HLNDV Spring Institute 2014

1. HLNDV Spring Institute 2014 May 2, 2014, 1:15-2:45pmReadmission Session

2. New Jersey Gainsharing Project • Started with 11 hospitals in 2009 • Organized by NJHA • Needed to get a Stark Law exemption for the hospital to be able to share savings with physicians • All Medicare recipients (not managed Medicare) were included

3. The Mechanics • Payments were broken up into incentives for performance and improvement • Performance was based on the cost of care for the physician compared with the lowest 25 percentile cost of care for the State of NJ for the given APR-DRG • Improvement was based on the cost of care for that physician’s patients in the same APR-DRG’s in the 2007 base year

4. The Mechanics (cont.) • The original mix was to reward physicians 2/3 for improvement and 1/3 for performance, so that historically poor performers would have an incentive to improve. • The expectation is that most hospitals would eventually change the percentage more to performance over time • Hospitals were also allowed to put parameters on payments

5. The Caveats • To ensure that services were not cut unnecessarily, CMS required that all hospitals monitor quality parameters which had to include: • Hospital mortality • 7 day readmissions • 30 day readmissions

6. Our Mortality Data

7. Our Readmission Data--7 Days

8. Our Readmission Data 30 Days

9. Readmissions Interventions • Began a Readmissions Committee in July 2011 • Multi-disciplinary group including nursing, physicians, PT, Case Management, Home Health, and Hospice • Eventually, post –acute partners attended • Initial focus was on Medicare CHF patients • We improved our CHF patient education program

10. Readmissions Committee • Eventually we expanded the scope of the Committee to include all Medicare patients (really all patients) • At the same time, many of our PCP’s were applying for and obtaining certification as Primary Care Medical Homes

11. Interventions • Follow up calls were made by Clinical Nurse Leaders • Most focused on transmittal of information • NOA pushed out to PCP’s • Admission and Discharge Summaries pushed out to the PCP of record • Discharge Medication Reconciliation, Discharge Instructions and Universal Transfer Form are faxed to the PCP office

12. Interventions (continued) • Other interventions looked at better communication • Inpatient Care Managers and Care Coordinators in the Family Practice offices exchanged cell numbers • Established System where Hospitalists could leave voicemails for PCP’s

13. Interventions (continued) • Partnered with the Advisory Board Company to be a Beta site for software Crimson RealTime Readmissions • Using a proprietary algorithm, it assesses patients and assigns them to high, medium, or low risk of readmission • Recommends interventions—making appointments prior to discharge, follow up calls, pharmacy input into Med Rec, Home Health referral, giving new prescriptions prior to discharge

14. AMI 2011-2014

15. CHF 2011-2014

16. Pneumonia 2011-2014

17. Medicare 2012-2014