hlndv spring institute 2014 may 2, 2014, 1:15-2:45pm readmission session
TRANSCRIPT
HLNDV Spring Institute 2014
May 2, 2014, 1:15-2:45pmReadmission Session
New Jersey Gainsharing Project
• Started with 11 hospitals in 2009• Organized by NJHA• Needed to get a Stark Law exemption for the
hospital to be able to share savings with physicians
• All Medicare recipients (not managed Medicare) were included
The Mechanics
• Payments were broken up into incentives for performance and improvement
• Performance was based on the cost of care for the physician compared with the lowest 25 percentile cost of care for the State of NJ for the given APR-DRG
• Improvement was based on the cost of care for that physician’s patients in the same APR-DRG’s in the 2007 base year
The Mechanics (cont.)
• The original mix was to reward physicians 2/3 for improvement and 1/3 for performance, so that historically poor performers would have an incentive to improve.
• The expectation is that most hospitals would eventually change the percentage more to performance over time
• Hospitals were also allowed to put parameters on payments
The Caveats
• To ensure that services were not cut unnecessarily, CMS required that all hospitals monitor quality parameters which had to include:– Hospital mortality – 7 day readmissions– 30 day readmissions
Our Mortality Data
Q1 2007
Q2 2007
Q3 2007
Q4 2007
Q1 2008
Q2 2008
Q3 2008
Q4 2008
Q1 2009
Q2 2009
Q3 2009
Q4 2009
Q1 2010
Q2 2010
Q3 2010
Q3 2010
Q1 2011
Q2 2011
Q3 2011
Q4 2011
0
0.01
0.02
0.03
0.04
0.05
0.06
0.07
0.08
UCL 0.06832
CL 0.04683
LCL 0.02534
30 D Mort Par
Data PointsLinear (Data Points)UCL+2 Sigma+1 SigmaAverage-1 Sigma-2 SigmaLCL
by Quarter
% 3
0 D
Mor
t
Our Readmission Data--7 Days
Q1 2007
Q2 2007
Q3 2007
Q4 2007
Q1 2008
Q2 2008
Q3 2008
Q4 2008
Q1 2009
Q2 2009
Q3 2009
Q4 2009
Q1 2010
Q2 2010
Q3 2010
Q3 2010
Q1 2011
Q2 2011
Q3 2011
Q4 2011
0
0.01
0.02
0.03
0.04
0.05
0.06
0.07
0.08
0.09
UCL 0.078093
CL 0.052095
LCL 0.026097
7 D Readm Par
Data PointsLinear (Data Points)UCL+2 Sigma+1 SigmaAverage-1 Sigma-2 SigmaLCL
by quarter
% 7
d R
ead
Our Readmission Data 30 Days
Q1 2007
Q2 2007
Q3 2007
Q4 2007
Q1 2008
Q2 2008
Q3 2008
Q4 2008
Q1 2009
Q2 2009
Q3 2009
Q4 2009
Q1 2010
Q2 2010
Q3 2010
Q3 2010
Q1 2011
Q2 2011
Q3 2011
Q4 2011
0
0.05
0.1
0.15
0.2
0.25
UCL 0.211714
CL 0.14331
LCL 0.074906
30 D Readm Par
Data PointsLinear (Data Points)UCL+2 Sigma+1 SigmaAverage-1 Sigma-2 SigmaLCL
by quarter
% 3
0D R
ead
3
Readmissions Interventions
• Began a Readmissions Committee in July 2011• Multi-disciplinary group including nursing,
physicians, PT, Case Management, Home Health, and Hospice– Eventually, post –acute partners attended
• Initial focus was on Medicare CHF patients• We improved our CHF patient education
program
Readmissions Committee
• Eventually we expanded the scope of the Committee to include all Medicare patients (really all patients)
• At the same time, many of our PCP’s were applying for and obtaining certification as Primary Care Medical Homes
Interventions
• Follow up calls were made by Clinical Nurse Leaders
• Most focused on transmittal of information– NOA pushed out to PCP’s– Admission and Discharge Summaries pushed out
to the PCP of record– Discharge Medication Reconciliation, Discharge
Instructions and Universal Transfer Form are faxed to the PCP office
Interventions (continued)
• Other interventions looked at better communication– Inpatient Care Managers and Care Coordinators in
the Family Practice offices exchanged cell numbers – Established System where Hospitalists could leave
voicemails for PCP’s
Interventions (continued)
• Partnered with the Advisory Board Company to be a Beta site for software Crimson RealTime Readmissions– Using a proprietary algorithm, it assesses patients
and assigns them to high, medium, or low risk of readmission
– Recommends interventions—making appointments prior to discharge, follow up calls, pharmacy input into Med Rec, Home Health referral, giving new prescriptions prior to discharge
AMI 2011-2014
Jan 2011
Feb 2011
Mar 2011
April 2011
May 2011
June 2011
July 2011
Aug 2011
Sept 2011
Oct
2011
Nov 2011
Dec 2011
Jan 2012
Feb 2012
Mar 2012
Apr
2012
May 2012
June 2012
July 2012
Aug 2012
Sept 2012
Oct
2012
Nov 2012
Dec 2012
Jan 2013
Feb 2013
Mar 2013
Apr
2013
May 2013
June 2013
July 2013
Aug 2013
Sept 2013
Oct
2013
Nov 2013
Dec 2013
Jan 2014
Feb 2014
0.00%
2.00%
4.00%
6.00%
8.00%
10.00%
12.00%
14.00%
16.00%
18.00%
20.00%
AMI Rehosp
Series1
Rolling 12 Months
Reh
osp
Rat
e
CHF 2011-2014
Jan 2011
Feb 2011
Mar 2011
April 2011
May 2011
June 2011
July 2011
Aug 2011
Sept 2011
Oct
2011
Nov 2011
Dec 2011
Jan 2012
Feb 2012
Mar 2012
Apr
2012
May 2012
June 2012
July 2012
Aug 2012
Sept 2012
Oct
2012
Nov 2012
Dec 2012
Jan 2013
Feb 2013
Mar 2013
Apr
2013
May 2013
June 2013
July 2013
Aug 2013
Sept 2013
Oct
2013
Nov 2013
Dec 2013
Jan 2014
Feb 2014
0.00%
5.00%
10.00%
15.00%
20.00%
25.00%
CHF Rehosp
Series1
Running 12 Months
Reh
osp
Rat
e
Pneumonia 2011-2014
Jan 2011
Feb 2011
Mar 2011
April 2011
May 2011
June 2011
July 2011
Aug 2011
Sept 2011
Oct
2011
Nov 2011
Dec 2011
Jan 2012
Feb 2012
Mar 2012
Apr
2012
May 2012
June 2012
July 2012
Aug 2012
Sept 2012
Oct
2012
Nov 2012
Dec 2012
Jan 2013
Feb 2013
Mar 2013
Apr
2013
May 2013
June 2013
July 2013
Aug 2013
Sept 2013
Oct
2013
Nov 2013
Dec 2013
Jan 2014
Feb 2014
0.00%
5.00%
10.00%
15.00%
20.00%
25.00%
Pneumonia Rehosp
Series1
Running 12 Months
Reh
osp
Rat
e
Medicare 2012-2014
June 2012
July 2012
Aug 2012
Sept 2012
Oct 2012
Nov 2012
Dec 2012
Jan 2013
Feb 2013
Mar 2013
Apr 2013
May 2013
June 2013
July 2013
Aug 2013
Sept 2013
Oct 2013
Nov 2013
Dec 2013
Jan 2014
Feb 2014
11.50%
12.00%
12.50%
13.00%
13.50%
14.00%
14.50%
15.00%
Medicare Rehosp
Series1
Running 12 months
Per
cen
t 30
D R
ead
m