard

Resources and Growth Scorecard

Outcomes Scorecard

Discussion in Small Groups

• Work in Small groups to analyze the 4 Pillars in front of you

• What stood out from each Pillar?• What were the top 3 concerns you see from the 4

completed Pillars?

• Readmission rates higher than expected• VAD Coordinator completing all tasks, ie: INTERMACS

data entry and equipment tracking• Timeliness of data entry • LOS was good!

• Overall, minimal financial oversight• Not reviewing clinical documentation• No bill review process• Coding accuracy and charges captured are poor• % over cost and contribution margin is low• Professional fees and VAD interrogation not being

captured or billed• Low % of private pay

Resources and Growth Pillar Key Findings

• Timeframes for notification of community referrers is high

• Patients not being taken back to their referrers • No shared care opportunities

Outcomes Pillar Key Findings

• Gold star in many areas• If you had only completed this pillar, instead of all 4,

would you be concerned for this program?

Case Study 2 Assessment

1. What stood out from the 4 Pillars?

2. Anything surprising?

3. What were the top 2 concerns you saw from the 4 completed scorecards?

What top 2 concerns did you see?

1. Financial Pillar 1. No review of billing or clinical documentation2. Poor to no capture of charges, accuracy or professional

fees3. Low private pay and commercial fees4. Program may be in financial trouble limiting resources

available2. Resources Growth

1. Delayed timing to communicate with community referrers2. No shared care

3. Minimal resources for program1. VC completing all tasks and data entry delayed

What top 2 actions would you take based on what you see?

1. Immediately address Financial Viability 1. Bill review to assess state of financials2. Implement charge capture and claim reviews3. If program can show financial viability, could potentially

fun resources for other needs (more FTEs, fund community activities, etc)

2. Despite poor financial viability, Outcomes are exceptional. 1. Assure financial are in order to continue to provide high

level care to population in need

Closing

• Where do you see yourself using this information at your center?

– Chiefs report?– Admin/Quality meetings?

• What 2 steps will you take at your center based on this information?

• Thank you!

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