NoCVA Preventing Avoidable Readmissions: Data Review

1. NoCVA Preventing Avoidable Readmissions: Data Review

2. Agenda Data manual Reading your monthly report Process measures Outcome measure HCAHPS RRI reports: cross-hospital readmit rates

3. Have you ever wondered? Where is NCQC getting my readmission rate? How does this readmission definition compare to CMS? When is my data due? When am I going to get a report from NCQC? When is the next data webinar? What are other hospitals asking about readmissions measurement in this collaborative?

4. Consider the lowly data manual… Located at: http://www.ncqualitycenter.org/engage-providers/hen-partnership-for-patients-overview/nocva-initiatives/readmissions-nc/reducing-readmissions-nc-resources/

9. Overview

11. Detailed timeline includes: • Data submission dates • Dates for data webinars • Estimated date you receive readmissions reports (NoCVA, CCNC)

12. What else is in the data manual? • Front: Overview of purpose & timelines • Middle: Information about each measure you are reporting • What to submit, how to submit it, and when. • Includes guidance on questions you may have, especially about process measures • End: Miscellany, e.g. FAQ sheet, how to use QDS, sample forms for monitoring performance.

14. Reading your monthly report

15. Reading your monthly report • Data is due on the 20th • Monthly reports are emailed on or around the 30th of the month to your project lead • Sent by secure email; check spam box.

16. Overview

21. Process Measures

22. Why do we have process measures? • Purpose is to guide improvement • Help identify opportunities & strengths • Make data-driven decisions as you decide what changes to make to patient flow, working with community partners, etc. • Provide feedback so you know if you have achieved reliability • It’s okay if the process measures are not at 100% in first month

23. Process Measures

24. Hospitals not yet entering data… The following hospitals don’t have any data in yet: Novant Franklin, Novant Rowan, VidantPungo, Vidant Duplin, Morehead Other hospitals have some, but not all, data in

25. CONGRATULATIONS to our data speedy-starters! Alamance Angel CFV-Bladen Carteret Duke Raleigh Vidant Edgecombe High Point Regional Iredell J. Arthur Dosher Lenoir McDowell New Hanover Novant Ortho Pender Vidant Roanoke Chowan Wayne

26. What do I do if my hospital doesn’t have a screening tool yet? • Hospitals should report all three process measures, even if they don’t have a screening tool yet. • Many hospitals are in this boat! • How to report? • Patients assessed at high risk of readmission. • Numerator=Number of patients assessed at high risk=0 • Denominator=All patients on unit • Other two process measures: Zero out of Zero • Numerator=Zero • Denominator=Zero

27. How to enter data if a hospital does NOT have a screening tool Percent of patients given an assessment for high risk of readmission Percent of high-risk patients whose care provider is informed within 48 hours Percent of high-risk patients who have a follow-up visit scheduled within 7 days NoCVA Hospital Engagement Network

28. Process Measures

29. % of patients given assessment for high risk of readmission • Measure asks for % given assessment, NOT % found to be at high risk • Target is 95% • Sampling permitted, but discouraged. • If sampling, sample must be >25 pts/month or 10% of patients, whichever is greater • Observation patients are included, if in your unit or population

30. VERY preliminary—does not reflect complete data.

31. Process Measures

32. Care provider informed of hospitalization within 48 hours If a patient does not have a PCP, they are still counted in this measure. Follow-up does NOT need to be with PCP, if another type of care provider is more appropriate.

33. Collaborative progress VERY preliminary—does not reflect complete data. Rates are high bcs non-reporters and those without a risk assessment tool are not included

34. Collab comparison chart • NoCVA will not show comparison data at this time bcs only four hospitals have identified those at high risk and are doing f/u with at least some of them! • Congratulations to the following four hospitals: • Duke Raleigh • Dosher • Vidant Roanoke-Chowan • Wayne

35. Process Measures

36. Follow-up appt within 7 days Follow-up is within 7 calendar days Patients who die while in hospital can be excluded from this measure Hospice, transfer to another facility or unit, AMA—these patients should still be included in your denominator.

37. Collab progress VERY preliminary—does not reflect complete data. Rates are high bcs non-reporters and those without a risk assessment tool are not included

38. How it’s really being done:Wayne and Vidant Roanoke-Chowan tell their stories

39. 1-30 day readmissions

40. 1-30 day readmission rate Readmissions for all causes Readmissions for all payers Within 1 to 30 days Not risk-adjusted

42. Overall collab progress

43. HCAHPS

44. Why HCAHPS? The changes you make to improve care transitions will result in lower readmissions scores AND better HCAHPS results. Connect the dots: Do patients see the changes you are making? We focus on four HCAHPS dimensions: communication w/nurses, communication w/doctors, communication about meds, discharge information Webinar in March w/national expert (Carrie Brady) will go in-depth on connection between patient experience and outcomes

45. All data from Oct11-Sept12

46. Coming soon! Cross-hospital readmission reports

47. Cross-hospital readmits Background on cross-hospital readmits Where to find your reports Some basic state-level results Invitation for your input

48. Readmissions: Background • Readmissions are common and costly • 1 of 5 Medicare patients is readmitted, costing $18 billion annually • Readmissions penalty program is expanding • FY 2013=1%; FY 2014=2% • FY 2014 national estimate= NEGATIVE 220 mil • FY 2014 NC estimate=NEGATIVE 7.7 mil, with 58 hospitals incurring a penalty • FY 2015: expansion to COPD and THA/TKA • Public reporting of hospital-wide readmission rates

49. How good is readmissions data? • Hospitals expressed frustration at the lack of all-hospital readmissions reporting. • SAME-hospital readmissions are easy to track • ALL-hospital readmission are much harder • National studies suggest average of 20% of patients readmit to other hospitals • This 20% makes a HUGE difference to hospital rankings.

50. NCHA’s RRI initiative • Goal: Develop a solution to match patients from one hospital to the next and provide more complete readmissions reporting for North Carolina hospitals. • Challenge: claims data does not include a stable identifier across hospitals. • Solution: NCHA worked with Truven to apply matching algorithm: • Multiple fields—Last name, first name, address, age, gender, zip, SSN, etc. to match patients • Both deterministic and probabilistic matches • Your CEO will get a letter soon!