Tracking Readmissions HomeTown Medicare Meeting Kerry Dunning, MHA, MSH, CPAR, RAC-CT GPS Healthcare Consultants March 2016

Set Goals? Track your hospital penalties Track readmissions from YOUR swing bed or SNF Reducing readmissions from skilled nursing by _____% How are you doing that? What’s next? 2 2

Why? Somebody else is looking at your data Hospitalization puts elderly at greater risk for complications and infections Rehospitalization increases likelihood for confusion, continuing decline, increased depression Hospitalization also increases the likelihood of reduced functioning on return to the skilled nursing facility Safety and falls Medication changes

What? CMS is offering financial incentives to reduce potentially avoidable hospital transfers OR penalties for those who don’t CMS is moving from volume to value mode (ACOs, bundled payments, preferred partners) CHF, Pneumonia, AMI, COPD, elective Hip and knee replacements Moving toward all condition readmissions

Looking at your penalties

Watching your readmissions http://ltcfocus.org/map/64/30-day-snf-rehospitalization#2010/GA/col=0&dir=asc&pg=1&lat=33.05029624734792&lng=-85.10943534784019&zoom=6

Looking for Preferred Partners

Measure your Rates Based on claims Does not include ER visits or Observation stays Excludes Medicare Advantage/Insurance % = # of persons sent to hospital # of persons admitted to the SNF/SWB

Why the Readmissions? EXCEL SPREADSHEET Discharges – Tracking Log Physician discharges? Nursing? Track by physician, NP, PA Time of day, certain day? Lack of education/lack of home evaluation INTERACT tools? Preventable or not? EXCEL SPREADSHEET

Graph and Review

Quality “GRADES” SNF Hospital metrics may be different Five Star Nursing Home Compare Facility Satisfaction on Survey QIS/Traditional Survey Hospital metrics may be different By diagnoses By discharge Managed Care/Insurance Contracts

Stop Unnecessary Readmissions Resident condition meeting Early changes in condition Teach back method Stop and Watch Tool eMR – alerts for change in condition Telemedicine Discharge planning /Education process/ How the patient can manage the disease at home

Contact: Kerry Dunning, MHA, MSH, CPAR, RAC-CT Chief Senior Services Officer GPS Healthcare Consultants 904-923-7229 Kerry.Dunning@gpshealthcon.com