Collaboration for Improved Clinical Outcomes

1. Collaboration for Improved Clinical Outcomes

2. Goals • Physicians and staff working as partner for patient care • Value of monitoring utilization of resources • Timely transitions: “Right level of care at the right time”

3. Readmission Focus • The Affordable Care Act of 2010 requires HHS to establish a readmission reduction program. • 20% of Medicare patients are readmitted to a hospital within one month of discharge • CMS’ goal to transition to value based purchasing--paying for care based on quality and not just quantity • Initial focus- AMI, CHF and pneumonia; 2015 possibilities- MedPAC recommendations of COPD, CABG and PTCA procedures, and other vascular procedures • Penalties- Oct 2012- 1%; Oct 2013- 2%; Oct 2014- 3%

4. Levels of Care

5. Breakdown of Inpatient Readmission Source Source: Health Care Financing Review| 2009 data

6. Current Industry Issues § Highly fragmented market of hospitals and PAC providers § Economic incentive for acute care providers to increase PAC patient volume and rapidly discharge § No coordination of patients over episode of care § No economic penalty for poor performance Medicare Policy is Rearranging the Post-Acute Landscape ____________________ Source: RTI International, 2009, “Examining Post Acute Care…” and Avalere Health, LLC, “Change in the SNF Marketplace” March 2012. Same Source for next slide

7. National Statistics 23% are Readmitted to Hospital 35% of Hospital Discharges are Admitted to Post- Acute for Additional Care (“Post-Acute Admissions”) 48% of Post-Acute Admissions go Home after Receiving Post-Acute Care 29% are Transferred to a Secondary Post-Acute Venue for Additional Care Medicare Statistics

8. 30-day Risk Adjusted Readmission Rates for a Portland Hospital Source: America Hospital Directory, 07/01/2008 to 06/30/2011 posted on 04/12/2013

9. Continuum of Care • Long Term Acute Care- MS DRGs • Skilled Nursing facilities- RUGs and per diem • Foster Home- per diem; Medicare not accepted • Home Health- DRGs • Hospice- per diem

10. What is a DRG? • Present- MS DRGs • MCC • CC • Non-CC • Future • Length of Stay • Short Stay • Long Stay • Medicare median

11. Opportunities • Improved clinical outcomes and patient satisfaction through coordination of care. • Right level of care at the right time for optimal patient care outcomes. • Partnerships for coordination of care

12. Thank You! Coming together is a beginning. Keeping together is progress.Working together is success. - Henry Ford