1 the impact of the aca: how readmissions penalties will affect the healthcare executive’s mission...
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The Impact of the ACA:How Readmissions Penalties Will Affect
the Healthcare Executive’s Mission
Healthcare Leadership Network of the Delaware ValleyMay 2, 2014
Paula A. BussardSenior Vice President, Policy & Regulatory ServicesThe Hospital & Healthsystem Association of Pennsylvania
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Preventable Readmissions
• 1 in every 5 Medicare patients are readmitted within one month of discharge.
• More than 2,000 hospitals affected by readmission penalties.
• About $270 million in Medicare funds. PA FFY 2013 - $12 million—PA ranked 32nd
PA FFY 2014 - $9 million—PA ranked 31st
• Increase in penalty to max of 3%.
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Readmission rates for 2010, as reported by Pennsylvania Health Care Cost Containment Council (PHC4):
Total readmission rate was 13.5% (2 out of every 15 hospital stays had a readmission within 30 days).
CHF readmission rate was 24.3%. Septicemia readmission rate was
21.0%. COPD readmission rate was
20.2%.
Preventable Readmissions
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Pennsylvania Hospital Engagement Network
HAP—one of 26 hospital engagement networks nationwide 60 Pennsylvania hospitals participating in the HEN collaborative
project:• 15 hospitals participated in one year BOOST project (Better
Outcomes for Older adults through Safe Transitions)• 45 hospitals in PA-HEN collaborative
Tracking readmission data for all Pennsylvania PA-HEN participating hospitals
PA-HEN has offered:• Regional networking sessions (including post-acute providers);
webinars; one-on-one coaching calls; and site visits• Priorities:
Health literacy training Post discharge best practices (appointments/phone calls) Medication reconciliation Patient education
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0%
5%
10%
15%
20%
25%
30%
2010n=118
2011n=118
Q1 2012(Dec-Feb)
n=118
Q2 2012(Mar-May)
118
Q3 2012(Jun-Aug)
n=118
Q4 2012(Sep-Nov)
n=117
Q1 2013 (Dec-Feb)
n=118
Q2 2013(Mar-May)
n=118
Rate
PA-HEN Wide Readmission Results (Rate of 30 day readmissions, all-cause, CHF and COPD)
CHF Rate COPD Rate All Cause Rate
GOAL
Reflects a 24% reduction from
baseline
PA-HEN Readmission Progress
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• Immersion project model• Health Literacy• Community Cross Continuum Teams
– Removal of silos– Collaboration with stakeholders– Regional events including health care and community
partners– Encourage education sharing – Encourage patient participation
• Paradigm shift from ‘doing to patients’ to ‘doing with patients’
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Current Priorities
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Average adult reads 3-5 grade levels below highest grade completed.
Therefore, up to ½ of US population may be at risk for:– Medical misunderstandings– Mistakes– Excess hospitalizations– Poor health outcomes
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Health Literacy
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Cross Continuum Teams
Primary careSpecialistsCare managementLong-term careHome healthHospicePharmacy
Personal careArea Agencies on
AgingHealth plansDurable medical
equipment
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Lessons Learned—Challenges
Patient and family educational needs EHR—helps, but can be burdensome Regional differences:
• Urban—higher indigent population, language and cultural barriers more prevalent
• Rural—can have limited community services Behavioral health care needs Regulatory and payment differences between
levels of care Loss of revenue
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Effective communication. Information sharing – health record exchange. Management of care:
• Transition of care.• Better outcomes.• Engagement of patient and families.• Better planning for chronic and end of life care.
• Use of innovative delivery models, including care in place and effective use of advanced practice professionals.
Measurement/performance indicators that are relevant across the continuum of care.
Understanding of financial performance and implications.
Lessons Learned—Opportunities
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Leadership Strategies to Sustain Quality Improvement and Prevention of Harm
Connecting quality and cost• Align with overall organizational goals and financial incentives
Define clear, measurable aims for improvement• Report out to organization and community, if appropriate
Plan, do, study, act• Multi-disciplinary team• Commit to data collection and reporting
Accountability and transparency• Community regularly with administrative and clinical leadership and
governing body• Show results (good and not-so-good)
Leadership must champion Hardwire the improvements into every day practice
• Everyone held to same standard
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Engaging Patients and Families
Health care consumers:
Expect care to be high quality.
Approach care with a deep sense of uncertainty and vulnerability.
Experience with care is very personal and granular.
See insurance companies as setting the rules.
Want hospitals to see them as people.
Want care to be respectful, professional, and quick.
Want hospitals to be empathetic and to stand up for them.
Source: Findings from HAP Focus Groups – conducted March 2014
PA ranked 40th in HCHAPS scores
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Primary Care
Physicians
Specialty Care
Physicians
Outpatient
Hospital Care and
ASCs
Inpatient Hospital Acute Care
Long Term Acute
Hospital Care
Inpatient Rehab
Hospital Care
Skilled Nursing Facility Care
Home Health Care
Medical Home
Acute Care Bundling
Acute Care Episode with PAC Bundling
Post Acute Care (PAC) Episode Bundling
Using Financing to Reshape the Organization and Outcomes of Care
Accountable Care Organizations
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