1. Mission Health System COPD Readmission Data
Cathryn C. Trimby, RRT, RCP
Quality and Data Manager
Six Sigma/Lean Certified
Mission Health System
Asheville, NC 28801

2. 6 Member Hospital System
Western North Carolina Tertiary Referral Center
708 Acute Beds and 62 BH Beds
Level II Trauma Center
Offer services to approximately 1M people in 18 counties
Regional Transport Provider
3rd Busiest ED in North Carolina

3. COPD Readmission Rate Definition
The number of Patients with a Principal Diagnosis of COPD that are readmitted for any cause to an acute care facility within 30 Days of a prior COPD index admission.
Total number of Patients with a Principle Diagnoses for COPD for the time period
Exclusion List-
Transfers
Admit Status- Elective
Patients who leave Against Medical Advice

4. COPD: Care Process Model (CPM)

5. COPD Readmission Risk Factors Comparison
Discharge period:
July 1, 2014-June 30, 2017
Mission Patient Complexity
Mission
State
National
Eligible Discharges
964
30,694
852,039
Mean Age
74.8
75.7
76.7
Risk Factors
Mission
State
National
AMI
29%
30%
CABG
24%
23%
25% HF
48%
50%
49% PN
56%
51%
Stroke 4% 6%
Vascular or
Circulatory Disease
44%
41%
Renal Failure
38%
36%
35%

6. COPD In Western North Carolina

7. MMH COPD Readmission Rate FY16 to FY18
Time Period
Overall 30-Day Readmission Rate
FY 17
15.75

8. Population Demographics
Gender
Race
Age
66.7% Medicaid

9. Discharge Disposition Analysis
DC Disposition mapped to Readmission

10. Readmission Demographics % Readmitted within 30 days
LOS effects on readmissions
Readmission post DC in Days
% Readmissions

11. Mobile Integrated Health Mission Community CaraMedics Program
Charles Blankenship, Manager Mission Health EMS
Stace Horine, MD, Medical Director
Randy Fugate Coordinator/Navigator

12. What is the Community CaraMedic Program?
A program that uses certified community paramedics to operate in expanded roles within their scope of practice under the direction of a physician to provide in-home care to patients who are “at risk” due to a recent hospital discharge, chronic medical condition, or other significant factor. Filling gaps when other services are not available.

13. A well-structured, well-supported and high functioning department
Medical Director - Medical administrator responsible for the oversight of community paramedic medical care and clinical services
Coordinator / Navigator - Provides administrative services and dispenses procedures and policies; monitors work activities, projects and progress
Care Manager – Responsible for enhancing the quality of care coordination, patient management throughout the continuum of care, and to assure cost-effectiveness of care
Community CaraMedic - Supports existing health services; provides integrated health services in partnership with other health professionals; extends access to health services in underserved and general populations, including primary care, public health, disease management, prevention and wellness, mental health, and dental health; and performs other duties as required.

14. Engaged and Planned FY18 Utilization
The Mission Community CaraMedics program is engaged
7 certified CaraMedics, 487 consults1

15. MHP achieved $910K savings on high risk Medicare Population with the assistance of Mission CaraMedics
Significant annualized savings
$3.3M in gross charges
$910K in Medicare savings
385 IP
days
Savings estimate based on annualized utilization savings and Mission Hospital FY 2016 average Medicare charges, payments and ALOS.

16. Length of Stay:
Mortality:
Readmissions

17. End Results: 30-Day Risk-Standardized Readmission Measures Better than the National/State Rates (1/18 Nationally and 1/2 State)
$1.3M
Decreased Readmissions
5.46%
Joint Commission Certified DSC Program Surveyed twice with No citations

18. Successful Practices Pulmonary Navigators/ Chronic Disease Specialists
Achieving and sustaining The Joint Commission Certification
Standardized Care: Care Process Model
“Coding Correctly” PI Team
System-wide Pay for Performance Mortality Review
Transitions of Care Team
PCP Focus
Community CaraMedic Program

19. Questions?