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An Initiative of the Florida Hospital AssociationHospital Improvement Innovation Network
Readmission StakeholderQuarterly Virtual Meeting #4October 18, 2018
• Welcome and Overview• EDie Overview• Orlando Health’s SNF to ED Handoff Tool• Questions/Sharing
Today’s Agenda
CMS Readmissions Penalties
2018 2019
Hospitals receiving no penalty
11 10
Hospitals receiving max penalty
6 2
Hospitals receiving a penalty
155 156
Percent of hospitals receiving a penalty
92.8% 94.0%
Average Penalty .94% .90%
Florida had 5th highest percentage of hospitals
penalized
CMS Readmissions Penalties
FY 2018 FY 2019
Texas 0.94 1.17
Nevada 0.84 1.00
Arkansas 1.10 0.98
Idaho 1.10 0.97
Massachussetts 0.92 0.96
New York 0.99 0.94
Kentucky 1.07 0.91
New Jersey 0.99 0.91
West Virginia 0.93 0.91
Wyoming 0.84 0.91
Florida 0.94 0.90
Average Penalty Percentage
BL 10‐16 11‐16 12‐16 1‐17 2‐17 3‐17 4‐17 5‐17 6‐17 7‐17 8‐17 9‐17 10‐17 11‐17 12‐17 1‐18 2‐18 3‐18 4‐18 5‐18 6‐18 7‐18
FL Rate 10.2 9.8 10.2 10.1 10.0 10.0 9.9 10.1 9.8 10.2 10.1 9.9 9.7 9.7 9.7 9.8 10.0 9.8 9.9 9.7 10.2 9.9 10.0
HRET HIIN Rate 9.1 8.6 8.7 8.4 8.9 8.9 8.7 8.7 8.8 8.6 8.8 8.7 8.7 8.7 8.7 8.3 8.9 8.9 8.1 8.8 8.6 7.9 7.9
# FL Reporting 88 86 86 86 86 86 86 82 83 82 82 82 83 82 79 74 72 72 72 71 70 65 57
#HRET Reporting 1,461 1,526 1,525 1,536 1,540 1,534 1,534 1,522 1,519 1,515 1,513 1,513 1,513 1,507 1,505 1,493 1,487 1,486 1,454 1,419 1,374 1,128 831
0.0
2.0
4.0
6.0
8.0
10.0
12.0
14.0
Rate per 100
30 Day, All Cause Readmissions
Source: HRET Comprehensive Data System, October 17, 2018
BL 10‐16 11‐16 12‐16 1‐17 2‐17 3‐17 4‐17 5‐17 6‐17 7‐17 8‐17 9‐17 10‐17 11‐17 12‐17 1‐18 2‐18 3‐18 4‐18 5‐18 6‐18 7‐18
FL Rate 13.6 13.1 13.2 12.8 13.0 12.8 12.8 13.1 12.4 13.8 13.5 12.9 12.6 12.6 12.8 13.4 12.9 12.4 12.9 12.7 13.1 13.4 13.6
HRET HIIN Rate 11.8 11.5 11.7 11.0 11.5 11.8 11.6 11.7 11.6 11.7 11.6 11.4 11.6 11.6 11.7 11.1 11.3 11.6 11.1 11.6 11.4 9.8 10.6
# FL Reporting 69 78 78 79 78 78 77 74 75 75 75 75 75 74 70 67 65 65 65 64 63 59 52
#HRET Reporting 1,168 1,366 1,365 1,371 1,386 1,383 1,377 1,364 1,362 1,360 1,356 1,353 1,350 1,350 1,334 1,325 1,324 1,313 1,276 1,243 1,208 997 703
0.0
2.0
4.0
6.0
8.0
10.0
12.0
14.0
16.0
18.0
20.0
Rate per 100
Readmissions ‐Medicare
Source: HRET Comprehensive Data System, October 17, 2018
Readmission Strategy Resources
www.fha.org
www.hret‐hiin.org
Emergency Department Information Exchange (EDie) OverviewAndrew Reeve and Alyn Ford,
Collective Medical
Strictly Confidential ‐©2018 Collective Medical
The Collective PlatformFHA Readmission Webinar
October 17, 2018
Alyn [email protected]
SVP, Network Development
Strictly Confidential ‐©2018 Collective Medical
Complex Patients: The Elephant in the Room
It's a fan!
It's atree!
It's arope!
It's aspear!
It's a wall!
With only a partial view into a patient’s situations, it’s easy to draw incorrect conclusions.
Collective Medical resolves this problem by creating a collaborative communication environment in which ALL members of the patient’s care team contribute.
This aggregate data provides a complete picture of the patient, enabling better care and avoiding the misdiagnoses or complications that can arise from a lack of information.
Strictly Confidential ‐©2018 Collective Medical
The Opportunity
ED as an IslandED is focused primarily on efficiency and is only concerned with acute care episode
ED and hospital at large view as separate from the larger care continuum
ED as a BridgeED is intrinsically connected to entirehealthcare enterprise and is focused on
items beyond efficiency
ED collaborates to help prevent readmissions, avoid preventable admissions, and promote
care coordination
Strictly Confidential ‐©2018 Collective Medical
Collective EDie delivers intelligent, real‐time care collaboration forcomplex patients in the ED
Ingest a thin slice of data independent of—and across—facility, system, EMR, or/and payer class
and
Real‐time analytics: What complexities just walked in the front door of my health system?
Ingest a thin slice of data independent of—and across—facility, system, EMR, or/and payer class
and
Real‐time analytics: What complexities just walked in the front door of my health system?
With ‘blindfolds’ removed, stakeholders collaborate across:
• organizations• IT systems
and• care settings
on shared, patient‐specific care guidelines with the patient’s complexity in full context
With ‘blindfolds’ removed, stakeholders collaborate across:
• organizations• IT systems
and• care settings
on shared, patient‐specific care guidelines with the patient’s complexity in full context
Configurable risk‐based notifications…
…pushed to the right stakeholders, directly into their workflows…
…presented as consumable, relevant patient insights results in…
high engagement, no alert fatigue, and consistent care
Configurable risk‐based notifications…
…pushed to the right stakeholders, directly into their workflows…
…presented as consumable, relevant patient insights results in…
high engagement, no alert fatigue, and consistent care
FOCUS ENGAGE COLLABORATE
Strictly Confidential ‐©2018 Collective Medical
CMS will reduce reimbursements for 2,573 hospitals in FY 2018 for excessive readmissions and withhold $564 million in payments over the next year.
Strictly Confidential ‐©2018 Collective MedicalStrictly Confidential ‐©2018 Collective Medical
Collective, as the technical backboneto a hospital’s readmissions program, has been proven to support drastic reductions in avoidable hospital readmissions.
Strictly Confidential ‐©2018 Collective MedicalStrictly Confidential ‐©2018 Collective Medical
Patient Scenario: SNF 30‐Day Readmission Alert
2. 20‐day stay; patientdischarged from SNF
to home
3. UnexpectedED encounter
1. Transfer from hospital
4. Direct SNFreadmission
Upon ED registrationa notification is sent tothe ED, hospital, PCP,
and SNF within30‐day window
Upon registration, SNFreceives care
guidelines from hospital
PCP notification regardinghospital discharge, SNFtransfer, and SNF readmit
Collective MedicalReal‐Time Care Coordination
Strictly Confidential ‐©2018 Collective MedicalStrictly Confidential ‐©2018 Collective Medical
The Patient Journey
Strictly Confidential ‐©2018 Collective MedicalStrictly Confidential ‐©2018 Collective Medical
• About Jack: 76 year old male; active lifestyle (tennis) lives in Des Moines, IA
• Primary insurance: Wellmark BCBS Medicare Advantage
• Conditions include: ‐ Chronic obstructive pulmonary disease (COPD)‐ Osteoarthritis; requires knee replacement
• Currently taking the following meds (among others): ‐ albuterol/ipratropium (Combivent); oral
prednisone (PRN)
• Has a primary care + pulmonologist friend, but in different health systems
Meet "Jack"
Strictly Confidential ‐©2018 Collective Medical
Usual State of Health (USOH)
1IP Surgery
2Discharged to SNF(Target LOS: 10 days)
3Discharged from SNFto ED
4Readmitted to IP from
ED
5Discharged back to SNF
6Discharged to Home
7Subsequent ED / IP visit
0Pre‐Surgery
Knee replacement, scheduled in advance
Paper charge strapped to patient chest during EMS ride from IP to SNF
‐‐‐IP discharge planner faxes / calls SNF to coordinate verbally with overloaded
SNF staff
Complication occurs; severe shortness of breath as a
result of COPD and aggressive prednisone tapering
because notes not transferred
to SNF
ED docs stabilize with appropriate
med dosing‐‐‐
Regulations require IP stay before being discharged to SNF again
Meds are normalized
‐‐‐Knee surgery healing occurs
‐‐‐But, handoff was from hospital
only, with no view by SNF team of patient’s broader
care team
Patient sent home‐‐‐
Ambulatory and IP care team
unaware of discharge
Meds for hospital/SNF stay, not home, so SOB
continues‐‐‐
Patient returns to ED for proper dosing
‐‐‐Potential 2nd IP readmit out of abundance of
caution
Context
Event Timeline
Strictly Confidential ‐©2018 Collective MedicalStrictly Confidential ‐©2018 Collective Medical
How it can be
Event Timeline
Patient flagged as high risk
based on COPD condition
‐‐‐Collective alerts provider team in
advance‐‐‐
Care manager assigned to
follow patient after surgery
Knee replacement, scheduled in advance
‐‐‐Patient carefully followed by care management, coordinating care across
EMRs, network nodes,
asynchronously (as emergencies happen at 2am)
Discharge summary + care plan transferred automatically to intaking SNF
‐‐‐Care team + IP discharge
planner notified when patient admits to SNF
SNF visit concludes as anticipated
‐‐‐Recurring patient assessment reports automatically sentto IP discharge planner + PCP to track progress, target LOS
Care team + care manager immediately
notified as patient departs SNF
‐‐‐Care plan
transferred to ambulatory care team
‐‐‐Home health
alerted of same, dispatched to home care automatically
Complication still occurs, but SNF is
empowered by additional information, including care team members (such as Jack’s pulmonologist
friend)‐‐‐
SOB complication but good data flow to EMS, ED
1IP Surgery
2Discharged to SNF(Target LOS: 10 days)
3Discharged from SNFto ED
4Discharged back to SNF
5Discharged to Home
0Pre‐Surgery
Strictly Confidential ‐©2018 Collective Medical
Results
Strictly Confidential ‐©2018 Collective Medical
Legacy Salmon Creek Medical Center | Tacoma, Washington
Opened in 2005, Legacy Salmon Creek Medical Center is a part of Legacy Health, a local, nonprofit health system with six hospitals. Legacy also includes more than 70 primary care, specialty and urgent care clinics, as well as almost 3,000 providers who are either employed, on the medical staff or part of Legacy Health Partners. Legacy Salmon Creek has a high‐volume ED, seeing 200 patients per day on average.
After joining the Collective network, Legacy Salmon Creek saw:
• 24.9% reduction in all‐cause 30‐day readmission rates (equating to 178 readmissions avoided)
• 81% reduction in the ED visit rate by high utilizers• A reduction in ED visits by high ED utilizers from 3,081 per year to 573
Strictly Confidential ‐©2018 Collective Medical
CHI St. Anthony Hospital | Pendleton, Oregon
CHI St. Anthony Hospital (St. Anthony) is a rural hospital serving Pendleton, Oregon. The 25‐bed critical access hospital is part of the Catholic Health Initiatives (CHI) family. The hospital needed to implement a strategy to reduce readmissions. Starting in 2015, with an all‐cause readmissions rate of 8%, St. Anthony structured a program around Collective’s EDie application. It saw significant results:
• By January 2017, the hospital had reduced all‐cause readmissions rates to 3%.• By June 2018, the hospital had reduced all‐cause readmissions rates to 1.72%.• This represents a 78% reduction in all‐cause 30‐day readmissions achieved in less than three years.
Strictly Confidential ‐©2018 Collective Medical
THANK YOU
Orlando Health’sSNF to ED Handoff Tool
Julie Haile, Director of Transition Services
Orlando Health
Questions / Sharing
• Readmissions Stakeholder Virtual Meeting #5• January 17, 2019 @ 12‐1pm ET• Email [email protected] to request a topic for discussion
Next Quarterly Virtual Meeting