the meaningful care organization: developing patient engagement strategies

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The Meaningful Care Organization – Developing Patient Engagement Strategies to Weather the Perfect Storm of 2013 Timothy Kelly, MS, MBA Dialog Medical A Standard Register Healthcare Company 2013 TxHIMA Annual Meeting & Convention Omni Fort Worth Hotel June 28-30, 2013

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Presentation to Texas HIMA 2013 Annual Meeting and Convention: Developing Patient Engagement Strategies to Weather the Perfect Storm of 2013

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Page 1: The Meaningful Care Organization: Developing Patient Engagement Strategies

The Meaningful Care Organization – Developing Patient Engagement Strategies to Weather the Perfect Storm of 2013

Timothy Kelly, MS, MBA Dialog Medical A Standard Register Healthcare Company

2013 TxHIMA Annual Meeting & Convention Omni Fort Worth Hotel June 28-30, 2013

Page 2: The Meaningful Care Organization: Developing Patient Engagement Strategies

2013 – A “Perfect Storm” Four Converging Legislative Initiatives

Page 3: The Meaningful Care Organization: Developing Patient Engagement Strategies

Cash for Clunkers and Meaningful Use

Cash for Clunkers <$3 billion

Grassley seeks accounting of 'Cash for Clunkers' costs. The Washington Post. January 7, 2010.

Rock and a hard place: An analysis of the $36 billion impact from health IT stimulus funding. Price Waterhouse Coopers. April 2009.

“Meaningful Use” (Healthcare Information Technology)

~$36 billion

Page 4: The Meaningful Care Organization: Developing Patient Engagement Strategies

American Recovery and Reinvestment Act of 2009

HITECH Act

Meaningful Use

Meaningful Use (MU)

HITECH Act

Page 5: The Meaningful Care Organization: Developing Patient Engagement Strategies

HITECH Act

“The changes we’re announcing today will lead to more coordination of patient care…and greater patient engagement in their own care” Health and Human Services Secretary Kathleen Sebelius announcing the Stage 2 Final Rule. August 23, 2012.

Page 6: The Meaningful Care Organization: Developing Patient Engagement Strategies

$12.6 billion in incentives paid to date (program inception through February 2013)

85% of eligible hospitals are participating in the EHR Incentive Program

75% of eligible hospitals have received an incentive payment to date

HITECH Act

Source: CMS Fact Sheet: A Record of Progress on Health Information Technology. CMS Media Relations. April 23, 2013.

Page 7: The Meaningful Care Organization: Developing Patient Engagement Strategies

Accountable Care Organizations

Patient Protection and Affordable Care Act of 2010

Medicare Shared Savings Program

Accountable Care Organizations

Accountable Care Organizations (ACOs)

Page 8: The Meaningful Care Organization: Developing Patient Engagement Strategies

Accountable Care Organizations

Voluntary groups of physicians, hospitals and other healthcare providers:

Responsible for care of a clearly defined Medicare population

Designed to foster patient-centered, coordinated care

If it succeeds in providing high-quality care while reducing cost, it shares in savings achieved for Medicare

Accountable Care Organizations (ACOs)

Source: Berwick DM. N Engl J Med 2011;365:1753-1756.

Page 9: The Meaningful Care Organization: Developing Patient Engagement Strategies

Three Goals of ACOs Better care for individuals Better health for

populations Slower growth in costs

through improvements in care

Berwick DM. N Engl J Med 2011;364(16):e32.

Accountable Care Organizations

Page 10: The Meaningful Care Organization: Developing Patient Engagement Strategies

Accountable Care Organizations

Accountable Care Organizations (ACOs)

Source: January 2012 survey of hospitals, physician organizations and health systems reported in: Tocknell MD. The Unsettled State of the ACO. HealthLeaders Media Intelligence Report. April 2012.

Currently part of an ACO?

11%

No - 89%

Plan to implement or join and ACO?

Yes - 61%

No - 39%

Yes -

Page 11: The Meaningful Care Organization: Developing Patient Engagement Strategies

Over 250 ACOs 106 on January 1, 20131

1 in 10 Americans is covered under an ACO2

Federal savings from this initiative could be up to $940 million over four years.1

Top Driver for creating an ACO – To engage physicians 56 percent of the respondents that

are or plan to be part of an ACO3 2HHS News Release. January 10, 2013. 1Gandhi N, Weil R. The ACO Surprise. New York: Oliver Wyman, November 2012. 3Tocknell MD. The Unsettled State of the ACO. HealthLeaders Media Intelligence Report. April 2012.

Accountable Care Organizations

Page 13: The Meaningful Care Organization: Developing Patient Engagement Strategies

Goals of Hospital VBP Program: Improve patient experience Better clinical outcomes

1 percent Medicare Holdback $ 850 million in 2013

Hospital Value-Based Purchasing (VBP) Program

Hospital Value-Based Purchasing Program Fact Sheet. Department of Health and Human Services. ICN 907664 November 2011.

Patient Satisfaction (30%)

Core Measures (70%)

VBP Performance Score

+

Page 14: The Meaningful Care Organization: Developing Patient Engagement Strategies

Patient-Centered Communications

HITECH

ACOs

Hospital VBP Program

Readmissions Reduction Program

Page 15: The Meaningful Care Organization: Developing Patient Engagement Strategies

Meaningful Use Objectives

Page 16: The Meaningful Care Organization: Developing Patient Engagement Strategies

Stages of Meaningful Use

Page 17: The Meaningful Care Organization: Developing Patient Engagement Strategies

Stages of Meaningful Use

Page 18: The Meaningful Care Organization: Developing Patient Engagement Strategies

Meaningful Use Objectives

Stage 1 Objectives for Hospitals 14 Core Objectives, 10 Menu Objectives (attain 5) First eligible payment year: 2011

Stage 2 Objectives for Hospitals 16 Core Objectives, 6 Menu Objectives (attain 3) First eligible payment year: 2014 Effectively incorporate all of the Stage 1 objectives,

along with additional objectives and higher measurement thresholds

Meaningful Use Objectives

Page 19: The Meaningful Care Organization: Developing Patient Engagement Strategies

Meaningful Use Objectives

Stage 2 Meaningful Use Objectives

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Core Objectives Demographics Vital Signs Clinical Decision Support CPOE Transitions of Care View, Download and

Transmit to Third Party Privacy and Security Smoking Status Lab Results into EHR Patient-Specific Education Medication Reconciliation

Patient Input

Output

Input

Output Input

Core Objectives Generate Patient Lists Immunization Registries Lab Results to Public

Health Agencies Syndromic Surveillance

Menu Objectives Imaging Results Advance Directives ePrescribing Electronic Notes Electronic Lab Results Family Health History

Patient

Input

Input

Page 20: The Meaningful Care Organization: Developing Patient Engagement Strategies

Why Focus on Patient-Centered Strategies that are “Output” or

Communication-Oriented”?

Page 21: The Meaningful Care Organization: Developing Patient Engagement Strategies

“The single biggest problem in communication is the illusion

that it has taken place.” George Bernard Shaw

Output/Communication-Oriented Strategies

Page 22: The Meaningful Care Organization: Developing Patient Engagement Strategies

For the first time in 2012 Consumer Reports rated hospitals.

Output/Communication-Oriented Strategies

Page 23: The Meaningful Care Organization: Developing Patient Engagement Strategies

Communication was consistently the most poorly rated category.

Output/Communication-Oriented Strategies

Page 24: The Meaningful Care Organization: Developing Patient Engagement Strategies

Output/Communication-Oriented Strategies

These metrics are moving beyond the government sites to mainstream, consumer sites

Patient Satisfaction

Source: Kelly T. HIStalk, August 8, 2012 http://histalk2.com/2012/08/08/readers-write-8812/ (Accessed 5/10/13)

Page 25: The Meaningful Care Organization: Developing Patient Engagement Strategies

“Output-Oriented” Meaningful Use Objectives

Page 26: The Meaningful Care Organization: Developing Patient Engagement Strategies

“Output-Oriented” MU Objectives

Patient-Specific Education Patients who are provided patient-

specific education resources

Number of unique patients admitted to the hospital’s inpatient or emergency

departments during the reporting period

> 10%

Page 27: The Meaningful Care Organization: Developing Patient Engagement Strategies

“Output-Oriented” MU Objectives

2 Measures for this Meaningful Use objective

Both must be satisfied in order to meet the objective

View, Download and Transmit to Third Party

Page 28: The Meaningful Care Organization: Developing Patient Engagement Strategies

“Output-Oriented” MU Objectives

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Patients whose information is available online within 36 hours of discharge

Number of unique patients discharged from the hospital’s inpatient or emergency

department during the reporting period

Patients who view, download or transmit to a third party the information provided online

Number of unique patients discharged from the hospital’s inpatient or emergency

department during the reporting period

> 50%

> 5%*

View, Download and Transmit to Third Party

*This measure was 10% in the Proposed Stage 2 Rule

Page 29: The Meaningful Care Organization: Developing Patient Engagement Strategies

Best Practices for Patient-Specific Education Materials

Page 30: The Meaningful Care Organization: Developing Patient Engagement Strategies

Best Practices

The informed consent discussion conducted by the surgeon should include:

1. The nature of the illness and the natural consequences of no treatment.

2. The nature of the proposed operation, including the estimated risks of mortality and morbidity.

3. The more common known complications, which should be described and discussed. The patient should understand the risks as well as the benefits of the proposed operation. The discussion should include a description of what to expect during the hospitalization and post hospital convalescence.

4. Alternative forms of treatment, including nonoperative techniques.

American College of Surgeons

American College of Surgeons Statements on Principles. Revised September 18, 2008. http://www.facs.org/fellows_info/statements/stonprin.html#anchor171960 (Accessed 5/10/13.)

Page 31: The Meaningful Care Organization: Developing Patient Engagement Strategies

Best Practices

Only 39% of 3,269 closed claims against anesthesiologists were judged to have adequate informed consent1

Inadequate informed consent was pursued as a secondary cause in more than 90% of ophthalmologic malpractice cases2

Lack of informed consent is one of the top 10 reasons for hospital malpractice claims3

Argument for Informed Consent

1Caplan RA, Posner KL. ASA Newsletter 1995;59(6):9-12. 2Kiss CG, Richter-Mueksch S, Stifter E, et at. Arch Ophthalmol 2004;122:94-98. 3Glabman M. Trustee 2004;57(2):12-16.

Page 32: The Meaningful Care Organization: Developing Patient Engagement Strategies

Best Practices

Needs to be electronic

Can’t be a “Medical Miranda Warning”

Argument for Informed Consent

Page 33: The Meaningful Care Organization: Developing Patient Engagement Strategies

Best Practices

WHO Surgical Safety Checklist

Page 34: The Meaningful Care Organization: Developing Patient Engagement Strategies

Best Practices

Need the consent for the Pre-Procedure Verification and/or the Time-Out

Verification of the consent is one of the most effective practices for avoiding wrong-patient/wrong-procedure/ wrong-site surgery1

Argument for Informed Consent

1Clarke JR, Johnston J, Finley ED. Ann Surg 2007;246:395-405.

Page 35: The Meaningful Care Organization: Developing Patient Engagement Strategies

Best Practices

Argument for Informed Consent

Page 36: The Meaningful Care Organization: Developing Patient Engagement Strategies

Best Practices

Reduce the risk of potentially life-threatening perioperative complications.

Pre-Procedure Instructions

Courtesy of the Baltimore VA Medical Center

Tea C. Perioperative concepts and nursing management. In: Smeltzer SC, et al, eds. Brunner and Suddarth’s Textbook of Medical-Surgical Nursing. Philadelphia, PA: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2010:422-483.

Page 37: The Meaningful Care Organization: Developing Patient Engagement Strategies

Best Practices

Lower the incidence of preventable surgery cancellations.

Pre-Procedure Instructions

Henderson BA et al. Incidence and causes of ocular surgery cancellations in an ambulatory surgical center. J Catarct Refract Surg. 2006;32(1):95-102

Pletta C et al. Efficiency improvement plan through patient education on thyroid imaging procedures. J Nucl Med. 2008;49(Supp 1):426P Courtesy of the Baltimore VAMC

Page 38: The Meaningful Care Organization: Developing Patient Engagement Strategies

Best Practices for Viewing, Downloading and Transmitting Patient Information

Page 39: The Meaningful Care Organization: Developing Patient Engagement Strategies

Best Practices

Providing patients with incomplete information at discharge can result in patient harm.

Discharge Instructions

Courtesy of the Portland VA Medical Center

Pennsylvania Patient Safety Advisory. 2008. Jun;5[2]:39-43.

Page 40: The Meaningful Care Organization: Developing Patient Engagement Strategies

Best Practices

Reduced the 14-day readmission rate three-fold by employing procedure-specific discharge instructions (4.1 per 1,000 outpatient procedures to 1.5 per 1,000).

Discharge Instructions

Boast P, Potts C. PS&QH. 2010;7(1):14-16.

Courtesy of the Portland VA Medical Center

Page 41: The Meaningful Care Organization: Developing Patient Engagement Strategies

Best Practices

Most valuable if they are sent well prior to the 36-hour threshold

Provided prior to admission

Paper as well as electronic

Discharge Instructions

Page 42: The Meaningful Care Organization: Developing Patient Engagement Strategies

Developing Initiatives in Your Own “Meaningful Care Organization”

Page 43: The Meaningful Care Organization: Developing Patient Engagement Strategies

The Meaningful Care Organization

Making Good on ACOs’ Promise — The Final Rule for the Medicare Shared Savings Program. N Engl J Med 2011;365(19):1753-1756. November 10, 2011.

http://www.nejm.org/doi/pdf/10.1056/NEJMp1111671

Meaningful Use – The Whiteboard Story – Stage 1 Final Rule Meaningful Use Objectives and Measures Compared to Stage 2 Final Objectives and Measures... Created as a reference tool for public use and convenience by The Advisory Board Company.

http://www.advisory.com/~/media/Advisory-com/CampaignItems/MU-Stage-2-White-Board-Story-Poster-2.pdf

Resources

43

Page 44: The Meaningful Care Organization: Developing Patient Engagement Strategies

Stage 1 Stage 2

Page 45: The Meaningful Care Organization: Developing Patient Engagement Strategies

The Meaningful Care Organization

“Meaningful Care” Checklist

45

Is the initiative patient-centered? Does it reduce risk? Does it enhance safety? Does it leverage the patient? Can you utilize HIT (EHR or

other systems)?

Does it support Stage 1 or Stage 2 Meaningful Objectives?

Yes No

Page 46: The Meaningful Care Organization: Developing Patient Engagement Strategies

Will a Focus on Patient-Centered Communications Impact the Selection

of Treatments/Procedures and Potentially the Efficiency of an ACO?

Page 47: The Meaningful Care Organization: Developing Patient Engagement Strategies

Potential Impact on Efficiency?

A series of nine reports of elective surgical procedures, released in late 2012, found wide variations in the treatments provided.

Dartmouth Atlas Project

Improving Patient Decision-Making: Regional Series. The Dartmouth Atlas of Health Care. http://www.dartmouthatlas.org/pages/decision_making_series (Accessed 5/10/13.)

Page 48: The Meaningful Care Organization: Developing Patient Engagement Strategies

Potential Impact on Efficiency?

Mastectomy rates range from 0.3 per 1,000 female Medicare patients in the San Francisco area, to 2.3 in Grand Forks, ND

Dartmouth Atlas Project

Page 49: The Meaningful Care Organization: Developing Patient Engagement Strategies

Potential Impact on Efficiency?

The report authors surmise that patients may not understand their full range of options and choices may be unduly influenced by providers and not patient preferences.

Dartmouth Atlas Project

Improving Patient Decision-Making: Regional Series. The Dartmouth Atlas of Health Care. http://www.dartmouthatlas.org/pages/decision_making_series (Accessed 5/10/13.)

Page 50: The Meaningful Care Organization: Developing Patient Engagement Strategies

Will a Focus on Patient-Centered Communications Impact Readmissions

or Patient Satisfaction?

Page 51: The Meaningful Care Organization: Developing Patient Engagement Strategies

Potential Impact on Readmissions/Satisfaction?

Press Ganey analysis of hospital readmission penalty scores vs. patient satisfaction scores.

Positive patient experience correlates well with low readmission rates and high readmission rates correlate well with poor patient experience.

Press Ganey HCAHPS Analysis

The Relationship Between HCAHPS Performance and Readmission Penalties. Press Ganey. http://healthcare.pressganey.com/content/201211-PIReadmissions (Accessed 5/10/13.)

Page 52: The Meaningful Care Organization: Developing Patient Engagement Strategies

Potential Impact on Readmissions/Satisfaction?

The relationship between patient satisfaction and readmissions is not causal. Rather it is most likely predictive of an environment stratified by patient-centered communications.

Press Ganey HCAHPS Analysis

Page 53: The Meaningful Care Organization: Developing Patient Engagement Strategies

Health Information Technology

Patient-Centered Communications

Greater Patient Satisfaction

Lower Readmission Rates

More Efficient ACOs

Patient Education Informed Consent Pre-Procedure Instructions Discharge Instructions

Stage 1 Stage 2 MU Objectives Stage 3

The Meaningful Care Organization

Page 54: The Meaningful Care Organization: Developing Patient Engagement Strategies

Questions?

www.standardregister.com/healthcare www.dialogmedical.com www.EngagingPatient.org (slides posted here)

Robbie Beck [email protected]

Tim Kelly [email protected]