The INTERACT Program What is it and why does it matter?

1. The INTERACT ProgramWhat is it and why does it matter? Karen Southard, RN, MHA April 2013

2. INTERACT is one of several evidence-basedcare transitions interventions. Intervention to Reduce Acute Care Transfers

3. The INTERACT Program Did you Know? • One of four patients admitted to a SNF are readmitted within 30 days. • Up to 2/3rds of hospital transfers are preventable. • Medicare is planning financial incentives to avoid hospital transfers through: • Bundled payments • Pay for Performance • Accountable Care Organizations

5. Annual Post-Acute Care Setting Readmissions(January 1, 2011 - December 31, 2011)

6. Care Transitions Communities in NC

7. Top Conditions for Admission & Readmission COPD Diabetes Heart Failure

8. Scenario: Mrs. B Mrs. B. has moderate to severe Alzheimer disease, congestive heart failure and left ventricular dysfunction and chronic pain from degenerative joint disease. The night nurse calls the on call doctor that Mrs. B has a non productive cough with a fever of 100.4. The doctor is unfamiliar with Mrs. B. Doctor’s action: Send Mrs. B to the ER

9. Hospital Scenario for Mrs. B Tests: CBC and Chemistry- normal VS- normal except for a low grade temp Chest X-ray- showed possible infiltrate in lower lobe of lung Treatment Plan: Admit for IV antibiotics IV fluids

10. Hospital Outcome for Mrs. B On second night of admission Mrs. B becomes confused , gets out of bed and falls fracturing her hip. One week later Mrs. B is discharged back to the Nursing Home: • Increased discomfort • Disabled • Cost for her admission to Medicare Part A: $10,000

11. Your Turn: What could have been done to prevent Mrs. B’s hospitalization: The night nurse could have assessed Mrs. B. using a standard protocol and called the on call NP who makes rounds at the home and is familiar with the residents and nursing team. The nurse could have utilized the SBAR communication tool and make a suggestion to watch Mrs. B and notify the NP if her condition changes. The NP would contact the daughter and make a plan to treat with oral antibiotics and fluids. Cost to Medicare: $200

12. The INTERACT Program Why it Matters • At Risk for Complications: • Delirium • Polypharmacy • Falls • Incontinence and catheter use • Hospital-acquired infections, immobility, de-conditioning, pressure ulcers Hospitalization Beauty Salon

13. The INTERACT Program Opportunities for You and Your Facility Shared Savings for Providers Low Low High $ Cost High Reduce Preventable Hospitalizations Improve Quality, Reduce Costs Quality Costs Avoided $

14. “If you don’t pay attention to this issue, you may be closed in five years” Joe Ouslander

15. What are your experiences? • Have you seen unnecessary hospitalizations of residents in your facility? • Have you had a resident suffer a complication during an unnecessary hospitalization?

16. INTERACT Can help your facility safely reduce hospital transfers by: • Preventing conditions from becoming severe enough to require hospitalization through early identification and assessment of changes in resident condition. • Managing some conditions in the NH without transfer when this is feasible and safe. • Improving advance care planning and the use of palliative care plans when appropriate as an alternative to hospitalization for some residents.

17. What are your experiences? What are the top three reasons for hospital transfers at your facility?

18. The Story of The Mission Skilled Nursing Facility Transitions GroupCommunity Care of Western NCWendy Sause, MSWLynette Fisher, RN

19. Our Community LTC Coalition 25 skilled nursing homes in the coalition Hold quarterly meetings Partnership with Mission Hospital Strategic focus on reducing hospital readmission

20. A Decade of Work Setting goals, developing measures, Introduction of INTERACT tools Building a coalition, improving community outcomes Improving communication and understanding each other’s contributions

21. It’s not a hospital project.

22. ARE YOU READY!? Honestly rate ability to manage a resident in-house • Send everything out, no diagnostic equipment, no available MD/NP • We have MD/NP available, basic diagnostics • We have MD/NP on site, diagnostics, most interventions available • Manage complex situations, rarely send out except for surgery, RX onsite

23. Why INTERACT is Important Resident and Family Impact on the Business Building Trust Improve Communication Evidence-Based Tools

24. Questions? This material was prepared by The Carolinas Center for Medical Excellence (CCME), the Medicare Quality Improvement Organization for North and South Carolina, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. 10SOW-BI-C8-13-28