1. HLNDV Spring Institute 2014 May 2, 2014, 1:15-2:45pm Readmission Session

2. New Jersey Gainsharing Project Started with 11 hospitals in 2009 Organized by NJHA Needed to get a Stark Law exemption for the hospital to be able to share savings with physicians All Medicare recipients (not managed Medicare) were included

3. The Mechanics Payments were broken up into incentives for performance and improvement Performance was based on the cost of care for the physician compared with the lowest 25 percentile cost of care for the State of NJ for the given APR-DRG Improvement was based on the cost of care for that physician’s patients in the same APR- DRG’s in the 2007 base year

4. The Mechanics (cont.) The original mix was to reward physicians 2/3 for improvement and 1/3 for performance, so that historically poor performers would have an incentive to improve. The expectation is that most hospitals would eventually change the percentage more to performance over time Hospitals were also allowed to put parameters on payments

5. The Caveats To ensure that services were not cut unnecessarily, CMS required that all hospitals monitor quality parameters which had to include: – Hospital mortality – 7 day readmissions – 30 day readmissions

6. Our Mortality Data

7. Our Readmission Data--7 Days

8. Our Readmission Data 30 Days

9. Readmissions Interventions Began a Readmissions Committee in July 2011 Multi-disciplinary group including nursing, physicians, PT, Case Management, Home Health, and Hospice – Eventually, post –acute partners attended Initial focus was on Medicare CHF patients We improved our CHF patient education program

10. Readmissions Committee Eventually we expanded the scope of the Committee to include all Medicare patients (really all patients) At the same time, many of our PCP’s were applying for and obtaining certification as Primary Care Medical Homes

11. Interventions Follow up calls were made by Clinical Nurse Leaders Most focused on transmittal of information – NOA pushed out to PCP’s – Admission and Discharge Summaries pushed out to the PCP of record – Discharge Medication Reconciliation, Discharge Instructions and Universal Transfer Form are faxed to the PCP office

12. Interventions (continued) Other interventions looked at better communication – Inpatient Care Managers and Care Coordinators in the Family Practice offices exchanged cell numbers – Established System where Hospitalists could leave voicemails for PCP’s

13. Interventions (continued) Partnered with the Advisory Board Company to be a Beta site for software Crimson RealTime Readmissions – Using a proprietary algorithm, it assesses patients and assigns them to high, medium, or low risk of readmission – Recommends interventions—making appointments prior to discharge, follow up calls, pharmacy input into Med Rec, Home Health referral, giving new prescriptions prior to discharge

14. AMI 2011-2014

15. CHF 2011-2014

16. Pneumonia 2011-2014

17. Medicare 2012-2014