Using Data to Drive Improvement€¦ · Operating Physician DRG Fracture First PAC Episode Count Average Net Episode Payment Average Target Amount Variance To Target Percent of Episodes

Using Data to Drive Improvement

Comprehensive Care for Joint Replacement Model

June 14, 2018


Audio available through device speakers OR by dialing (800) 832-0736

Conference Room:*2657582#Access Code: 061418#

Welcome

Kathy Woods, BSN, RNCJR Learning System Team

The Lewin Group

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Laura Maynard, M.Div.CJR Learning System Team

The Lewin Group


Webinar Agenda

• Welcome

• Meeting Logistics

• St. Francis Medical Center Presentation

• Questions, Answers, & Discussion

• Announcements & Reminders

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Meeting Logistics

• All telephone lines are muted• We encourage comments, questions, and

reactions via Chat• Participate!

– Chat– Polls– Post-Event Survey

Comprehensive Care for Joint Replacement Model 4

Introduction to Adobe Connect

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Download Available Resources

Closed Captioning

To Ask Questions

or Send Messages

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Telephone

To Raise Your Hand

Let’s Chat!

• Use the Chat pod to submit anyquestions or comments

• Please use “@” if yourquestion/comment is directed to aspecific presenter

• Submit your question/comment byclicking the chat bubble icon

• Please share in Chat now:– Organization– State– A CJR improvement activity currently

in progress at your organization

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St. Francis Medical Center Presentation


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Hailey Hill, MHAManager of Special Projects & Joint

Replacement Coordination

CJR Data Driven Improvement

Hailey Hill, MHAManager of Special Projects & Joint Replacement Coordination

St. Francis Medical Center – Monroe, LA

St. Francis Medical CenterFranciscan Missionaries of Our Lady Health System

• Located in Monroe, LA• 352 licensed beds• Volume FY17 410 (DRG 469 & 470)

• 60% of volume is CJR• Hospital owned SNF & IRF• Non-Employed Orthopedic

Surgeons

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CJR Data Drivers

• Data-Driven Continuous Quality Improvement

• Right Care, Right Time• Coordination Across the

Care Continuum

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Data Driven Continuous Quality Improvement

Dashboards• Utilized in Various Committees

– Care Redesign Committee– Gainsharing Committee– Executive Committee– Post Acute Community Meetings

• Utilizes a combination of CMS Claims Data andInternally Tracked Data

• Template has evolved over time

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Dashboard Example

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2017Q2 2017Q3 2017Q4

Description Num Den % Num Den % Num Den % Num Den % Num Den % Num Den

Total # of pt admissions 116 97 81 72 86.0

% of CJR Patients 65 116 56% 58 97 60% 50 81 62% 54 72 75% 227 366 62% 47 86

% of CJR TKAs 37 65 57% 38 58 66% 33 50 66% 27 54 50% 135 227 59% 25 47

% of CJR THAs 13 65 20% 11 58 19% 10 50 20% 12 54 22% 46 227 20% 6 47

% of CJR Fractures 15 65 23% 9 58 16% 7 50 14% 15 54 28% 46 227 20% 16 47

% of CJR DRG 470 (no MCC) 60 65 92% 56 58 97% 47 50 94% 54 54 100% 217 227 96% 44 47

% of CJR DRG 469 (with MCC) 5 65 8% 2 58 3% 3 50 6% 0 54 0% 10 227 4% 3 47

Discharge Disposition

% of CJR Elective Discharge to Home 34 50 68% 35 49 71% 28 43 65% 24 39 62% 121 181 67% 23 31

Goal CJR Elective Discharge to Home

% of CJR Fractures Discharge to Home 0 10 0% 1 9 11% 3 7 43% 2 15 13% 1 16

Financial

Volume & Variance DRG 470 Elective

Volume & Variance DRG 469 Elective

Volume & Variance DRG 470 Fracture

Volume & Variance DRG 469 Fracture

Total Volume & Variance

Length of Stay

Fractures - all volume

Electives - all volume

Multimodal Electives - all volume

Patient Satisfaction

TJP - Electives: Overall Score

TJP - Electives: Overall Rank

3.28

4.79

2016Q4 2017Q1 My Hospital PY Avg

Performance Year 2

80%80%80%80%

$39,630.60

$47,173.50

63.089.2

89.091.7

59.589.8

40.087.8

36.086.8

99.095.2

3.13

3.36

70%

$31,553.33

$21,214.72

($20,818.93)

$31,157.54

60%

($25,632.93)

$61,171.17

4.29

3.15

3.21

4.86

($31,377.90)

$47,559.12

$61,830.97

$50,556.72

$5,483.19

($70,311.76)

($87,826.51)

($47,167.16)

($9,281.45)

3.14

3.28

5.16

3.28

6.71

$99,465.81

3.11

5.75

($10,969.12)

$102,120.59

($15,335.74)

$192,253.68

$48,059.13

$44,728.74

Performance Year 3

Note: Data not finalNote: Data not final

($23,358.62)

Total

ALOS

$52,457.11

Physician Dashboard

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Operating Physician DRG Fracture First PAC Episode CountAverage

Net Episode PaymentAverage

Target Amount Variance To Target

Percent of Episodesw/ At Least 1Readmission

A 470 Fracture Self-Care 1 $12,657.40 $33,837.00 $21,179.60 0%A 470 Non-Fracture HHA 47 $16,704.20 $18,304.34 $75,206.58 4%A 470 Non-Fracture SNF 32 $20,665.04 $18,306.72 ($75,466.19) 3%A 470 Non-Fracture Self-Care 25 $14,362.32 $18,311.68 $98,733.95 4%

105 $17,315.18 $18,454.74 $119,653.94 4%B 469 Fracture SNF 1 $66,375.90 $45,104.00 ($21,271.90) 100%B 469 Non-Fracture HHA 1 $26,235.81 $31,719.00 $5,483.19 0%B 470 Fracture SNF 1 $26,545.14 $33,728.00 $7,182.86 0%B 470 Non-Fracture HHA 12 $16,740.67 $18,316.42 $18,908.97 0%B 470 Non-Fracture SNF 13 $26,989.38 $18,307.31 ($112,866.94) 0%B 470 Non-Fracture Self-Care 6 $15,200.42 $18,304.17 $18,622.50 0%

34 $22,414.98 $19,946.12 ($83,941.32) 3%C 469 Fracture SNF 2 $25,833.04 $45,104.00 $38,541.92 0%C 470 Fracture HHA 2 $16,863.51 $33,728.00 $33,728.98 0%C 470 Fracture SNF 10 $37,725.10 $33,782.50 ($39,425.98) 30%C 470 Fracture Self-Care 2 $32,461.23 $33,728.00 $2,533.55 50%C 470 Non-Fracture HHA 2 $17,178.36 $18,296.00 $2,235.29 0%C 470 Non-Fracture Self-Care 1 $16,720.65 $18,296.00 $1,575.35 0%

19 $30,454.94 $32,517.53 $39,189.11 21%

158 $19,992.70 $20,466.77 $74,901.73 6%

TOTAL PHYSICIAN A

TOTAL PHYSICIAN B

TOTAL PHYSICIAN C

TOTAL

Top 3 physicians for Performance Year 2

Post Acute Dashboards

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Claimrole Provider Volume Total PaymentAvg Payment

per Episode Days/VisitsAvg Days/Visits

per EpisodeCost per Unit(Days/Visit)

Percent DirectReadmissions

DirectReadmissions Star Rating*

HHA A 45 $127,264.18 $2,828.09 454 10.09 $280.32 0% 0 5.0HHA B 23 $75,203.92 $3,269.74 442 19.22 $170.14 0% 0 3.0HHA C 7 $14,559.40 $2,079.91 47 6.71 $309.77 0% 0 5.0HHA D 6 $20,483.95 $3,413.99 125 20.83 $163.87 0% 0 2.5HHA E 5 $19,916.40 $3,983.28 155 31.00 $128.49 20% 1 2.0HHA F 4 $12,550.83 $3,137.71 133 33.25 $94.37 0% 0 2.5HHA G 3 $9,043.21 $3,014.40 80 26.67 $113.04 0% 0 2.5HHA H 3 $12,887.65 $4,295.88 96 32.00 $134.25 0% 0 3.0HHA I 2 $6,650.63 $3,325.31 25 12.50 $266.03 0% 0 5.0HHA J 2 $6,396.88 $3,198.44 39 19.50 $164.02 0% 0 3.0HHA K 2 $5,371.54 $2,685.77 30 15.00 $179.05 0% 0 1.5HHA L 2 $7,263.20 $3,631.60 42 21.00 $172.93 0% 0 3.5HHA M 2 $6,089.61 $3,044.80 21 10.50 $289.98 0% 0 2.5HHA N 1 $2,164.31 $2,164.31 6 6.00 $360.72 0% 0 2.5HHA O 1 $2,843.77 $2,843.77 11 11.00 $258.52 0% 0 .HHA P 1 $2,065.12 $2,065.12 7 7.00 $295.02 100% 1 4.0HHA Q 1 $2,327.65 $2,327.65 29 29.00 $80.26 0% 0 4.5HHA R 1 $2,860.86 $2,860.86 11 11.00 $260.08 0% 0 3.0HHA S 1 $3,594.52 $3,594.52 22 22.00 $163.39 0% 0 3.0

IP Rehab AA 1 $15,903.11 $15,903.11 12 12.00 $1,325.26 0% 0 .SNF AAA 41 $124,376.78 $3,033.58 310 7.56 $401.22 0% 0 5.0SNF BBB 4 $63,901.82 $15,975.46 141 35.25 $453.20 0% 0 1.0SNF CCC 2 $13,810.80 $6,905.40 27 13.50 $511.51 0% 0 4.0SNF DDD 2 $6,129.60 $3,064.80 15 7.50 $408.64 0% 0 4.0SNF EEE 2 $12,411.85 $6,205.92 33 16.50 $376.12 0% 0 2.0SNF FFF 1 $26,566.54 $26,566.54 70 70.00 $379.52 0% 0 2.0SNF GGG 1 $19,612.34 $19,612.34 80 80.00 $245.15 100% 1 3.0SNF HHH 1 $8,196.00 $8,196.00 19 19.00 $431.37 0% 0 1.0SNF III 1 $9,925.26 $9,925.26 41 41.00 $242.08 0% 0 1.0SNF JJJ 1 $26,832.25 $26,832.25 57 57.00 $470.74 0% 0 4.0SNF KKK 1 $19,313.29 $19,313.29 42 42.00 $459.84 0% 0 4.0SNF LLL 1 $2,646.19 $2,646.19 7 7.00 $378.03 0% 0 4.0SNF MMM* 1 $80,806.93 $80,806.93 20 20.00 $4,040.35 0% 0 .SNF NNN* 1 $13,287.69 $13,287.69 28 28.00 $474.56 0% 0 2.0SNF OOO* 1 $13,019.34 $13,019.34 7 7.00 $1,859.91 0% 0 .

*INDICATES A CRITICAL ACCESS HOSPITAL SWING BEDDirect Readmission for SNF/IP Rehab is when the discharge day of SNF/IP Rehab equals admit date of an acute inpatient claimDirect Readmission for HHA is an acute inpatient claim during a HHA claim

Goal: Home Health 2 weeks of PT Only, 3 Visits Per Week, Transition to Outpatient

Expectation: Inpatient for Medical Necessity Only, 5-7 Days + Daily Weekend PT

Non-Fractures Only for Performance Year 2

Right Care, Right Time1. Standardized, evidence-informed clinical protocols

a. Use fewer disabling medicationsb. Ambulate patients early and oftenc. Eliminate/Reduce use of Foley Catheters

2. Risk Stratificationa. Patient Expectations – Post Acute Setting

Prediction Toolb. MRSA/MSSA Screening & Decolonization

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Post Op Pain Management: Multimodal + Continuous Adductor Canal Block

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Coordination Across the Continuum1. Engage Post Acute Providers

a. Quarterly Community Meetingsb. In-services on CJR

2. Develop / Implement Clinical Protocolsa. Transitional Care Nurseb. Outpatient, Home Health, & SNF Pathways

(Electives: PY1 CJR 65% going to SNF, PY2 65% going home)

3. Incentivize Collaborationa. Preferred Provider Network

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Value Based Partners Initiative

Initiated: FMOL Health System LevelFocus: Health Leaders Network (HLN) ACONeed: High Quality & Cost Efficient Post Acute Providers

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Value Based Partners Initiative Timeline

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Value Based Partners Initiative

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Application Data Elements:• Hospital Admission Rate• Emergency Room Visit Rate• Follow-up Appointment with MD• Admits Patients on Weekends &

Evenings• Prevention of Harm• Average Number of Recertification's• Oasis Assessment• Patient Satisfaction• Reimbursement per Beneficiary• Fall Rate• UTI Rate

Thank you for your time!Questions?

Email: [email protected]

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Questions & Answers

• Use the Chat pod to submit any questions

• Please use “@” if question is directed to a specific presenter

• “Raise your Hand” to ask a question verbally

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Poll

Are you using data to drive improvement in your organization? [Select one option]• Yes• No• I don’t know


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Summary & Reflection


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Leaving in Action

• Please respond into word cloud:– What new information have you identified today that

you will continue to think about and work on throughout the next month?

Comprehensive Care for Joint Replacement Model 25

Announcements & Reminders


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Continue Discussion on CJR Connect

• Join the Discussion!o Engage with your peers on CJR Connect by liking and commenting on their

posts• If you would like to ask a question of your peers or today’s speakers, you can:

o Go to the Groups tab, select “CJR All” and post your question in the group, OR

o Go to the Chatter tab, type a message into the open text box using the new “Post to All” feature.

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Upcoming Events

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If you have any questions about these events, send an email to [email protected].

Risk Stratification Affinity Group Session 4 June 27, 20182:00 – 3:00 PM EDT

Lessons Learned from the CJR Care Navigation and Risk Stratification Affinity Groups

July 12, 20182:00 – 3:00 PM EDT

mailto:[email protected]

Reminders

• Send any questions to [email protected].

• To request a CJR Connect account, go to: https://app.innovation.cms.gov/CJRConnect/CommunityLoginand click “New User? Click Here.”

• Please take a few minutes to respond to the Post-Event Survey!

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mailto:[email protected]

https://app.innovation.cms.gov/CJRConnect/CommunityLogin

Documents

Using Data to Drive Improvement€¦ · Operating Physician DRG Fracture First PAC Episode Count Average Net Episode Payment Average Target Amount Variance To Target Percent of Episodes