CCSC “Pathway to Home” for Care Transition Support

1. CCSC “Pathway to Home” for Care Transition Support A Marketing Program to Create Referral Opportunities Session 1 of 3 part program

2. The Program • “Pathways to Home” Care Transition Support is a program “branded” to CCSC and their affiliates • The program is designed to help members capitalize on the increasing attention put on patients being readmitted into a hospital within 30 days after a prior stay • The program is designed to provide you with the tools you need to be successful in marketing this program

3. The program and training • Three training sessions • First : Definition of the problem, technical information and background, starting your initial research • Second: Program details • Third: Marketing the program…from A to Z • Tools • Discharge guide for patients • Sales tools

4. So lets get started!

5. The “Readmission” Opportunity • Hospitals are being financially hit starting very SOON by having patients readmitted into the hospital 30 days after they are discharged. • Part of 2010 “Affordable Care Act” • This means that Hospitals are looking at strategies to help patients stay out of the hospital after they are discharged. • This offers an opportunity for your agency!

6. Step 1: Understand the terms being used and what is occurring

7. 2010 Affordable Care Act • Here are some the concerns that the Affordable Care Act is trying to correct: • Hospitalizations are costly, accounting for 30% of total healthcare spend • 37% of Medicare spend • 18% of Medicare patients discharged from hospitals are readmitted within 30 days of discharge. • Associated Cost:$15-17 Billion per year

8. ….and do understand that… • Some Readmissions are planned! • Such as follow-up to surgery or procedure • And some unplanned readmissions will always occur, not matter what the efforts

9. Hospital Readmissions Reduction Program • Part of CMS Inpatient Prospective Payment System • Will eventually reduce hospital’s Medicare reimbursement by 2% • The Hospital Readmissions Reduction Program is a penalty-only plan designed to retrieve payments from hospitals that have received additional revenue associated with readmitted patients. • Unlike CMS’s other high-profile quality initiative, the Hospital Inpatient Value-Based Purchasing Program, which allows high-performing hospitals to earn a bonus payment!

10. So…Here’s what is happening now…. • Hospitals with higher-than-average 30-day risk-adjusted readmission rates for • heart failure • acute myocardial infarction • pneumonia cases between July 1, 2008, and June 30, 2011, will receive reduced Medicare payments starting in FY 2013, capped at a maximum of 1% of inpatient payments.

11. …and here is what will happen in the future • The penalties will increase in subsequent years to a maximum of 2% of inpatient payments in FY 2014 and 3% from FY 2015 onwards. • Diseases they will be penalizing on will also increase.

12. What counts as a readmission

13. Who will this affect and how much? • Approximately three quarters of all hospitals are line for some penalty • About 2300 of 3100 hospitals involved in this program will see some penalty • Average penalty will be about 0.30% of inpatient payments • 60% of hospitals will see payment reductions of $10,000 to $500,000 • Average penalty in terms of dollars per facility will be $88,000 • The average Medicare payment for a preventable readmission totaled approximately $7,200

14. Step 2: Do your research on your local hospitals

15. Researching Hospital Readmission rates in your area • Readmission rates are posted for hospitals on the “Medicare Hospital Compare Quality of Care” website • www.hospitalcompare.hhs.gov • Search by your zip to see results of all the hospitals in your area: • Will let you compare 3 hospitals at a time • You will want to click on “Outcomes of Care Measure” • You will want to click on the “View Graphs” THIS SITE WILL HELP YOU IDENTIFY HOSPITALS IN YOUR AREA THAT ARE EXPERIENCING THE MOST PAIN, BUT ALL HOSPITALS ARE PAYING CLOSE ATTENTION TO THESE MEASURES.

16. The Hospital Compare Website

17. Results of a search in my area

18. After you have identified hospitals in your area….identify who you will call on in your hospital • Who will be most aware of readmission rates? • Utilization Review and /or case management department head • CEO or C suite executives • Finance Related executives • “Charge Description Manager” • Vendor Compliance ( or even Purchasing) • Care Transition Coach • Performance Management Exec • “Pilot” projects or special projects on readmissions (Rns’) • Continuous quality improvement staff or Quality Improvement Director • ACO contracting specialist Hint: Go on Hospital Websites to see if they list “leadership” contacts. Look to “news or press releases” on websites as ways to capture a key contact name.

19. Step 3: Understand the reasons for readmissions and the patients that may be most involved with unplanned readmissions

20. “Research shows a strong link between attention to care transitions and lower readmission rates. When patients move from the hospital to the next site of care - be it their home or a nursing home, rehabilitation facility, or a hospice, they benefit from having a clear treatment plan they can understand and follow, providers who are aware of and are able to carry out the plan and access to the right medications and support services. “-”Reducing Hospital Admission: Lessons from Top Performing Hospitals”, April 2011, Sharon Silow-Carroll, Jennifer N. Edwards and Aimee Lashbrook, Health Management Associates

21. What factors affect readmission rates • Fragmented systems of care • Lack of PCP or Primary Care physician or a “medical home” • Increases specialization prohibits providers ability to treat and manage patients with multiple conditions • Sometimes older adults will see as much as 16 physicians a year! • Increase of use of Hospitalists • Lack of understanding of discharge plans or inability to appropriately self manage their care • No follow up care visits with PCP

22. Who are the patient’s with the highest risk for readmission • Patients with multiple conditions • Patients who are on multiple NEW prescription medications • Patients who suffer from CHF • Patients who suffer from end stage renal disease • Patients who suffer from Alzheimer’s or other forms of dementia • Patients who lack appropriate family support

23. Step 4: Understand the steps some hospitals are taking now to lower readmissions

24. Hospital activity • Looking at improving their discharge planning • Engaging in “predictive modeling” activities to identify high risk patients • Creating Care Transition Coaches • Utilizing telemonitoring devices • Developing more formal relationships with PAC providers

25. Getting ready to approach hospitals • Do your home work • Create a list of hospitals in your area • Know where hospitals stand in comparison to others in avoidable readmissions • Start to develop potential contacts/departments within hospital • Know the terms

26. Hospitals Readmission Pain • Hospitals historically have not had to be very concerned about what happened to a patient once they left the walls of their facility….now they do! • Hospitals will be looking to Home Health Care and Home Care Companies to provide ideas and programs

27. Questions?

28. Next session • We will talk about “Pathways to Home” features and how they connect with issues hospitals are facing.