NoCVA Preventing Avoidable Readmissions: Data Review

• Data manual• Reading your monthly report• Process measures• Outcome measure• HCAHPS• RRI reports: cross-hospital readmit rates

Agenda

• Where is NCQC getting my readmission rate? How does this readmission definition compare to CMS?

• When is my data due? When am I going to get a report from NCQC? When is the next data webinar?

• What are other hospitals asking about readmissions measurement in this collaborative?

Have you ever wondered?

Consider the lowly data manual…

Located at: http://www.ncqualitycenter.org/engage-providers/hen-partnership-for-patients-overview/nocva-initiatives/readmissions-nc/reducing-readmissions-nc-resources/

Overview

Detailed timeline includes:• Data submission dates• Dates for data webinars

• Estimated date you receive

readmissions reports (NoCVA, CCNC)

What else is in the data manual?

• Front: Overview of purpose & timelines• Middle: Information about each measure you are

reportingo What to submit, how to submit it, and when.o Includes guidance on questions you may have,

especially about process measures• End: Miscellany, e.g. FAQ sheet, how to use QDS,

sample forms for monitoring performance.

Reading your monthly report

Reading your monthly report

• Data is due on the 20th

• Monthly reports are emailed on or around the 30th of the month to your project leado Sent by secure email; check spam box.

Overview

Process Measures

Why do we have process measures?

• Purpose is to guide improvement• Help identify opportunities & strengths• Make data-driven decisions as you decide what

changes to make to patient flow, working with community partners, etc.

• Provide feedback so you know if you have achieved reliability

• It’s okay if the process measures are not at 100% in first month

Process Measures

Follow-up visit scheduled within 7 daysFor all high-risk patients in pilot unit. Hospital does not need to track

whether patient attends visit.

Care provider informed of hospitalizationFor all high-risk patients in pilot unit. Inform care provider within 48 hours

of admission.

Patients given assessment for high risk of readmissionAll patients in your pilot unit are assessed.

Hospitals not yet entering data…

• The following hospitals don’t have any data in yet: Novant Franklin, Novant Rowan, Vidant Pungo, Vidant Duplin, Morehead

• Other hospitals have some, but not all, data in

CONGRATULATIONS to our data speedy-starters!

• Alamance• Angel• CFV-Bladen• Carteret• Duke Raleigh• Vidant Edgecombe• High Point Regional• Iredell• J. Arthur Dosher

• Lenoir• McDowell• New Hanover• Novant Ortho• Pender• Vidant Roanoke Chowan• Wayne

What do I do if my hospital doesn’t have a screening tool yet?

• Hospitals should report all three process measures, even if they don’t have a screening tool yet.o Many hospitals are in this boat!

• How to report?o Patients assessed at high risk of readmission.

Numerator=Number of patients assessed at high risk=0Denominator=All patients on unit

o Other two process measures: Zero out of ZeroNumerator=ZeroDenominator=Zero

How to enter data if a hospital does NOT have a screening tool

Percent of patients given an assessment for high risk of

readmission

Percent of high-risk patients whose care provider is

informed within 48 hours

Percent of high-risk patients who have a follow-up visit

scheduled within 7 days

Process Measures

Follow-up visit scheduled within 7 daysFor all high-risk patients in pilot unit. Hospital does not need to track whether

patient attends visit.

Care provider informed of hospitalizationFor all high-risk patients in pilot unit. Inform care provider within 48 hours of

admission.

Patients given assessment for high risk of readmissionAll patients in your pilot unit are assessed.

% of patients given assessment for high risk of readmission

• Measure asks for % given assessment, NOT % found to be at high risko Target is 95%

• Sampling permitted, but discouraged.o If sampling, sample must be >25 pts/month or 10% of

patients, whichever is greater• Observation patients are included, if in your unit or

population

VERY preliminary—does not reflect complete data.

Process Measures

Follow-up visit scheduled within 7 daysFor all high-risk patients in pilot unit. Hospital does not need to track

whether patient attends visit.

Care provider informed of hospitalizationFor all high-risk patients in pilot unit. Inform care provider within 48 hours of admission.

Patients given assessment for high risk of readmissionAll patients in your pilot unit are assessed.

Care provider informed of hospitalization within 48 hours

• If a patient does not have a PCP, they are still counted in this measure.

• Follow-up does NOT need to be with PCP, if another type of care provider is more appropriate.

Collaborative progress

VERY preliminary—does not reflect complete data. Rates are high bcs non-reporters and those without a risk assessment tool are not included

Collab comparison chart

• NoCVA will not show comparison data at this time bcs only four hospitals have identified those at high risk and are doing f/u with at least some of them!

• Congratulations to the following four hospitals:o Duke Raleigho Doshero Vidant Roanoke-Chowano Wayne

Process Measures

Follow-up visit scheduled within 7 daysFor all high-risk patients in pilot unit. Hospital does not need to track whether patient attends

visit.

Care provider informed of hospitalizationFor all high-risk patients in pilot unit. Inform care provider within 48 hours of admission.

Patients given assessment for high risk of readmissionAll patients in your pilot unit are assessed.

Follow-up appt within 7 days

• Follow-up is within 7 calendar days• Patients who die while in hospital can be excluded

from this measure• Hospice, transfer to another facility or unit, AMA—

these patients should still be included in your denominator.

Collab progress

VERY preliminary—does not reflect complete data. Rates are high bcs non-reporters and those without a risk assessment tool are not included

How it’s really being done:

Wayne and Vidant Roanoke-Chowan tell their stories

1-30 day readmissions

1-30 day readmission rate

• Readmissions for all causes• Readmissions for all payers• Within 1 to 30 days• Not risk-adjusted

CMS HF CMS all-cause NCQC Collab CCNCTimeframe? 0-30 0-30 1-30 (same day

excluded)0-30

Other hospitals? Yes Yes No Yes

Risk-adjustment? Yes Yes No Yes

Payer? Medicare Medicare Every payer Medicaid

Clinical condition (first visit)?

Includes HF only Excludes psych, rehab, and cancer pts

Includes every condition

Excludes about 40% of patients

Clinical reason (readmit dx or procedure)

Excludes planned (used to exclude nothing)

Excludes planned Includes every readmit

Only includes clinically related readmits

Frequent fliers? Only 1 readmit counted per 30 day window

Multiple readmits within 30 days are possible

Multiple readmits within 30 days are possible

Only 1 readmit counted per ‘chain’ of clinically related discharges

Overall collab progress

HCAHPS

Why HCAHPS?

• The changes you make to improve care transitions will result in lower readmissions scores AND better HCAHPS results.

• Connect the dots: Do patients see the changes you are making?

• We focus on four HCAHPS dimensions: communication w/nurses, communication w/doctors, communication about meds, discharge information

• Webinar in March w/national expert (Carrie Brady) will go in-depth on connection between patient experience and outcomes

Nurse comm

MD comm Comm on meds

Discharge instructions

Current collab average

80% 83% 65% 85%

Ntnl avg 78% 81% 63% 84%

Ntnl 25th 81% 85% 67% 87%

Your hospital?

All data from Oct11-Sept12

Coming soon! Cross-hospital readmission reports

Cross-hospital readmits

• Background on cross-hospital readmits• Where to find your reports• Some basic state-level results• Invitation for your input

48

Readmissions: Background

• Readmissions are common and costlyo 1 of 5 Medicare patients is readmitted, costing

$18 billion annually• Readmissions penalty program is expandingo FY 2013=1%; FY 2014=2%

FY 2014 national estimate= NEGATIVE 220 milFY 2014 NC estimate=NEGATIVE 7.7 mil, with 58

hospitals incurring a penaltyo FY 2015: expansion to COPD and THA/TKAo Public reporting of hospital-wide readmission

rates

49

How good is readmissions data?

• Hospitals expressed frustration at the lack of all-hospital readmissions reporting.o SAME-hospital readmissions are easy to tracko ALL-hospital readmission are much harder

• National studies suggest average of 20% of patients readmit to other hospitals o This 20% makes a HUGE difference to hospital

rankings.

NCHA’s RRI initiative

• Goal: Develop a solution to match patients from one hospital to the next and provide more complete readmissions reporting for North Carolina hospitals.

• Challenge: claims data does not include a stable identifier across hospitals.

• Solution: NCHA worked with Truven to apply matching algorithm:o Multiple fields—Last name, first name, address, age, gender, zip,

SSN, etc. to match patientso Both deterministic and probabilistic matches

• Your CEO will get a letter soon!

Correlation: Same versus All Hospital rates

Hospital Rankings: Same vs. All HospitalRank: Same-Hospital

ReadmissionsRank: All-Hospital

ReadmissionsA 1 4B 2 69C 3 60D 4 3E 5 1F 6 2G 7 25H 8 7I 9 12J 10 13K 11 18L 12 9M 13 10N 14 27O 15 17

#1=Best readmission rate

53

https://www.ncha.org/readmissions/reports

54

Any Reason: Summary

Timeframe: 1/1/13-2/28/13

55

Any Reason: Top 10 By CCS

56

Any Reason: Patient Migration

57

‘Normal’ Outmigration Rates

Same Classification: Summary

All reports are also available using only readmissions within the same CCS category.

Summary and next steps

• Reports provide MUCH more complete picture of readmissionso 1 of 5 patients readmits elsewhere

• Hospital CEOs will receive announcement soon• Watch for webinars in coming weeks—CMO/CEO,

quality, and planning

Feedback!

• Reports are available at: https://www.ncha.org/readmissions/reportso Don’t have NCHA password? TELL US!

• Feedback is very welcome—send to (eroedder@ncha.org) or 919 677-4125. o This is great!o This is a start, but what I really need is XYZ! That’s what would

make this actionable for me!o This isn’t really relevant to reducing readmissions, because I am

so busy doing other work that more data isn’t helpful.o I don’t understand what this graph/measure is supposed to be.o I’m interested, but don’t know what to say yet.. Can someone f/u

with me later?

Summary

• Data manual is HUGE RESOURCE • Review your monthly report• Process measures are importanto Enter them, including zeros

• Outcome data presented• HCAHPS data presented• RRI Cross-hospital readmit rates should be on your

radar. Provide feedback if interested.

Announcements

Submission of process measures Nov. 20

Upcoming monthly webinars (second Monday from 1:30pm – 2:30pm)

Webinar: Models for Community Action Presentations from teams that are effectively engaging their communities

December 9, 2013 1:30

Learning Session 2, The Solutions Center, Durham, NC

January 30, 20141:00 – 5:00

NC ACT Care Transitions Summit, Sheraton Imperial, Durham, NC

January 31, 20148:30 – 3:45

Storyboards

• Complete an online storyboard outline by January 17, 2014 at: 2014 NC Care Transitions Storyboard

• Storyboards must be based on efforts to improve care transitions and not advertise products or services. Avoid using manufacturer or vendor trade names if products are mentioned.

• Storyboards should be self standing and able to fit on a 4ft x 4ft table space or on an easel. If you feel you would need additional display space, you must notify James Hayes at jhayes@ncha.org to discuss your needs no later January 10, 2014.

• Poster presenters are encouraged to stand by their storyboards during morning and afternoon breaks to answer questions from Summit participants.

www.ncact.org