1. October 20, 2017 Providence St. Joseph, Burbank
Welcome! Greater Los Angeles Care Coordination Learning and Action Network Hosted in Partnership With LA Care Health Plan and Los Angeles Right Care Initiative
October 20, 2017
Providence St. Joseph, Burbank

2. CME and CEU Evaluation Link
Continuing Medical Education (CME), and Contact Hours for RN/LVN/NHA:
MDs, DOs, PAs, and LCSWs, LMFTs, LPCCs, LEPs:
You may complete the paper evaluation available at the event or, for greater accuracy, visit the website link above and complete the online form.
Nurses and Nursing Home Administrators:
To claim your credits, you MUST visit the website link in the box above and complete the online form. You must submit a valid license number in order to obtain a certificate. Your certificate/notification will be ed to you a few weeks after the close date (Friday, November 17, 2017).

3. Listen and Hunt for “Pearls”
“Pearl” = strategy that you will act on
At the end of the day, tell us:
The strategy that I have not yet used is ________.
The action I will take to utilize this strategy in a powerful way is ___________.

4. HSAG: Your Partner in Healthcare Quality
HSAG is California’s Medicare Quality Innovation Network-Quality Improvement Organization (QIN-QIO).
QIN-QIOs in every state and territory are united in a network administered by the Centers for Medicare & Medicaid Services (CMS).
The QIN-QIO program is the largest federal program dedicated to improving health quality at the community level.
Committed to improving quality of healthcare for more than 35 years
Provides quality expertise to those who deliver care and those who receive care
Engages healthcare providers, stakeholders, Medicare patients, families, and caregivers
Provides technical assistance, convenes learning and action networks, and analyzes data for improvement

5. National: 18.4% vs. CA Rate: 18.8%
Your Hospital Medicare Fee-for-Service (FFS) 30-Day, All-Cause Hospital Readmission Rates
Calendar Year
Greater Los Angeles
2012
23.5%
2013
22.3%
2014
21.8%
2015
22.1%
2016
23.3%
Q1 2017
23.2%
National: 18.4%
vs.
CA Rate: 18.8%
Data files provided to Health Services Advisory Group (HSAG) by the Centers for Medicare & Medicaid Services (CMS) were used for analysis in this report. The data files include Part-A claims for Medicare Fee-for-Service beneficiaries.

6. Medicare Fee-For-Service (FFS) All-Cause Hospital Readmission Rates
Greater Los Angeles, California, and U.S.
The ASAT data file representing calendar year 2010 to Q was used for the analyses in this report. The ASAT data file is provided to Health Services Advisory Group (HSAG) by the Centers for Medicare & Medicaid Services (CMS). The ASAT data file includes Part-A claims for Medicare Fee-for-Service beneficiaries.

7. Community Medicare FFS Readmission Rate Comparison
Readmit Rate Q2 2016–Q1 2017
Los Angeles
23.2%
San Fernando
21.6%
Antelope Valley
21.4%
San Bernardino
San Francisco
19.0%
Orange County
18.0%
Riverside
18.6%
San Diego
18.3%
Kern
18.5%
Ventura County
Sacramento
17.2%
Contra Costa
17.8%
Data files provided to Health Services Advisory Group (HSAG) by the Centers for Medicare & Medicaid Services (CMS) were used for analysis in this report. The data files include Part-A claims for Medicare Fee-for-Service beneficiaries.

8. Los Angeles FFS All-Cause, 30-Day Readmission Rate: Q2 2016–Q1 2017
Group
Discharged To
Discharges
Readmissions
Readmission Rate
Greater Los Angeles
Home
16,337
3,725
22.8%
Skilled Nursing Facility (SNF)
11,357
2,784
24.5%
Home Health Agency (HHA)
8,368
1,860
22.2%
Hospice
779 27
3.5%
Other
3,435
936
27.2%
Total
40,276
9,332
23.2%
State
733,939
138,654
18.9%
Data to follow
Data files provided to Health Services Advisory Group (HSAG) by the Centers for Medicare & Medicaid Services (CMS) were used for analysis in this report. The data files include Part-A claims for Medicare Fee-for-Service beneficiaries.

9. Los Angeles Physician Follow-Up Visits: Patients Discharged from Hospital Directly to Home
Number of Patients Discharged
From Hospital
to Home
Number of Patients Completing Physician
Follow-Up Visit
in 30 Days
% of Discharged Patients Completing Physician
Follow-Up Visits
Were Patients Readmitted?
12,768
7,944
62.2% No
9,838
6,703
68.1%
Yes
2,930
1,241
42.4%
Data to follow
57.6% of readmissions did not complete a 30-day follow-up visit
Data files provided to Health Services Advisory Group (HSAG) by the Centers for Medicare & Medicaid Services (CMS) were used for analysis in this report. The data files include Part-A claims for Medicare Fee-for-Service beneficiaries.

10. Los Angeles FFS Days to Readmission: Q2 2016–Q1 2017
Setting
0–7
8–14
15–21
22–30
Count
Rate
Home
1543
41.5%
875
23.5%
643
17.3%
664
17.8%
SNF
882
31.6%
732
26.3%
564
20.3%
606
21.8%
HHA
693
37.3%
455
24.5%
350
18.8%
362
19.5%
Hospice 14
51.8% 6
22.2% 5
18.5% 2
7.4%
Other
420
44.9%
205
21.9%
162
149
15.9%
Total
3552
38.1%
2273
24.4%
1724
1783
19.1%
Data to follow
62.5% returning within one week of discharge
Data files provided to Health Services Advisory Group (HSAG) by the Centers for Medicare & Medicaid Services (CMS) were used for analysis in this report. The data files include Part-A claims for Medicare Fee-for-Service beneficiaries.

11. Los Angeles Readmission RIR* Q1 2014–Q1 2017
Desired Direction RIR:
Target: 12% RIR by Q3 2018
Source: Medicare Fee for Service Claims Data. Baseline period: CY 2014.
*The formula for Relative Improvement Rate (RIR) is (Baseline-Current)/Baseline.

12. Los Angeles 12-Month Sprint to Improve the Readmission RIR by 12% by Q3 2018
Number of readmissions reduced per month to meet the 12% RIR goal=93
We start with where we are now. Q We actually put our data from Q here because that is the most recent data we have available and we’ll start with that to project our future improvement needs.
**Q data is actually Q data that is being used as a proxy and projecting
forward. The formula for Relative Improvement Rate (RIR) is (Baseline-Current)/Baseline.
Baseline period: CY 2014.

13. Overall Facility Readmission Rate
Los Angeles Hospital Readmission Rates by Hospital for High-Risk Medications (HRMs): Q1 2017
Hospital
HRM Readmission Rate
Anticoagulant
Diabetic
Opioid
Overall Facility Readmission Rate A
37.5%
41.7%
30.0%
31.8%
37.6% B
22.2%
21.7%
18.8%
27.9%
27.5% C
23.5%
24.3%
23.4%
28.2%
19.8% D
27.7%
33.8%
29.3%
25.2%
25.8% E
18.3%
34.5%
20.8% F
22.1%
27.6%
24.7%
16.7%
18.6% G
22.9%
31.3%
18.0% H
25.0%
17.0%
17.6%
Data files provided to Health Services Advisory Group (HSAG) by the Centers for Medicare & Medicaid Services (CMS) were used for analysis in this report. The data files include Part-A and Part-D claims for Medicare Fee-for-Service beneficiaries.

14. Los Angeles Hospital Readmission Rates by Hospital for HRMs: Q1 2017 (cont.)
HRM Readmission Rate
Anticoagulant
Diabetic
Opioid
Overall Facility Readmission Rate I
28.4%
31.0%
27.1%
28.2%
26.4% J
19.7%
22.2%
17.4%
38.5%
18.4% K
16.7%
16.8%
18.9%
18.1%
15.1% L
29.3%
29.7%
33.3%
33.7%
21.9% M
22.3%
26.3%
22.4%
22.7%
19.3% N
24.9%
21.6%
20.2%
32.2%
31.1% O
27.9%
25.0%
28.8%
35.5%
30.7% P
24.2%
30.8%
25.9%
17.6%
23.7%
Data files provided to Health Services Advisory Group (HSAG) by the Centers for Medicare & Medicaid Services (CMS) were used for analysis in this report. The data files include Part-A and Part-D claims for Medicare Fee-for-Service beneficiaries.

15. Los Angeles Hospital Readmission Rates by Hospital for HRMs: Q1 2017
Data files provided to Health Services Advisory Group (HSAG) by the Centers for Medicare & Medicaid Services (CMS) were used for analysis in this report. The data files include Part-A and Part-D claims for Medicare Fee-for-Service beneficiaries.

16. Los Angeles Hospital Readmission Rates by Hospital for HRMs—Anticoagulants: Q1 2017
Data files provided to Health Services Advisory Group (HSAG) by the Centers for Medicare & Medicaid Services (CMS) were used for analysis in this report. The data files include Part-A and Part-D claims for Medicare Fee-for-Service beneficiaries.

17. Los Angeles Hospital Readmission Rates by Hospital for HRMs—Diabetic Agents: Q1 2017
Data files provided to Health Services Advisory Group (HSAG) by the Centers for Medicare & Medicaid Services (CMS) were used for analysis in this report. The data files include Part-A and Part-D claims for Medicare Fee-for-Service beneficiaries.

18. Los Angeles Hospital Readmission Rates by Hospital for HRMs—Opioids: Q1 2017
Data files provided to Health Services Advisory Group (HSAG) by the Centers for Medicare & Medicaid Services (CMS) were used for analysis in this report. The data files include Part-A and Part-D claims for Medicare Fee-for-Service beneficiaries.

19. Upcoming HSAG Events Greater Los Angeles Learning and Action Network
January 9, 2018, The California Endowment
Adverse Drug Event Report Review Webinar
October 24, 2017, 12–1 p.m.
Change in Condition Webinar Series
November 2017
January, March, May 2018

20. CMS Disclaimer
This material was prepared by Health Services Advisory Group, the Medicare Quality Improvement Organization for California, 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. Publication No. CA-11SOW-C