Patient Re-Admissions
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This document discusses patient re-admissions and strategies to reduce them. It defines a hospital re-admission as an admission within 30 days of discharge from the same or another hospital. Nearly 20% of Medicare hospitalizations result in re-admission within 30 days, with heart failure, myocardial infarction and pneumonia having some of the highest re-admission rates. The Affordable Care Act established the Hospital Readmissions Reduction Program to reduce payments to hospitals with excess re-admissions. Common reasons for re-admission include medication errors and failure to follow up with a physician. Various organizations are working on initiatives to improve care transitions and reduce preventable re-admissions.
Patient Re-Admissions
- 1. Pa#ent Re-‐Admissions-‐ How are you Controlling? Wednesday, July 23, 2014 Disclaimer: Nothing that we are sharing is intended as legally binding or prescrip7ve advice. This presenta7on is a synthesis of publically available informa7on and best prac7ces.
- 2. • CMS defines Hospital Re-‐admission as: – Admission to a sub sec9on hospital with-‐in 30 days of discharge from the same or another sub-‐ sec9on of the hospital What is a Hospital Re-‐Admission?
- 3. • Agency for HealthCare Research and Quality Reported: – Nearly 20% of Medicare hospitaliza9ons followed by readmission with-‐in 30 days – 90% of readmissions unplanned • Medicare Payment Advisory Commission reported: – 4.4 million Medicare hospital readmissions may be preventable – Translates to 75% of readmissions – Implementa9on of Hospital Readmissions Reduc9on Program has impacted the reported outcomes hRp://healthcare-‐execu9ve-‐insight.advanceweb.com/Web-‐Extras/ Long-‐Term-‐Care-‐Feature/Best-‐Prac9ces-‐for-‐Reducing-‐ Readmissions.aspx Quick Facts
- 4. • The JAMA study reported the following outcomes: – 24.8% of HF pa9ents readmiRed – 19.9% of MI pa9ents readmiRed – 18.3% of pneumonia pa9ents readmiRed hRp://jama.jamanetwork.com/ar9cle.aspx? ar9cleid=1558276#qundefined • JAMA (The Journal of American Medical Associa9on) conducted a study from 2007-‐2009 for Medicare beneficiaries reviewing readmissions for pa9ents with heart failure, myocardial infarc9on, and pneumonia Pa9ent Readmission Sta9s9cs
- 5. • Sec9on 3025 of Affordable Care Act establishes the Hospital Readmissions Reduc9on Program – Requires CMS to reduce payments to IPPS Hospitals with excess admissions – Effec9ve for discharges beginning October 1, 2012 Background
- 6. • Adopted readmission measures for condi9ons – Acute Myocardial Infarc9on – Heart Failure – Pneumonia • Established methodology to calculate excess readmission ra9o • Established policy of using risk adjustment methodology • Established applicable 3 years of discharge data and the use of a minimum 25 cases to calculate hospital excess readmission ra9o CMS Re-‐Admission Measures
- 7. CMS Payment Adjustment Process • CMS determines which hospitals subject to Hospital Readmissions program • Determines methodology to calculate hospital readmission • What por9on of IPPS payment is used to calculate readjustment payment amount • Process for hospitals to review readmission data and submit correc9ons before rates made public
- 8. CMS Formulas to Calculate the Readmission Adjustment Factor
- 10. Aggregate payments for excess readmissions
- 11. Ra9o
- 12. – For FY 2013, the higher of the Ra9o or 0.99 (1% reduc9on – For FY 2014, the higher of the Ra9o or 0.98 (2% reduc9on) – For FY 2015, the higher of the Ra9o or 0.97 (3% reduc9on) Readmission Adjustment Factor
- 13. Formulas to Compute the Readmission Payment Adjustment Amount
- 14. Wage-‐adjusted DRG opera9ng amount
- 15. Base Opera9ng DRG Payment Amount
- 16. Readmissions Payment Adjustment Amount
- 17. • CMS Proposing Rule to include 2 addi9onal readmission measures in 2015 – COPD – THA/TKA 2015 CMS IPPS Proposed Rule
- 18. • HealthCare Market Resources site 2 most common reasons for Hospital Re-‐admission – Medica9on Errors – Failure to see a physician – Strategies to reduce • Supervised home care visits aker discharge Common Reasons for Re-‐Admission
- 19. What are other organiza9ons Doing?
- 20. • The Agency for HealthCare Research and Quality advocates the use of a PSO Program – U9liza9on of Common Formats • Available for hospitals to review 30 day readmissions – RED (Re-‐engineered Discharge) • Free toolkit used to reduce readmissions by encouraging beRer communica9on between pa9ents and clinicians – Project Boost • Provides resources to reduce readmissions in elderly popula9on – PSNET (Pa9ent Safety Network) • Shows how problems in hospital discharge process can lead to hospital readmissions – STAAR(State Ac9on on Avoidable Rehospitaliza9ons) Ini9a9ve • Mul9state effort to improve care transi9ons Pa9ent Safety Organiza9on Program
- 21. – The Mayo Clinic’s Knowledge and Evalua9on Research Unit focusing on the assessment of pa9ent capacity – Resources pa9ent has available when they discharge – Physical and mental Limita9ons Assessment of Pa9ent Capacity
- 22. – Support Na9onal Quality strategy focus on improving cardiovascular Health – Use payment and reimbursement mechanisms to encourage delivery of clinical preven9ve services – Expand use of interoperable HIT – Support implementa9on of community based preventa9ve services – Reduce risk barriers to accessing clinical and community preventa9ve services – Enhance coordina9on and integra9on of clinical, behavioral, and complementary health strategies. Clinical and Community Preven9on Services Recommenda9ons
- 23. – A study conducted at Cleveland Clinic suggests a 3-‐step mini-‐ cog quiz completed by heart failure pa9ents at discharge may predict who will be readmiRed or die with-‐in 30 days – Mini-‐cog tested for correla9on to heart failure pa9ents – Research concluded 23% of heart failure inpa9ents who completed mini-‐ cog had a high likelihood of cogni9ve impairment – 30 day re-‐admission and mortality rate for pa9ents with high cogni9ve impairment score were twice the norm with a rate at 47% – Study recommenda9ons » Evaluated discharge loca9ons » Structured in home support » Incorporate Mini-‐Cog test into Care rou9ne hRp://my.clevelandclinic.org/media_rela9ons/library/ 2014/2014-‐3-‐29-‐cleveland-‐clinic-‐study-‐finds-‐simple-‐test-‐of-‐ pa9ent-‐cogni9on-‐may-‐predict-‐heart-‐failure-‐readmissions.aspx Mini Cog Quiz Study
- 24. – Select group of Medicare pa9ents in AZ receiving trackers in their inhalers to determine how oken medica9ons is used – Study hopes to iden9fy pa9ents at earliest stage of aRack of exacerba9on with COPD – Sensors monitor medica9on usage and send loca9on and data to smartphone app – If pa9ents using medica9on more frequently or a rescue inhaler u9lized alert sent to caregiver Mobile Aps and Sensors
- 25. – Improve communica9on • U9lize strong interac9ve communica9on • U9liza9on of EHR’s and HIE’s – Support Care transi9ons through • Expanding care beyond medical community – Transporta9on Services – Meal Prepara9ons – Cleaning Services – Follow up care • Missed follow up appointments aker discharge hRp://healthcare-‐execu9ve-‐insight.advanceweb.com/Web-‐Extras/Long-‐Term-‐Care-‐ Feature/Best-‐Prac9ces-‐for-‐Reducing-‐Readmissions.aspx Best Prac9ces
- 26. Parallel Coordina9on of Care • Dr. Eiran Goronoski former director of Heart Care at home is advises to focus on the pa9ent as apposed to the condi9ons for readmission – Proposes partnership with quality skilled nursing facili9es • 17% of all pa9ents go to a SNF – Parallel solu9ons for care coordina9on “A pa9ent centered, rather than a condi9on centered, mindset in the midst of care transi9ons is key” hRp://www.beckershospitalreview.com/quality/when-‐ readmission-‐programs-‐fail-‐what-‐s-‐next.html