The Impact of the ACA: How Readmissions Penalties Will Affect the Healthcare Executive’s Mission Healthcare Leadership Network of the Delaware Valley May 2, 2014 Paula A. Bussard Senior Vice President, Policy & Regulatory Services The Hospital & Healthsystem Association of Pennsylvania
Preventable Readmissions • 1 in every 5 Medicare patients are readmitted within one month of discharge. • More than 2,000 hospitals affected by readmission penalties. • About $270 million in Medicare funds. • PA FFY 2013 - $12 million—PA ranked 32nd • PA FFY 2014 - $9 million—PA ranked 31st • Increase in penalty to max of 3%.
Preventable Readmissions • Readmission rates for 2010, as reported by Pennsylvania Health Care Cost Containment Council (PHC4): • Total readmission rate was 13.5% (2 out of every 15 hospital stays had a readmission within 30 days). • CHF readmission rate was 24.3%. • Septicemia readmission rate was 21.0%. • COPD readmission rate was 20.2%.
Pennsylvania Hospital Engagement Network • HAP—one of 26 hospital engagement networks nationwide • 60 Pennsylvania hospitals participating in the HEN collaborative project: • 15 hospitals participated in one year BOOST project (Better Outcomes for Older adults through Safe Transitions) • 45 hospitals in PA-HEN collaborative • Tracking readmission data for all Pennsylvania PA-HEN participating hospitals • PA-HEN has offered: • Regional networking sessions (including post-acute providers); webinars; one-on-one coaching calls; and site visits • Priorities: • Health literacy training • Post discharge best practices (appointments/phone calls) • Medication reconciliation • Patient education
PA-HEN Readmission Progress Reflects a 24% reduction from baseline 5
Current Priorities • Immersion project model • Health Literacy • Community Cross Continuum Teams • Removal of silos • Collaboration with stakeholders • Regional events including health care and community partners • Encourage education sharing • Encourage patient participation • Paradigm shift from ‘doing to patients’ to ‘doing with patients’ 6
Health Literacy Average adult reads 3-5 grade levels below highest grade completed. Therefore, up to ½ of US population may be at risk for: • Medical misunderstandings • Mistakes • Excess hospitalizations • Poor health outcomes 7
Cross Continuum Teams • Primary care • Specialists • Care management • Long-term care • Home health • Hospice • Pharmacy • Personal care • Area Agencies on Aging • Health plans • Durable medical equipment
Lessons Learned—Challenges • Patient and family educational needs • EHR—helps, but can be burdensome • Regional differences: • Urban—higher indigent population, language and cultural barriers more prevalent • Rural—can have limited community services • Behavioral health care needs • Regulatory and payment differences between levels of care • Loss of revenue
Lessons Learned—Opportunities • Effective communication. • Information sharing – health record exchange. • Management of care: • Transition of care. • Better outcomes. • Engagement of patient and families. • Better planning for chronic and end of life care. • Use of innovative delivery models, including care in place and effective use of advanced practice professionals. • Measurement/performance indicators that are relevant across the continuum of care. • Understanding of financial performance and implications.
Leadership Strategies to Sustain Quality Improvement and Prevention of Harm • Connecting quality and cost • Align with overall organizational goals and financial incentives • Define clear, measurable aims for improvement • Report out to organization and community, if appropriate • Plan, do, study, act • Multi-disciplinary team • Commit to data collection and reporting • Accountability and transparency • Community regularly with administrative and clinical leadership and governing body • Show results (good and not-so-good) • Leadership must champion • Hardwire the improvements into every day practice • Everyone held to same standard
Engaging Patients and Families • Health care consumers: • Expect care to be high quality. • Approach care with a deep sense of • uncertainty and vulnerability. • Experience with care is very personal and • granular. • See insurance companies as setting the rules. • Want hospitals to see them as people. • Want care to be respectful, professional, • and quick. • Want hospitals to be empathetic and to stand up for them. PA ranked 40th in HCHAPS scores Source: Findings from HAP Focus Groups – conducted March 2014 12 12
Using Financing to Reshape the Organization and Outcomes of Care Primary Care Physicians Specialty Care Physicians Outpatient Hospital Care and ASCs Inpatient Hospital Acute Care Long Term Acute Hospital Care Inpatient Rehab Hospital Care Skilled Nursing Facility Care Home Health Care Accountable Care Organizations Post Acute Care (PAC) Episode Bundling Acute Care Episode with PAC Bundling Acute Care Bundling Medical Home 13
Questions The Hospital & Healthsystem Association of Pennsylvania May 2014