Using Data to Drive Improvement
Comprehensive Care for Joint Replacement Model
June 14, 2018
Comprehensive Care for Joint Replacement Model
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
Comprehensive Care for Joint Replacement Model
Webinar Agenda
• Welcome
• Meeting Logistics
• St. Francis Medical Center Presentation
• Questions, Answers, & Discussion
• Announcements & Reminders
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Comprehensive Care for Joint Replacement Model
Meeting Logistics
• All telephone lines are muted• We encourage comments, questions, and
reactions via Chat• Participate!
– Chat– Polls– Post-Event Survey
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Introduction to Adobe Connect
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Comprehensive Care for Joint Replacement Model
Download Available Resources
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• Please share in Chat now:– Organization– State– A CJR improvement activity currently
in progress at your organization
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Comprehensive Care for Joint Replacement Model
St. Francis Medical Center Presentation
Comprehensive Care for Joint Replacement Model
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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
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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Comprehensive Care for Joint Replacement Model
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?
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Announcements & Reminders
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Continue Discussion on CJR Connect
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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
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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Comprehensive Care for Joint Replacement Model