What Makes An Attractive Post-Acute Partner for ACO's

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What Makes An Attractive

Post-Acute Partner for ACO's

Holli Benthusen, OTR/L

Regional Director of Business Development & Client Relations

Cell 352-428-2836 email: [email protected]

Margaret Kopp, SLP M.S. CCC SLP

Vice President of Clinical Services and Quality Management

Cell 954-290-1888 email: [email protected]

April 2015

Learner Objectives

• Describe new payment initiatives including ACO’s

and Bundled Payment models

• Identify appropriate reporting features to monitor

and track quality measures and outcomes

• Describe strategies for developing positive

relationships within the healthcare community

• Prepare a facility report card to be able to attract

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Healthcare Reform

Theme of the Affordable Care Act • Increasing value and reducing

costs

– ACO’s – Bundling

Overview

“This year, we are not looking for rate increases; we are looking for market improvement.”

Jay Picerno, CFO, COO Barnabas Health a large system in West Orange,

New Jersey

“Its not just financial data. It’s also

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Opportunities Created by Healthcare Reform: Kaiser Health News

FAQ On ACOs: Accountable Care Organizations, Explained April 2014

• One of the main ways the Affordable Care Act seeks to reduce health

care costs is by encouraging doctors, hospitals and other health care providers to form networks which coordinate patient care and become eligible for bonuses when they deliver that care more efficiently

• Providers make more if they keep their patients healthy.

• About four million Medicare beneficiaries are now in an ACO, and, combined with the private sector, more than 428 provider groups have already signed up.

• An estimated 14 % of the U.S. population is now being served by an ACO.

• Significant opportunity exists to better manage patients discharged from acute care hospitals.

Why address healthcare spending?

• As lawmakers searched for ways to reduce the national

deficit, Medicare became a prime target.

• With baby boomers entering retirement age, the costs of

caring for elderly and disabled Americans are expected to

soar.

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Changes in Population, by Age Group,

from CBO

What exactly is an Accountable Care

Organizations-ACOs?

• CMS developed final rule October 20, 2011

• Under the Patient Protection and Affordable Care Act

(Affordable Care Act)

• Improve care coordination to Medicare patients across

care settings including:

– doctor’s offices – hospitals

– long-term care facilities

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How does CMS describe an ACO?

• Accountable Care Organizations (ACOs) are groups of

doctors, hospitals, and other health care providers, who

come together voluntarily to give coordinated high quality

care to their Medicare patients.

• The goal of coordinated care is to ensure patients,

especially the chronically ill:

– Get the right care at the right time

– Avoid unnecessary duplication of services – Prevent medical errors

• When an ACO succeeds both in delivering high-quality

care and spending health care dollars more wisely, it will

share in the savings

it achieves for the Medicare program.

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Medicare ACO Programs

as of March 2015

Medicare Shared Savings Program —program that helps Medicare

fee-for-service program providers become an ACO.

– 360 Medicare ACOs have been established in 47 states, serving over 5.6 million Americans with Medicare

Pioneer ACO Model (ongoing)—program designed for early adopters of

coordinated care. No longer accepting applications.

– Currently there are 19 ACOs participating in the Pioneer ACO Model

Advance Payment ACO Model (ongoing)—The Advance Payment ACO Model

is meant to help smaller ACOs with less access to capital participate in the Shared Savings Program.- there are 35 ACO’s in this program that get up front and monthly payments for participation in the Shared Savings Program.

Medicare ACO Programs as of March 2015

Investment Model (Applications under review)

• New model of pre-paid shared savings that builds on the

experience with the Advance Payment Model to encourage

new ACOs to form in rural and underserved areas and

current Medicare Shared Savings Program ACOs to

transition to arrangements with greater financial risk.

• Participation in the ACO Investment Model will be limited to

two distinct groups:

– New Shared Savings Program ACOs joining in 2016

• rural geographies and areas where there has been little ACO activity, • offering pre-payment of shared savings in both upfront and ongoing per

beneficiary per month payments.

– ACOs that joined Shared Savings Program starting in 2012, 2013 and 2014

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Medicare ACO Programs as of March 2015

• Comprehensive ESRD (End Stage Renal Disease) Initiative (Applications under review)

– First disease-specific Accountable Care Organization (ACO) model – Designed by CMS to identify, test, and evaluate new ways to improve

care for Medicare beneficiaries with ESRD.

– Through the Comprehensive ESRD Care initiative, CMS will partner with groups of health care providers and suppliers – ESRD Seamless Care Organizations (ESCOs) – to test and evaluate a new model of payment and care delivery specific to Medicare beneficiaries with ESRD.

– Participating ESCOs will be clinically and financially responsible for all care offered to a group of matched beneficiaries, not only dialysis care or care specifically related to a beneficiary’s ESRD.

• CMS reopened the Request for Applications (RFA) after consideration of stakeholder feedback and revision of the RFA.

• With this open application period, CMS is interested in creating opportunities for small (non-large-dialysis organization, LDO) to participate

• Key is to make sure that the financial business case for all ESCOs is compelling enough to partner with CMS under the Comprehensive ESRD Care Initiative.

Medicare ACO Programs as of March 2015

Medicare Health Care Quality Demonstration (ongoing)

• Section 646 of the Medicare Modernization Act (MMA) mandates a 5-year demonstration program under which CMS will test major changes to improve quality of care while increasing efficiency across an entire health care system.

– Described as an Accountable Care Organization

• CMS to use this demonstration to identify, develop, test, and

disseminate major and multi-faceted improvements to the health care system. Broadly stated, the goals of the Medicare Health Care Quality demonstration are to:

– Improve patient safety; – Enhance quality; – Increase efficiency; and

– Reduce scientific uncertainty and the unwarranted variation in medical practice that results in both lower quality and higher costs.

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Medicare ACO Programs as of March 2015

Next Generation ACO Model (Announced)

• A new opportunity in accountable care: o More predictable financial targets; o Greater opportunities to coordinate care;

o High quality standards consistent with other Medicare programs and models. o Creates a financial model with long-term sustainability

• The Model seeks to test how strong financial incentives for ACOs can improve health outcomes and reduce growth in expenditures for Original Medicare fee-for-service (FFS) beneficiaries

• Protect Medicare FFS beneficiaries’ freedom of choice-– Allows beneficiaries a choice to remain aligned to the ACO

• Offer benefit enhancements that directly improve the patient experience and support coordinated care

• Smooth ACO cash flow and improve investment capabilities through alternative payment mechanisms.

• CMS expects approximately 15 to 20 ACOs to participate • Application process starts June 2015 for January 2016 start

Medicare ACO Programs as of March 2015

Private, For-Profit Demo Project for the Program of

All-Inclusive Care for the Elderly (PACE) (Ongoing)

• Congress authorized a study to compare the costs, quality,

and access to services provided by for-profit entities to

those of nonprofit PACE providers.

• Background

• Six providers are participating in the demonstration:

serves1,088 beneficiaries in Pennsylvania

– Pennsylvania PACE, Inc.(started 2007 thru 2015) – SeniorLIFE Altoona, Inc. (started 5/2011 thru 12/2015) – SeniorLIFE Greensburg (started 2/2013 thru 12/2015) – SeniorLIFE Washington, Inc. (started 5/2011 thru 12/2015) – SeniorLIFE York, Inc. (started 5/2011 thru 12/2015)

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Medicare ACO Programs as of March 2015

Nursing Home Value-Based Purchasing Demonstration

• CMS will assess the performance of participating nursing homes based on selected quality measures.

• incentive payment awards will be made to those nursing homes that perform the best or improve the most in terms of quality • For each State, nursing homes with scores in the top 20 percent

and homes that are in the top 20 percent in terms of improvement in their scores will be eligible for a share of that State’s savings pool.

• 3 states chosen: Arizona, New York and Wisconsin

• Began July 1, 2009. The number of participating nursing homes in each State is as follows:

– Arizona - 41 homes; – New York - 79 homes; – Wisconsin - 62 homes.

Medicare ACO Programs as of March 2015

Rural Community Hospital Demonstration (ongoing)

• The goal of the program is to test the feasibility and advisability of cost based reimbursement for small rural hospitals that are too large to be Critical Access Hospitals.

• In recent years, hospitals in this category have experienced negative Medicare margins on inpatient services.

• CMS is conducting an extensive evaluation of the demonstration, testing the benefits to the community and financial impact on participating hospitals. • Timeline has been extended another 5 year period

• 23 Hospitals participating

• Participating rural community hospitals must be located in one of the 20 states with the lowest population density. These States are: Alaska, Arizona,

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21 Medicare ACOs continue to succeed in improving

care, lowering cost growth CMS Fact Sheet, November 7, 2014

• ACO’s in the Pioneer Model, and the Medicare Shared Savings Program generated over $417 million in total program savings.

• At the same time, ACO’s qualified for over $460 million in shared savings payments • Both had higher quality and better patient experience than published benchmarks in

results of the 23 Pioneer ACO’s and the first year of performance for the Medicare Shared Savings Program

• Pioneer Performance Year 2 Results:

• Estimated saving of over $96 million

• Saved Medicare Trust Fund ~$41 million

• 11 Pioneer ACOs earned shared savings, 3 generated losses, and 3 elected to defer payments

until year 3

• Mean quality score increased by 19% from 71.8% to 85.2%

• Medicare Shared Savings Year 1 Results

• 58 held spending $705 million below targets and earned performance payments of $315 million

• 1 ACO on track 2 overspent its target by $10 million and owed shared losses of $4 million

• An additional 60 ACOs reduced costs compared to their benchmarks but did not qualify for

shared savings

• Improved quality measures on 30 of 33

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Texas Only

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Texas Innovation Models

3/2015 State Innovation Models Initiative: Model Design Awards Number of Participants:1 Health Care Innovation Awards Number of Participants:12 Advance Payment ACO Model Number of Participants:4 Health Care Innovation Awards Round Two Number of Participants:1 BPCI Initiative: Model 2 Number of Participants:137 Graduate Nurse Education Demonstration Number of Participants:1 BPCI Initiative: Model 3 Number of Participants:489 Independence at Home Demonstration Number of Participants:2 BPCI Initiative: Model 4 Number of Participants:2 Innovation Advisors Program Number of Participants:1 Community‐based Care Transitions Program Number of Participants:4 Strong Start for Mothers and Newborns Initiative Number of Participants:13 Federally Qualified Health Center (FQHC) Advanced Primary Care Practice Demonstration Number of Participants:6 Incentives for the Prevention of Chronic Disease in Medicaid Demonstration Number of Participants:1

CMS: Additional Innovation Models

• The Innovation Center develops payment service

delivery models in accordance with the Social Security

Act ,the Affordable Care Act (ACA) and previous

legislation

• CMS Innovation Models are organized into seven

categories and can be found at

(http://innovation.cms.gov/initiatives/index.html#views=models)

– Bundled Payments for Care – Primary Care Transformation

– Initiatives Focused on the Medicaid and CHIP.

– Initiatives Focused on the Medicare-Medicaid Enrollees. – Initiatives to Speed the Adoption of Best Practices

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Bundled Payments for Care

Improvement initiative (BPCI)-4

models

• August 23, 2011, CMS invited providers to apply to help test and develop 4 different models of bundling payments with different phases of risk.

• The Bundled Payments initiative is comprised of four broadly defined models of care, which link payments for multiple services beneficiaries receive during an episode of care.

• Model 1 includes an episode of care focused on the acute care inpatient hospitalization. Awardees agree to provide a standard discount to Medicare from the usual Part A hospital inpatient payments.

• Models 2 and 3 involve a retrospective bundled payment arrangement where actual expenditures are reconciled against a target price for an episode of care. • Model 4 involves a prospective bundled payment arrangement, where a lump sum

payment is made to a provider for the entire episode of care.

• Over the course of the three-year initiative, CMS will work with participating organizations to assess whether the models being tested result in improved patient care and lower costs to Medicare.

• These models may lead to higher quality, more coordinated care at a lower cost to Medicare.

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The 4 Models

BPCI Model 1: Retrospective Acute Care Hospital Stay Only

• Episode of care is defined as the inpatient stay in the acute care

hospital.

• Medicare will pay the hospital a discounted amount based on the Inpatient PPS

– Medicare will continue to pay physicians separately for their services under the Medicare Physician Fee Schedule.

• Under certain circumstances, hospitals and physicians are permitted to share gains $$ arising from the providers’ care redesign efforts

• Number of participants: 21

• Participation began in April, 2013 and an additional Awardee was added in January, 2014 and includes most Medicare fee-for-service discharges for the participating hospitals

BPCI Model 2: Retrospective Acute &

Post Acute Care Episode

• The episode of care will include the inpatient stay in the acute care hospital and all related services during the episode.

– The episode will end either 30, 60, or 90 days after hospital discharge. – Participants can select up to 48 different clinical condition episodes.

– Model 2 Episode Initiators are acute care hospitals (ACH) or physician group practices (PGP)

• The 3-day inpatient hospital stay prior to Medicare Part A covered skilled nursing facility (SNF) services is waived for beneficiaries who are discharged from an inpatient hospital stay of less than 3 days to receive post-hospital care from skilled nursing facilities (SNFs), covered under Medicare Part A, as long as all other coverage requirements are satisfied.

• The Waiver is made available to Awardees that provide a list of their SNF partners to CMS, where a majority of the SNF partners for a specified period of time had a quality rating of 3 or more stars under the CMS 5-Star Quality Rating System.

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BPCI Model 3: Retrospective Post Acute

Care Only

• For Model 3, the episode of care will be triggered by an acute care hospital stay and will begin at the start of the post-acute care with a participating:

– skilled nursing facility, – inpatient rehabilitation facility, – long-term care hospital – or home health agency.

• The post-acute care services included in the episode must begin within 30 days of discharge from the inpatient stay and will end either a minimum of 30, 60, or 90 days after the initiation of the episode.

• Participants can select up to 48 different clinical condition episodes.

• There are 4,727 participants/awardees involved

In both Models 2 and 3, the bundle will include:

• Physicians’ services

• Care by post-acute providers • Related readmissions

• Other related Medicare Part B services included in the episode such as

– clinical laboratory services

– durable medical equipment, prosthetics, orthotics and supplies – Part B drugs

• A target price will be set that will be based on historical fee-for-service payments for the participant’s Medicare beneficiaries in the episode and will include a discount.

• Payments will be made at the usual fee-for-service payment rates, after which the aggregate Medicare payment for the episode will be reconciled against the target price.

• Any reduction in expenditures beyond the discount reflected in the target price will be paid to the participant and may be shared among their provider partners.

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BPCI Model 4: Prospective Acute Care

Hospital Stay Only

• CMS will make a single, prospectively determined bundled

payment to the hospital that would encompass all services

furnished during the inpatient stay by the hospital,

physicians, and other practitioners.

• Physicians and other practitioners will submit “no-pay”

claims to Medicare and will be paid by the hospital out of

the bundled payment.

• Related readmissions for 30 days after hospital discharge

will be included in the bundled payment amount.

• Participants can select up to 48 different clinical condition

episodes.

• There are 17 participants/awardees involved

Primary Care Transformation

• Primary Care Transformation -Primary care providers are a key point of contact for patients’ health care needs.

• Strengthening and increasing access to primary care is critical to promoting health and reducing overall health care costs.

• Advanced primary care practices – also called “medical homes” – utilize a team-based approach, while emphasizing prevention, health

information technology, care coordination, and shared decision making among patients and their providers.

• Number of Participants:

– Comprehensive Primary Care Initiative- 479

– FQHC Advanced Primary Care Practice Demonstration- 434 – Advanced Primary Care Initiatives- under development – Graduate Nurse Education Demonstration-5

– Independence at Home-14 Independent Practices and 1 Consortium – Multi-Payer Advanced Primary Care Practice-6

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Additional Initiatives for Innovation

• Initiatives Focused on the Medicaid and CHIP

• Medicaid and the Children’s Health Insurance Program (CHIP) are administered by the states but are jointly funded by the federal government and states. Initiatives in this category are administered by the participating states.

• Initiatives Focused on the Medicare-Medicaid Enrollees

• Individuals enrolled in both Medicare and Medicaid (the “dual eligibles”) account for a disproportionate share of the programs’ expenditures. A fully integrated, person-centered system of care that ensures that all their needs are met could better serve this population in a high quality, cost effective manner.

• Initiatives to Accelerate the Development and Testing of New Payment and Service Delivery Models

• Many innovations necessary to improve the health care system will come from local communities and health care leaders from across the entire country. By partnering with these local and regional stakeholders, CMS can help accelerate the testing of models today that may be the next breakthrough tomorrow.

• Initiatives to Speed the Adoption of Best Practices

• Recent studies indicate that it takes nearly 17 years on average before best practices - backed by research - are incorporated into widespread clinical practice—and even then the application of the knowledge is very uneven. The Innovation Center is partnering with a broad range of health care providers, federal agencies professional societies and other experts and stakeholders to test new models for disseminating evidence-based best practices and significantly increasing the speed of adoption.

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Episode of Care

Medicare Patients’ Use of Post-Acute Services Throughout an “Episode of Care” (1)

35% of Medicare Beneficiaries are Discharged from Acute Hospitals to Post-Acute Care *52% of the 35% are admitted to SNFs within 90 days *

(1)_{Source: RTI, 2009: Examining Post Acute Care Relationships in an Integrated Hospital System}

How Are Hospitals Measuring SNF

Performance?

As of October 1st_{, 2012 hospitals in the bottom quartile will face cuts from}

Medicare.

• Adopted readmission measures for the applicable conditions of

1. Acute Myocardial Infarction (AMI),

2. Heart Failure (HF) and

3. Pneumonia (PN)

CMS is finalizing the expansion of the applicable conditions for FY 2015 to include:

1. Patients admitted for an acute exacerbation of chronic obstructive pulmonary disease

(COPD)

2. Patients admitted for elective total hip arthroplasty (THA) and total knee arthroplasty

(TKA).

•SNFs are in a powerful position to use data to their competitive advantage

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Top Outcomes against which providers

will be measured by hospitals include:

• Perceived quality of care and outcomes.

• Readmissions-Incidents of hospital readmissions

• FY- 2013 and 2014-Adopted readmission measures for the applicable

conditions of Acute Myocardial Infarction (AMI), Heart Failure (HF) and Pneumonia (PN)

• In the FY 2014 IPPS rule, CMS expanded the applicable conditions for FY 2015 to include: (1) patients admitted for an acute exacerbation of chronic obstructive pulmonary disease (COPD); and (2) patients admitted for elective total hip arthroplasty (THA) and total knee arthroplasty (TKA).

• Communication and coordination of care.

• Lowest cost, as measured by length of stay (LOS)

www.healthtech.net

Why Would You Want to be an ACO Partner?

•ACOs and Bundled Payment Models are growing

•Savings are being realized… and shared

•Quality is being measured

•Opportunity to collaborate with hospital and

community healthcare providers

•Opportunity to obtain data related to DRGs, costs,

hospital readmissions

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How to become the Preferred Discharge Destination?

Quality measures- Does your facility have these

measures?

• Patient/family satisfaction surveys

• Statistical reporting including:

– Patient functional independence measure outcome

scores

– LOS by diagnosis

– Discharge destination

– Staffing

– Therapy Expertise

Quality Measures- Rehabilitation Outcomes Implementation

1. Establish a means of collecting rehabilitation data in a

consistent manner to allow clinicians to:

• Follow changes in functional status • Measure the effectiveness of treatment

• Track and report to assess quality and cost effectiveness of program

2. Determine method for obtaining Patient Outcome*:

– Software/Services/Tool

– Partnering with Contracted Therapy

• Established Outcome tool • Inter rater reliability

• Report Capability/level of standardization • 3rd_{Party Surveys}

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Outcome Measures-Report Card of Performance

• Pull together a profile of the building to help “sell

value” to ACO’s

• Establish method of pulling metrics together to be

able to highlight strengths of facility and program

– Use data to address concerned areas

• Patient Surveys

• Annual Surveys

• 5 Star Rating*

*

Recently rating measures have been adjusted making this a more challenging achievement

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Facility Outcome Report

Age Range accepted Under 60 case by case Average Age 74 years old

Bariatrics Case by case Smoking/ Non‐smoking Non smoking campus

Facility Facts

Facility Outcome Report

Intensity of Therapy/Sub-acute Rehab

Average Length of Stay 16 days Therapy Availability 7 days/week

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Facility Outcome Report

Discharge Destination

Home 89% ALF 3% SNF 8%

Facility Outcome Report

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Facility Outcome Report

Patient Satisfaction

Physical Therapy Courtesy of PT 4.50 PT explained treatment & program 4.55 Involved in setting PT goals 4.40 PT helped meet goals and overall improvement 4.50 Occupational Therapy Courtesy of OT 4.60 OT explained treatment & program 4.70 Involved in setting OT goals 4.63 OT helped meet goals and overall improvement 4.66 Speech Therapy Courtesy of ST 4.25 ST explained treatment & program 4.25 Involved in setting ST goals 4.25 ST helped meet goals and overall improvement 4.25 Likelihood to recommend program 4.10 Overall level of satisfaction with program 4.47 ***Based upon rating 1‐5 with 5 being the highest score

Facility Outcome Report

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Diagnosis groups/data on point gain and LOS

Row Labels Therapy Discharges Avg Age Avg Days Post Onset Avg Admit Score Avg DC Score Avg Gain Avg LOS Avg PreMorbid Avg Goal Outcomes SELECT MEDICAL REHABILITATION SERVICES (180) 867.00 81 21 2.74 4.03 1.29 24.56 5.81 5.29 Region 1 (1) 867.00 81 21 2.74 4.03 1.29 24.56 5.81 5.29 45 GK 88.00 81 21 2.43 3.93 1.50 35.02 5.28 4.50 ECC 88.00 81 21 2.43 3.93 1.50 35.02 5.28 4.50 Other 20.00 86 10 3.46 4.91 1.46 43.00 5.77 5.26 CVA 8.00 86 19 2.36 2.95 0.59 37.38 4.59 4.09 Parkinsons Disease 5.00 71 6 2.00 3.14 1.14 55.40 3.71 3.00 Dysphagia 13.00 85 12 2.00 3.91 1.91 41.62 5.36 4.23 Osteoarthritis 6.00 81 4 2.09 4.45 2.36 29.50 5.09 4.45 After Care Trauma 6.00 75 10 1.58 3.13 1.54 16.00 6.25 4.83 COPD 5.00 72 13 3.40 5.60 2.20 22.40 6.00 5.80 3.00 87 303 1.00 1.75 0.75 28.67 1.25 1.25 Pneumonia 8.00 84 8 2.77 3.54 0.77 12.75 4.54 3.92 Acute Renal Failure 4.00 67 9 3.33 4.83 1.50 50.25 5.50 4.83 CHF 4.00 76 13 1.89 4.44 2.56 38.00 5.44 4.22 Osteomyelitis 2.00 71 7 1.00 1.75 0.75 7.50 5.25 3.25 Joint Replaced Hip 2.00 68 58 0.67 5.33 4.67 28.50 6.67 4.33 UTI 2.00 102 5 2.38 2.63 0.25 53.50 4.50 4.38

Facility Outcome Report

Return to Hospital within 30 days 11%

What about looking further to

determine …

Return to Hospital by Diagnosis

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Key Diagnoses: Hospital Readmissions vs.

DC To Lesser Level of Care

7 Point Rating Scale with 7 being Independent

DX Therapy D/C Days Post

Onset Admit Score D/C Score Point Gain

LOS/Tx Duration CHF 16 13 3.08 3.17 .08 7.88 COPD 10 8 3.79 3.75 ‐.04 8.30 Hip 4 6 2.00 2.36 .36 6.00 Knee 0 0 0 0 0 0 Pneumonia 6 9 3.75 3.88 .13 8.67 DX Therapy D/C Days Post

Onset Admit Score D/C Score Point Gain

LOS/Tx Duration CHF 38 13 2.77 4.41 1.64 24.00 COPD 26 10 3.15 4.81 1.65 23.88 Hip 20 10 2.97 5.38 2.41 29.50 Knee 17 5 3.36 5.43 2.07 21.00 Pneumonia 33 11 2.52 4.48 1.95 27.61

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Improvement of Patients by Hospital Referral

Measurements of Functional Improvement

Row Labels Therapy Discharges Avg Age Avg Day s Post Ons et Avg Admit Score Avg DC Score Avg Gain Avg LOS Avg PreM orbid Avg Goal Outcomes SELECT MEDICAL REHABILITATION SERVICES (180) 90 82 8 2.82 4.11 1.29 21.89 6.36 5.96 Region 1 (1) 90 82 8 2.82 4.11 1.29 21.89 6.36 5.96 DW 90 82 8 2.82 4.11 1.29 21.89 6.36 5.96 QH 90 82 8 2.82 4.11 1.29 21.89 6.36 5.96 1 91 9 Ambulation 13 81 7 3.10 4.10 1.00 24.22 6.06 5.68 Bathing/Showering 1 86 10 2.33 3.67 1.33 39.00 6.67 6.33 Bed Mobility 8 81 7 3.04 4.71 1.67 22.55 6.83 6.25 Cognition ‐ Problem Solving 6 82 7 2.50 3.75 1.25 21.11 6.31 5.63 Cognition ‐ Executive Function 3 77 8 3.75 5.25 1.50 22.39 6.63 6.38 Cognition ‐ Judgment 2 86 7 2.86 3.43 0.57 12.29 5.43 5.43 Cognition ‐ Memory 9 82 8 2.50 3.79 1.29 24.88 6.08 5.46 Cognition ‐ Orientation 2 87 9 1.60 2.80 1.20 23.45 6.40 5.20 Dressing ‐ Lower Extremity 13 81 8 2.48 3.77 1.29 20.19 6.48 6.39 Dressing ‐ Upper Extremity 4 79 8 3.09 4.55 1.45 23.73 6.36 6.09 Grooming 0 67 6 5.00 6.00 1.00 9.00 7.00 6.00 IADLs ‐ Medication Mgnt 0 82 7 4.00 4.00 10.00 7.00 7.00 Step Negotiation 1 81 6 0.50 0.50 4.50 6.50 6.00 Swallowing 3 90 8 4.00 5.20 1.20 26.93 5.60 6.00 Toileting 13 81 8 2.67 4.13 1.47 20.46 6.47 6.37 Transfers 11 81 7 3.04 4.39 1.36 21.96 6.71 5.96

Diagnostic Findings by Physician

Example: COPD Patients of Dr. C

3.40 5.60 2.20 0.00 1.00 2.00 3.00 4.00 5.00 6.00 Total

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Facility Outcome Report

Support to the Hospital/Continuum

•ER/hospital

•Lab

Our facility makes referrals to hospital:

•Radiology

•Wound Center

•Home Care

•Hospice

√ Emergency Room/Hospital √ Home Care √ Hospice

Readmission Rates

• Investigate the Acute Care Hospitals in region

readmission rates and how they monitor the post

acute continuum

• Gather information on readmissions- who will be

tagged?

• Directly to hospital • From Home to hospital? • Home health to hospital?

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Readmission Rates

• Ensure that discharges are appropriate and that all

safety and education are completed prior to D/C

• Utilize methods to get patient and family buy-in • Home Assessments

• Home Health and/or Outpatient follow up • Home Exercise Programs (HEP)

• LOS- weighing effective care and costs to prevent

early discharges and subsequent readmissions back

to acute care

• Focus on the RIGHT CARE at the RIGHT Time and

Place!

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Resource Available to AHCA Members

LTC Trend Tracker

Web based program that shows a dashboard of

trends and statistics from CMS

Reports of hospital readmissions and discharge

to community rates

Can build and save custom reports

Recently revamped and easier, cleaner and

faster to use

www.ltctrendtracker.com

Communication and Coordination of Care

• Once a facility can quantify their outcomes, programs,

and relationship marketing strategies and package

and share their Facility Outcome Report, what else

can be done to help facilitate becoming the provider of

choice?

– Patient Health Records- how are they shared? – Established Nursing Home liaison

• Who is primary contact • Who is back up contacts • What happens on weekends

– What types of patients does SNF accept – Niche marketing

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Communication and Coordination of Care

• What is the turn around time for admissions?

• What typically is the discharge planners’ customer

service experience?

• How is the family introduced to the building?

• How is the family introduced to therapy?

Reasons for Hospital CEOs

to consider regarding referrals

• Return to Hospital rate

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Five Questions for Case

Managers/Social Workers

1. What are the top 3‐4 issues that influence a

referral?

2. What most often influences the patient/family

decision?

3. How often do families request to tour a facility prior

to making a decision?

4. Do specialty services, i.e. respiratory therapy,

massage therapy, specialists, make a difference?

5. What percent of referrals have insurance other than

Medicare?

Reasons for Case Management or

Social Worker referrals to a SNF

1. Location of patient’s home or family members’ home

2. Insurance

3. PCP/physician referral

4. Speed of response once referral is made

5. Relationship with facility marketer/admissions staff

6. Patient/family previous experience at facility

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Reasons for Case Management or

Social Worker referrals to a SNF

8. Reputation of facility/referral from someone patient/family

knows

9. Medicare.gov website reviews (Star rating)

10. Age of patient

11. Diagnosis

12. Smoking

13. Return to hospital rate

14. Transportation

Post-acute providers will be asked by

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Preferred Discharge Destination

• Quality measures.

– Patient/family satisfaction reports.

– Therapy software statistical reports including:

• Patient functional independence measure outcome scores

• LOS by diagnosis

• Discharge destination

• Staffing/productivity levels, etc.

• Electronic medical records.

• Clinical pathways and precautions related to the rehab needs associated with the top 5 diagnosis

• Use of therapeutic modalities as a means to measure patient status (BP cuff, pulse oximeter,

stethoscope).

• Staffing levels to support patient census and needs, including weekends.

• Screens following all patient incidents.

• Nursing education and training related to top 3 diagnosis that would penalize acute care referral