nocva preventing avoidable readmissions: data review
DESCRIPTION
NoCVA Preventing Avoidable Readmissions: Data Review. Agenda. Data manual Reading your monthly report Process m easures Outcome measure HCAHPS RRI reports: cross-hospital readmit rates. Have you ever wondered?. - PowerPoint PPT PresentationTRANSCRIPT
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
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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
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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
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https://www.ncha.org/readmissions/reports
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Any Reason: Summary
Timeframe: 1/1/13-2/28/13
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Any Reason: Top 10 By CCS
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Any Reason: Patient Migration
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‘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 ([email protected]) 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 [email protected] 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