Interdisciplinary Team Role Play Panel Discussion

Hospital Readmission Rate Reduction

Change in Readmission Rates Comparison in change in Readmission Rates for Targeted Conditions and Nontargeted Conditions within 30 Days after Discharge. Targeted conditions were acute myocardial infarction, heart failure, and pneumonia. Points represent the mean rate weighted by the number of hospital index stays during the month. Solid lines represent the predicted rates. Slopes are the monthly change in the predicted rates, generated from a linear combination of regression coefficients. October 2007 through March 2010 was the period before enactment of the Affordable Care Act (ACA); April 2010 through September 2012 was the period of implementation of the Hospital Readmissions Reduction Program, which set financial penalties for hospitals that had higher-than-expected readmission rates for targeted conditions October 2012 through May 2015 was the long-term follow-up period after penalties were initiated.

Hospital Readmission Penalties: Coming Soon to a Nursing Home Near You! Journal of The American Geriatrics Society 64:614-618, March 2016 Protecting Access of Medicare Act (PAMA) of 2014 Provisions for hospital readmission financial penalties for skilled nursing facilities Start 2018 Similar to the Affordable Care Act mandate for hospital penalties Opportunities for Improvement Poor communication and care coordination between care settings Including post- hospitalization and post-SNF care Management of patients with greater acuity within the SNF

The Penalties All SNFs experience a 2% reduction in reimbursement from CMS 2018 SNFs recoup by demonstrating acceptable risk-adjusted ratio and benchmark readmission rates as calculated by CMS Any admission within 30 days post hospital discharge Shared responsibility with hospital Some exceptions – e.g. planned readmission, cancer treatment

Potential Solutions to the Problem of Readmissions Practice core geriatric principles SNF Interdisciplinary team involvement Medical Director Involvement Management plans for complex multimorbidity Contingency planning, reduce high risk medications (Beers List), Antibiotic Stewardship Define individual goals of care Use available resources to assist with family communication Involvement of all team members in transitions of care

Nursing Home Compare Five Star Rating System

Findings