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Collaboration for Improved Clinical Outcomes
Patients’ Needs
Vibra, ARU, SNFs,
HHA, et al
Clinical/Financial
Stability and Patient/Reside
nt/Client Satisfaction
Physicians and staff working as partner for patient care
Value of monitoring utilization of resources Timely transitions: “Right level of care at
the right time”
Goals
The Affordable Care Act of 2010 requires HHS to establish a readmission reduction program.
20% of Medicare patients are readmitted to a hospital within one month of discharge
CMS’ goal to transition to value based purchasing--paying for care based on quality and not just quantity
Initial focus- AMI, CHF and pneumonia; 2015 possibilities- MedPAC recommendations of COPD, CABG and PTCA procedures, and other vascular procedures
Penalties- Oct 2012- 1%; Oct 2013- 2%; Oct 2014- 3%
Readmission Focus
Levels of Care
ADULTDAYCARE
HOMEHEALTH
CARE
ASSI STEDLI VI NG
The Continuum of Healthcare Sites of Service
ACUTE CAREHOSPITALS
TRANSCARE ICU
SKILLEDNURSING
FACILITIES
SUBACUTE & I NPATI ENT
REHAB
LTACHs
OUTPATIENTREHAB
HOSPI CE
Severity of patient illness
Inte
nsity o
f patient serv
ice
High
Low
Low High
HOME
TRANSCARE
CHRONICCARE
Breakdown of Inpatient Readmission Source
64%Home w/o any post
acute care
20%Skilled Nursing Facilities
11%Home
w/home health care
5%Rehab , LTACH or
Psych Hospitals
Source: Health Care Financing Review| 2009 data
Current Industry Issues§ Highly fragmented market of hospitals and PAC providers§ Economic incentive for acute care providers to increase PAC patient volume and rapidly discharge§ No coordination of patients over episode of care§ No economic penalty for poor performance
Medicare Policy is Rearranging the Post-Acute Landscape____________________Source: RTI International, 2009, “Examining Post Acute Care…” and Avalere Health, LLC, “Change in the SNF Marketplace” March 2012. Same Source for next slide
23% are Readmitted to Hospital
35% of Hospital Discharges are Admitted to Post-Acute for Additional Care (“Post-Acute Admissions”)
48% of Post-Acute Admissions go Home after Receiving Post-Acute Care
29% are Transferred to a Secondary Post-Acute Venuefor Additional Care
National Statistics
Medicare Statistics
30-day Risk Adjusted Readmission Rates for a Portland HospitalMeasure Number of
PatientsReadmission
RateNational Average
Heart Attack 209 18.0% 19.7%
Heart Failure 201 28.0% 24.7%
Pneumonia 109 18.7% 18.5%
Source: America Hospital Directory, 07/01/2008 to 06/30/2011 posted on 04/12/2013
Long Term Acute Care- MS DRGs Skilled Nursing facilities- RUGs and per
diem Foster Home- per diem; Medicare not
accepted Home Health- DRGs Hospice- per diem
Continuum of Care
Present- MS DRGs◦ MCC◦ CC◦ Non-CC
Future Length of Stay
◦ Short Stay◦ Long Stay◦ Medicare median
What is a DRG?
Opportunities
1. Improved clinical outcomes and patient satisfaction through coordination of care.
2. Right level of care at the right time for optimal patient care outcomes.
3. Partnerships for coordination of care
Thank You!
Coming together is a beginning.Keeping together is progress.Working together is success.
- Henry Ford
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