29
An Initiative of the Florida Hospital Association Hospital Improvement Innovation Network Readmission Stakeholder Quarterly Virtual Meeting #4 October 18, 2018

Stakeholder Virtual Meeting 18, - FHAOct 18, 2018  · 2.0 4.0 6.0 8.0 10.0 12.0 14.0 16.0 18.0 20.0 ... healthcare enterprise and is focused on ... system with six hospitals. Legacy

  • Upload
    others

  • View
    2

  • Download
    0

Embed Size (px)

Citation preview

Page 1: Stakeholder Virtual Meeting 18, - FHAOct 18, 2018  · 2.0 4.0 6.0 8.0 10.0 12.0 14.0 16.0 18.0 20.0 ... healthcare enterprise and is focused on ... system with six hospitals. Legacy

An Initiative of the Florida Hospital AssociationHospital Improvement Innovation Network

Readmission StakeholderQuarterly Virtual Meeting #4October 18, 2018

Page 2: Stakeholder Virtual Meeting 18, - FHAOct 18, 2018  · 2.0 4.0 6.0 8.0 10.0 12.0 14.0 16.0 18.0 20.0 ... healthcare enterprise and is focused on ... system with six hospitals. Legacy

• Welcome and Overview• EDie Overview• Orlando Health’s SNF to ED Handoff Tool• Questions/Sharing

Today’s Agenda

Page 3: Stakeholder Virtual Meeting 18, - FHAOct 18, 2018  · 2.0 4.0 6.0 8.0 10.0 12.0 14.0 16.0 18.0 20.0 ... healthcare enterprise and is focused on ... system with six hospitals. Legacy
Page 4: Stakeholder Virtual Meeting 18, - FHAOct 18, 2018  · 2.0 4.0 6.0 8.0 10.0 12.0 14.0 16.0 18.0 20.0 ... healthcare enterprise and is focused on ... system with six hospitals. Legacy

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

Page 5: Stakeholder Virtual Meeting 18, - FHAOct 18, 2018  · 2.0 4.0 6.0 8.0 10.0 12.0 14.0 16.0 18.0 20.0 ... healthcare enterprise and is focused on ... system with six hospitals. Legacy

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 

Page 6: Stakeholder Virtual Meeting 18, - FHAOct 18, 2018  · 2.0 4.0 6.0 8.0 10.0 12.0 14.0 16.0 18.0 20.0 ... healthcare enterprise and is focused on ... system with six hospitals. Legacy

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

Page 7: Stakeholder Virtual Meeting 18, - FHAOct 18, 2018  · 2.0 4.0 6.0 8.0 10.0 12.0 14.0 16.0 18.0 20.0 ... healthcare enterprise and is focused on ... system with six hospitals. Legacy

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

Page 8: Stakeholder Virtual Meeting 18, - FHAOct 18, 2018  · 2.0 4.0 6.0 8.0 10.0 12.0 14.0 16.0 18.0 20.0 ... healthcare enterprise and is focused on ... system with six hospitals. Legacy

Readmission Strategy Resources

www.fha.org

www.hret‐hiin.org

Page 9: Stakeholder Virtual Meeting 18, - FHAOct 18, 2018  · 2.0 4.0 6.0 8.0 10.0 12.0 14.0 16.0 18.0 20.0 ... healthcare enterprise and is focused on ... system with six hospitals. Legacy

Emergency Department Information Exchange (EDie) OverviewAndrew Reeve and Alyn Ford,

Collective Medical

Page 10: Stakeholder Virtual Meeting 18, - FHAOct 18, 2018  · 2.0 4.0 6.0 8.0 10.0 12.0 14.0 16.0 18.0 20.0 ... healthcare enterprise and is focused on ... system with six hospitals. Legacy

Strictly Confidential ‐©2018 Collective Medical

The Collective PlatformFHA Readmission Webinar

October 17, 2018

Alyn [email protected]

SVP, Network Development

Page 11: Stakeholder Virtual Meeting 18, - FHAOct 18, 2018  · 2.0 4.0 6.0 8.0 10.0 12.0 14.0 16.0 18.0 20.0 ... healthcare enterprise and is focused on ... system with six hospitals. Legacy

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.

Page 12: Stakeholder Virtual Meeting 18, - FHAOct 18, 2018  · 2.0 4.0 6.0 8.0 10.0 12.0 14.0 16.0 18.0 20.0 ... healthcare enterprise and is focused on ... system with six hospitals. Legacy

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

Page 13: Stakeholder Virtual Meeting 18, - FHAOct 18, 2018  · 2.0 4.0 6.0 8.0 10.0 12.0 14.0 16.0 18.0 20.0 ... healthcare enterprise and is focused on ... system with six hospitals. Legacy

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

Page 14: Stakeholder Virtual Meeting 18, - FHAOct 18, 2018  · 2.0 4.0 6.0 8.0 10.0 12.0 14.0 16.0 18.0 20.0 ... healthcare enterprise and is focused on ... system with six hospitals. Legacy

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.

Page 15: Stakeholder Virtual Meeting 18, - FHAOct 18, 2018  · 2.0 4.0 6.0 8.0 10.0 12.0 14.0 16.0 18.0 20.0 ... healthcare enterprise and is focused on ... system with six hospitals. Legacy

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.

Page 16: Stakeholder Virtual Meeting 18, - FHAOct 18, 2018  · 2.0 4.0 6.0 8.0 10.0 12.0 14.0 16.0 18.0 20.0 ... healthcare enterprise and is focused on ... system with six hospitals. Legacy

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

Page 17: Stakeholder Virtual Meeting 18, - FHAOct 18, 2018  · 2.0 4.0 6.0 8.0 10.0 12.0 14.0 16.0 18.0 20.0 ... healthcare enterprise and is focused on ... system with six hospitals. Legacy

Strictly Confidential ‐©2018 Collective MedicalStrictly Confidential ‐©2018 Collective Medical

The Patient Journey

Page 18: Stakeholder Virtual Meeting 18, - FHAOct 18, 2018  · 2.0 4.0 6.0 8.0 10.0 12.0 14.0 16.0 18.0 20.0 ... healthcare enterprise and is focused on ... system with six hospitals. Legacy

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"

Page 19: Stakeholder Virtual Meeting 18, - FHAOct 18, 2018  · 2.0 4.0 6.0 8.0 10.0 12.0 14.0 16.0 18.0 20.0 ... healthcare enterprise and is focused on ... system with six hospitals. Legacy

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

Page 20: Stakeholder Virtual Meeting 18, - FHAOct 18, 2018  · 2.0 4.0 6.0 8.0 10.0 12.0 14.0 16.0 18.0 20.0 ... healthcare enterprise and is focused on ... system with six hospitals. Legacy

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

Page 21: Stakeholder Virtual Meeting 18, - FHAOct 18, 2018  · 2.0 4.0 6.0 8.0 10.0 12.0 14.0 16.0 18.0 20.0 ... healthcare enterprise and is focused on ... system with six hospitals. Legacy

Strictly Confidential ‐©2018 Collective Medical

Results

Page 22: Stakeholder Virtual Meeting 18, - FHAOct 18, 2018  · 2.0 4.0 6.0 8.0 10.0 12.0 14.0 16.0 18.0 20.0 ... healthcare enterprise and is focused on ... system with six hospitals. Legacy

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

Page 23: Stakeholder Virtual Meeting 18, - FHAOct 18, 2018  · 2.0 4.0 6.0 8.0 10.0 12.0 14.0 16.0 18.0 20.0 ... healthcare enterprise and is focused on ... system with six hospitals. Legacy

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.

Page 24: Stakeholder Virtual Meeting 18, - FHAOct 18, 2018  · 2.0 4.0 6.0 8.0 10.0 12.0 14.0 16.0 18.0 20.0 ... healthcare enterprise and is focused on ... system with six hospitals. Legacy

Strictly Confidential ‐©2018 Collective Medical

THANK YOU

Page 25: Stakeholder Virtual Meeting 18, - FHAOct 18, 2018  · 2.0 4.0 6.0 8.0 10.0 12.0 14.0 16.0 18.0 20.0 ... healthcare enterprise and is focused on ... system with six hospitals. Legacy

Orlando Health’sSNF to ED Handoff Tool

Julie Haile, Director of Transition Services

Page 26: Stakeholder Virtual Meeting 18, - FHAOct 18, 2018  · 2.0 4.0 6.0 8.0 10.0 12.0 14.0 16.0 18.0 20.0 ... healthcare enterprise and is focused on ... system with six hospitals. Legacy

Orlando Health

Page 27: Stakeholder Virtual Meeting 18, - FHAOct 18, 2018  · 2.0 4.0 6.0 8.0 10.0 12.0 14.0 16.0 18.0 20.0 ... healthcare enterprise and is focused on ... system with six hospitals. Legacy

Questions / Sharing

Page 28: Stakeholder Virtual Meeting 18, - FHAOct 18, 2018  · 2.0 4.0 6.0 8.0 10.0 12.0 14.0 16.0 18.0 20.0 ... healthcare enterprise and is focused on ... system with six hospitals. Legacy

• Readmissions Stakeholder Virtual Meeting #5• January 17, 2019 @ 12‐1pm ET• Email [email protected] to request a topic for discussion

Next Quarterly Virtual Meeting

Page 29: Stakeholder Virtual Meeting 18, - FHAOct 18, 2018  · 2.0 4.0 6.0 8.0 10.0 12.0 14.0 16.0 18.0 20.0 ... healthcare enterprise and is focused on ... system with six hospitals. Legacy

We are here to help!

[email protected]‐841‐6230

Contact Us