Join us for a Webinar on Wednesday January 25

Space is limited.

Our past webinars with The Advisory Board Co. have been very well attended and, according to attendees, incredibly valuable. Don’t miss this opportunity to get the latest thinking on preventing avoidable readmissions.

Reserve your Webinar seat now at:
https://www1.gotomeeting.com/register/518577609

Join The Advisory Board and ReInforced Care for a free 60-minute Webinar.  During this time we will discuss the roadmap on how to build a readmission prevention strategy and coordinate care for complex patients across the continuum. The Webinar will focus on the following areas:

• Leveraging analytics to target resources
• Re-designing inpatient processes
• Securing prompt post-discharge provider access
• Building cross-setting relationships
• Assuring a smooth transition home with timely follow-up
• Aligning stakeholder incentives

Register today to hear real life examples and best practices for adopting a principled approach to reducing avoidable rehospitalizations.

Featured presenters:

Katherine Virkstis, ND
Senior Consultant with the Nursing Executive Center at The Advisory Board Company

Patricia Vida, RN, MBA
Vice President of Innovation at ReInforced Care

All Webinar attendees will be registered in a raffle for an iPad 2.

The Webinar will be hosted and sponsored by ReInforced Care.

Visit the original blog post here.

–Pat Vida, RN, MBA, VP of Innovation, ReInforced Care

–Pat Vida, RN, MBA, VP of Innovation, ReInforced Care

Article in FierceHealthcare

Simple, improved discharge care cuts readmissions
By Alicia Caramenico
Following recent data that discharge instructions boost patient satisfaction comes proof that improved discharge care can reduce hospitals’ readmission rates.

Thanks to an initiative that centered on educating and following up with patients after they leave the hospital, Charleston Area Medical Center (CAMC) has seen readmission rates of heart failure and pneumonia patients plummet, reports the Daily Mail.

In April and May of this year, 10.64 percent of heart failure patients were readmitted to the West Virginia hospital within 30 days of discharge, down from 24.54 percent in the first quarter, according to CAMC Chief Quality Officer Dale Wood, the article notes.

Moreover, the hospital readmitted 4.4 percent pneumonia patients in April and May, a significant drop from the 11.11 percent readmitted in the first quarter.

Wood credits the success to simplifying discharge instructions; giving patients handouts with important reminders, such as taking their medications, visiting their doctor within 14 days of their discharge, monitoring their weight; and making follow-up calls to patients with a simple phone survey.

As hospitals look to cut avoidable hospitalizations and associated costs, more institutions are starting to amend their discharge processes. For example, the Colorado Hospital Association and UnitedHealthcare yesterday launched a two-year initiative designed to improve patient knowledge about their follow-up care, reports 9 News.

Sixteen participating healthcare facilities are developing safeguards and other protocols after they release patients from the hospital, Dr. Christopher Stanley, the senior medical director of UnitedHealthcare of the Rocky Mountain Region, told 9 News. Those protocols include education on how to take prescribed medicines and when to make follow-up appointments with doctors.

Stanley hopes the improved discharge process will empower patients to take a more active role in staying healthy once they’re home, reducing the likelihood of complications or adverse events after discharge, and ultimately hospital readmissions.

For more:
- read the Daily Mail article
- read the Spokane Journal of Business article
- here’s the 9 News article

The Advisory Board’s Brandi Greenberg just published an excellent overview of Value-Based Purchasing. For our readers’ edification and convenience, we reproduce her introduction here and have provided a link to the PDF.

–sk

Health Care Industry
Committee Program Director

Brandi Greenberg

Value-Based Purchasing Overview

Given recent buzz about the Hospital Value-Based Purchasing (VBP) Program and Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) Measures, we wanted to call out the topic in this month’s director’s message by providing our industry members with basic insight on what exactly the program entails, how it is designed to work and what it means for you. We hope this primer helps your teams gain some familiarity with VBP and HCAHPS Experience of Care measures, particularly those who may not have had extensive exposure to date.

Staffing, outsourcing and management firms have an essential role to play in impacting hospitals’ performance scores, which are partially determined by 8 Experience of Care measures. Three measures of note are “communication with nurses,” “communication with doctors,” and “responsiveness of hospital staff.” To see the full list and learn how these opportunities could impact your strategy, click here.

What is the Value-Based Purchasing Program?

The Hospital Inpatient Value-Based Purchasing (VBP) program is required by the Patient Protection and Affordable Care Act (PPACA) and will impact how hospitals get paid for care provided. VBP is essentially a pay-for-performance program that uses incentives to motivate hospitals to achieve high performance on a group of clinical and service quality metrics. While service quality (also called patient experience /satisfaction, or service excellence) has always been a priority for nurse leaders, other members of the c-suite are now also concerned about it because it will impact reimbursement. Value-Based Purchasing has become a CXO-level issue because acute care hospitals are at risk of losing up to 1% of their Medicare payments if they do not perform well against these measures.

How does Value-Based Purchasing Work?

Under VBP, CMS will withhold 1% of all inpatient Medicare payments from qualifying hospitals in 2013 (approximately $275K for the average hospital). This withhold will gradually increase to 2% of Medicare payments by 2017. CMS will then restribute these withheld payments based on each hospital’s Total Performance Score (TPS), which is calculated by performance on 12 Care measures (quality) and 8 Experience of Care measures (patient satisfaction). An organization’s TPS is determined by its overall performance against national benchmarks as well as its improvement over previous scores. Patient satisfaction measures account for 30% of the TPS, and quality measures determine the remaining 70%. This 30/70 structure means that patient satisfaction measures can help to offset lower scores in quality measures and vice versa. Advisory Board analysis indicates that roughly half of all program participants will earn back less than the original 1% withhold (a loss), and half will earn back more (a bonus). In other words, a hospital needs to perform above the median in order to break-even.

To continue reading, download the pdf.

The readmissions issue is far from new; however, the fact that readmissions are going to create financial penalties for hospitals is new.  This has been on the table for a while now and the time for the actual penalties is getting close enough to worry everyone.  Although the hospital is not the only provider involved in the patient’s care it does seem by many to be the most capable of organizing a strategy to reduce the likelihood of readmission.  Many organizations have already started to develop their plans.  There is no one “magic bullet”.

The studies are clear that in order to reduce the risk of readmission, patients need to take their medications, follow-up with their physicians and better manage their health.  Easily said, but not so easily accomplished.  Patients are often ill-equipped to accomplish these goals.  Often patients are faced with the lack of knowledge, funds or support. In order to assist patients, organizations are working on programs to assure that the patients are taught at an appropriate learning level and that they can reiterate what they have learned.  In addition it is becoming clear that once the patient leaves the hospital other issues can get in the way.

Following up with patients after discharge is becoming a “must do”, rather than a “nice to do”.  If the patients are having trouble completing their discharge plan, someone needs to be made aware of this in order to assist them.  If no one reaches out to the patient it may go undetected.  Our program goal is to reach as many patients post discharge as possible to assess their situation and to coach them through the transition.  With a contact rate of over 88% we have the ability to influence the patients care continuum beyond the walls of the hospital into their homes.  We can do this cost effectively because this is our “core competency.”  As a partner with the hospital we can blend their care guidelines and our communication skills to reduce the risk of readmission and to improve the patient’s experience.

Please contact us to learn more.

–Pat Vida, RN, MBA, VP of Innovation, ReInforced Care, Inc.

Link to original Washington Post article

Medicare rule would decrease payments to hospitals with high re-admission rates

By Jordan Rau, Published: July 30

When hospitals discharge patients, they typically see their job as done. But soon they could be on the hook for what happens after Medicare patients leave the premises, and particularly if they are re-admitted within a month.

In an effort to save money and improve care, Medicare, the federal program for the elderly and disabled, is about to release a final rule aimed at getting hospitals to pay more attention to patients after discharge.

A key component of the new approach is to cut back payments to hospitals where high numbers of patients are re-admitted, prodding hospitals to make sure patients see their doctors and fill their prescriptions.

Medicare also wants to pay less to hospitals with higher-than-average costs for patient care. It has proposed calculating the costs by combining a patient’s hospital expenses with fees incurred up to 90 days after discharge.

The efforts, called for in last year’s health-care law, are part of a push to make hospitals the hub for coordinating care. Hospital care is the largest chunk of Medicare spending; Medicare says re-admissions alone cost $26 billion a decade. Plus, many experts argue that hospitals are the most organized actors in a splintered and often dysfunctional health system and thus best able to take the lead in overseeing patient care.

Hospitals’ objections

Hospital groups complain that Medicare’s plans could punish them for things they cannot control, such as unavoidable re-admissions and patients who cannot afford the costs of prescriptions.

“A lot of this is very unfair,” said Blair Childs, a vice president at Premier, an alliance of more than 200 hospitals.

He said hospitals that do not have a lot of money to invest in improving their oversight of former patients could end up losing more money under Medicare’s proposals, putting them in an even bigger financial hole. In particular, he said, the changes may hurt inner-city hospitals.

“These are often very stressed hospitals, and they’re the ones that are going to be penalized the most,” Childs said.

Some academics who have studied hospitals also think Medicare is potentially being too harsh.

“The truth is the 30-day re-admission is a relatively lousy quality measure for a hospital because a lot is happening outside a hospital’s control,” said Ashish Jha, a professor at the Harvard School of Public Health.

Medicare’s penalties could be significant — and widespread. Almost 7 percent of acute-care hospitals — 307 out of 4,498 — had higher-than-expected re-admission rates for heart failure, heart attack or pneumonia, according to Medicare data. Under Medicare’s draft proposal, which it put out in May, penalties would start in October 2012 and hospitals with the worst re-admission rates eventually could lose up to 3 percent of their regular Medicare payments.

Hospitals with patients who cost Medicare lots of money during and after their hospital stays also could be hurt. Beginning in October 2013, these spending levels would count for a fifth of Medicare’s “value-based purchasing program,” which alters hospital payments based on a long list of quality measures.

“The incentives we’re putting into place have created a whole new way to think about hospital care,” said Jonathan Blum, deputy administrator of the federal Centers for Medicare and Medicaid Services (CMS).

These initiatives come on top of other Medicare experiments that will make not just hospitals but also surgeons responsible for costs run up from complications that occur beyond the operating room. One approach is “bundled payments,” in which Medicare pays a set fee for the entire cost of a patient’s treatment, including expenses after discharge. And Medicare’s high-profile venture to create “accountable care organizations,” in which teams of doctors and hospitals share the financial risks and rewards for caring for patients, would also hold hospitals partially to account for the costs of treatments that patients get elsewhere.

CMS has limited leeway to tinker with the re-admissions rule, because much of it was spelled out in the health-care law. CMS has more freedom to change its plan to measure per-patient spending; the law did not detail how it should work.

‘Health-care managers’

Regardless of what CMS decides, many hospitals are already scrambling to change how they supervise former patients, said Chas Roades, chief research officer at the Advisory Board Co., a health-care consultancy.

“One of the big themes I’m hearing now across the hospital industry is, ‘We can no longer think of ourselves as just hospital companies. We have to be full-service health-care managers,’ ” Roades said.

Consider Trinity Health, which owns 50 hospitals around the country, including Holy Cross in Silver Spring. Before patients leave the hospital, Trinity’s nurses now set up appointments for them with their regular doctors. They also make sure patients can get to the appointment, by helping them figure out whether Medicare or Medicaid pays for transportation or by paying for the trips directly.

“We’re trying to do a better job of sending them home better prepared rather than just saying good luck,” said Terry O’Rourke, Trinity’s chief clinical officer. But he said there are limits to what they can do.

“The majority of physicians are not employed by the hospital,” O’Rourke said, “and we don’t have control over their practices.”

Kavita Patel, a Brookings Institution fellow and former Obama administration official, said changes occurring in both the private sector and Medicare will speed up the trend of hospitals’ overseeing the care of former patients.

For example, she said, many hospitals are buying the practices of primary-care doctors, making it easier for them to arrange and oversee the care of patients after discharge.

“The more hospitals realize they’re going to be held accountable, that’s where they are going to get creative,” Patel said.

Rau is a senior correspondent with Kaiser Health News. KHN, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health-care-policy organization that is not affiliated with Kaiser Permanente.

The Ashland, MA-based ReInforced Care has been proactively communicating to selected South Shore patients for over a year, providing valuable data to the Hospital on how well patients follow their discharge plans, make and keep follow-up appointments with caregivers, and obtain and take prescribed medications. The program also provides valuable, actionable feedback on the patient’s experience in the hospital.  During the initial period of selective outreach, readmission rates of those contacted were reduced by over 13%. The new contract will expand the program to all discharged patients aged 50 and over.

The ReInforced Care PM360™ program gives patients an increased level of satisfaction with their care; satisfaction which is measured both directly and in feedback provided to third-party patient experience surveys. In addition, a comprehensive offering of data and analysis provides the Hospital with a critical window of visibility into internal care processes; enabling important changes and adjustments which both improve the quality of care and reduce unnecessary readmissions, which have a negative impact both psychologically and financially.

–Pat Vida, RN, MBA, VP of Innovation, ReInforced Care

Link to original article

Our Take: The clock is ticking to the beginning of the penalties for 30 day readmissions. The Advisory Board has developed a great tool for assessing your hospital’s risk. It is definitely worth reviewing. ReInforced Care can reduce your risk through our Patient Experience Management System. Contact us today to learn more.

– Pat Vida, RN, MBA, VP of Innovation, ReInforced Care

–Pat Vida, RN, MBA, VP of Innovation, ReInforced Care

News Release

Up to $500 million in Affordable Care Act funding will help health providers improve care

Partnership for Patients announces Federal contracting opportunities

The U.S. Department of Health and Human Services (HHS) announced that up to $500 million in Partnership for Patients funding will be available to help hospitals, health care provider organizations and others improve care and stop millions of preventable injuries and complications related to health care acquired conditions and unnecessary readmissions. This funding, made available by the Affordable Care Act, will be awarded by the Centers for Medicare & Medicaid Services (CMS) Innovation Center through a solicitation and other procurements for federal contracts announced today.

“Since the Partnership for Patients was announced, we have had an overwhelming response from hospitals, doctors, employers, and other partners who want to be a part of this historic effort to improve patient safety,” said CMS Administrator Donald M. Berwick, M.D. “We are now looking to contract with local and statewide entities that can foster and support hospitals’ efforts to improve health care and reduce harm to patients.”

The Partnership for Patients is a new public-private partnership that will help improve the quality, safety, and affordability of health care for all Americans. The Partnership’s two goals arereducing harm in hospital settings by 40-percent and reducing hospital readmissions by 20- percent over a 3-year period. To achieve these goals, the Partnership is seeking to contract with large health care systems, associations, state organizations, or other interested parties to support hospitals in the hard work of redesigning care processes to reduce harm. “Hospital Engagement Contractors” will be asked to conduct the following:

• Design intensive programs to teach and support hospitals in making care safer;
• Conduct trainings for hospitals and care providers;
• Provide technical assistance for hospitals and care providers; and
• Establish and implement a system to track and monitor hospital progress in meeting quality
  improvement goals.

In addition to the Hospital Engagement Contractors, CMS will also be working with other contractors to develop and share ideas and practices that improve patient safety. These efforts include work with patients and families to understand their thoughts on how to best improve patient safety and transitions between different health care settings – such as when a patient is discharged from a hospital to a nursing home.

These contracts make available the first round of funding – which will ultimately total up to $500 million – that the Innovation Center has committed to this effort. Solicitations for proposals are available on the Federal Business Opportunities website at: www.fbo.gov.

When the Partnership for Patients was announced, the Obama administration committed up to $1 billion in Affordable Care Act funding to help achieve the two goals. At the time of the announcement, up to $500 million was made available through the Community-based Care Transitions Program to ensure patients safely transition between settings of care (access the Transitions Program solicitation here).Today’s announcement makes available the start of $500 million additional Innovation Center funds to help reduce health care acquired conditions and reduce unnecessary readmissions.
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Note: All HHS press releases, fact sheets and other press materials are available at http://www.hhs.gov/news.

Last revised: June 22, 2011

Here’s the relevant excerpt, but we urge you to read the blog directly on an ongoing basis.

THURSDAY, JUNE 09, 2011