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