breakout session the journey to episodic care · 2017. 4. 21. · the journey to episodic care...

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B R E A K O U T S E S S I O N

The Journey to Episodic Care

Director of Quality Improvement Rothman Institute

Chris Vannello

PRESENTED BY


Rothman Institute Overview Founded 1970: Richard H. Rothman, MD, PhD Current Chairman/President: Alexander R. Vaccaro, MD, PhD Private Practice: Sub Chapter S Academic/Teaching Affiliation:

Sidney Kimmel Medical College at Thomas Jefferson University

Thomas Jefferson University Hospital

Coverage Area: Philadelphia/Delaware Valley & South Jersey

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Rothman Institute overview

Ancillary Services

Sports Team Coverage Services

4 Pro Teams 6 Colleges

43 High Schools

•  Joints •  Spine •  Shoulder •  Foot & Ankle •  Hand •  Sports Medicine •  Ortho-Oncology •  Trauma •  Pain Management

60 Researchers and Staff

Providers

Clinical Research

Department

150 Physicians 50 PA’s & NP’s

X-Ray, MRI, PT/OT, Orthotics,

Nutrition


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In the beginning…


Quality Performance Reporting

(QPR)

Quality Assessment and Implementation

(QAI)

Partnership: 2009 to present


Documentation and Coding

Adherence to Pathway/Best Practice

PAT vs. Patient Optimization

Key areas impacting complications & other process measures


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Actual vs. Predicted Complication Trends & Comparison - Annual Total Knee Replacement - University Hospital

2014 Q1 - 2016 Q4 Client – All Payer

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4.91%

5.49%

2.93%

5.19% 5.59%

6.66%

2.54%

5.73%

0.00%

1.00%

2.00%

3.00%

4.00%

5.00%

6.00%

7.00%

Q1 '14 - Q4 '14 Q1 '15 - Q4 '15 Q1 '16 - Q4 '16

Actual Predicted

0.95 0.98

0.44 0.44

0.00

0.20

0.40

0.60

0.80

1.00

1.20

Q1 '14 - Q4 '14 Q1 '15 - Q4 '15 Q1 '16 - Q4 '16

A/P A/P Top Perf

Year Volume Complications Q1 '14 - Q4 '14 489 24 Q1 '15 - Q4 '15 546 30 Q1 '16 - Q4 '16 581 17


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Actual vs. Predicted Complication Trends & Comparison - Annual Total Hip Replacement - University Hospital

2014 Q1 - 2016 Q4 Client – All Payer

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Year Volume Complications Q1 '14 - Q4 '14 167 9 Q1 '15 - Q4 '15 210 5 Q1 '16 - Q4 '16 270 3

5.39%

2.38%

1.11%

3.49%

4.13%

6.87%

1.90%

4.35%

0.00%

1.00%

2.00%

3.00%

4.00%

5.00%

6.00%

7.00%

8.00%

Q1 '14 - Q4 '14 Q1 '15 - Q4 '15 Q1 '16 - Q4 '16

Actual Predicted

1.54

0.58

0.16

0.44

0.00

0.20

0.40

0.60

0.80

1.00

1.20

1.40

1.60

1.80

Q1 '14 - Q4 '14 Q1 '15 - Q4 '15 Q1 '16 - Q4 '16

A/P A/P Top Perf


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Data, data, data Navigating the episode of care

Patient Outcomes Cost of Care Clinical Metrics


Per Diem/Case Rate Volume Based Fee for Service

Current payment structure


Higher Patient Responsibility

Plans

New Products Value-Based

Narrow Network, Tiered Plans,

Exchange Plans Quality, Service

& Cost

Bundled & Global Payment, Shared

Savings Plans

Incentives and Penalties

Bang for your

buck

New Models

Future payment structure


Choose the right procedures

•  Start simple — elective procedures

•  Hip fracture — NO

•  Spine trauma/complex cases — NO

•  Oncology — NO


Must have… Navigation

•  Patient navigation

•  Automation

•  Technology

•  Care coordination

•  PCP

•  Hospital

•  Specialists

•  Post-acute facilities

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Risk Assessment

Goals

Reduce Preventable

Complications

Reduce Preventable Readmissions


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The risk assessment Navigating the episode of care

Patient Answers Yes/No Questions

43 Medical and 15 Social Questions Do you have:

Diabetes?

Seizures?

Sleep apnea?

Do you live alone?

Do you require help with daily activities?

Auto-Scores Risk Result, Pertinent

Positives Displayed

RISK:


Site of surgical and post-op services Demand matching concept

Episode of Care

ASC Specialty Hospital

Comm. Hospital

Univ. Hospital PT

Home Health

Rehab Facility

Operative Facilities Post-Op care (Rehab)

Acuity Level Rehab Requirements

Low High Low High

Cost Structure Cost Structure

Low High Low High


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Quality Alliance Partners

Physical Therapy

Home Health

Agencies (Nursing, Rehab)

Skilled Nursing Facilities

Inpatient Rehab

Facilities

Urgent Care Centers


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Quality Alliance Partners

Care Coordination Agreement

“Value” Providers

Virtual Narrow Network – Each

Market


(1)  Source: Data Gen – “Evaluating Opportunities in Medicare Bundled Payment Program” Gloria Kupferman; January 2014

High-Risk Patients

Co-Morbidities

Readmission HF; COPD; Infections

Post Acute Care HHA; SNF; IRF

Episode of care – MSK Best opportunity for savings

Cost Drivers(1)


Metrics

•  30-day mortality

•  30-day re-operation

•  AFIB

•  CVA

•  Deep Infx

•  Dislocations

•  Dural tears

•  DVT

•  GI Bleed

•  Hemorrhage

•  Inpatient mortality

•  Intra-op peri-prosthetic fracture

•  MI

•  Nerve palsy

•  Non-ortho surgical procedure unrelated index surgery

•  Paralysis

•  PE

•  Peri-prosthetic fx

•  Respiratory failure with intubation

•  Return to OR

•  Superficial infx

•  Unexpected ICU stay

•  Vascular injury

•  Wound dehiscence

•  Wrong level surgery

•  Wrong site surgery


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Metrics

•  Average LOS

•  Discharge Disposition

•  Quality of Life Scores

•  Functional Outcomes

•  Practice Patient Satisfaction

•  HCAHPS

•  Online Reputation Scores


Active with Hospital QI Committees

Research Transparency

Monitor Data/Performance Improvement

What to do with your data??

QI Committees Guidelines & Protocols


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30-day readmission rate


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Discharge Disposition


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breakout session the journey to episodic care · 2017. 4. 21. · the journey to episodic care...

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