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The Impact of the ACA:How Readmissions Penalties Will Affect

the Healthcare Executive’s Mission

Healthcare Leadership Network of the Delaware ValleyMay 2, 2014

Paula A. BussardSenior Vice President, Policy & Regulatory ServicesThe Hospital & Healthsystem Association of Pennsylvania

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Preventable Readmissions

• 1 in every 5 Medicare patients are readmitted within one month of discharge.

• More than 2,000 hospitals affected by readmission penalties.

• About $270 million in Medicare funds. PA FFY 2013 - $12 million—PA ranked 32nd

PA FFY 2014 - $9 million—PA ranked 31st

• Increase in penalty to max of 3%.

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Readmission rates for 2010, as reported by Pennsylvania Health Care Cost Containment Council (PHC4):

Total readmission rate was 13.5% (2 out of every 15 hospital stays had a readmission within 30 days).

CHF readmission rate was 24.3%. Septicemia readmission rate was

21.0%. COPD readmission rate was

20.2%.

Preventable Readmissions

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Pennsylvania Hospital Engagement Network

HAP—one of 26 hospital engagement networks nationwide 60 Pennsylvania hospitals participating in the HEN collaborative

project:• 15 hospitals participated in one year BOOST project (Better

Outcomes for Older adults through Safe Transitions)• 45 hospitals in PA-HEN collaborative

Tracking readmission data for all Pennsylvania PA-HEN participating hospitals

PA-HEN has offered:• Regional networking sessions (including post-acute providers);

webinars; one-on-one coaching calls; and site visits• Priorities:

Health literacy training Post discharge best practices (appointments/phone calls) Medication reconciliation Patient education

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0%

5%

10%

15%

20%

25%

30%

2010n=118

2011n=118

Q1 2012(Dec-Feb)

n=118

Q2 2012(Mar-May)

118

Q3 2012(Jun-Aug)

n=118

Q4 2012(Sep-Nov)

n=117

Q1 2013 (Dec-Feb)

n=118

Q2 2013(Mar-May)

n=118

Rate

PA-HEN Wide Readmission Results (Rate of 30 day readmissions, all-cause, CHF and COPD)

CHF Rate COPD Rate All Cause Rate

GOAL

Reflects a 24% reduction from

baseline

PA-HEN Readmission Progress

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• Immersion project model• Health Literacy• Community Cross Continuum Teams

– Removal of silos– Collaboration with stakeholders– Regional events including health care and community

partners– Encourage education sharing – Encourage patient participation

• Paradigm shift from ‘doing to patients’ to ‘doing with patients’

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Current Priorities

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Average adult reads 3-5 grade levels below highest grade completed.

Therefore, up to ½ of US population may be at risk for:– Medical misunderstandings– Mistakes– Excess hospitalizations– Poor health outcomes

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Health Literacy

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Cross Continuum Teams

Primary careSpecialistsCare managementLong-term careHome healthHospicePharmacy

Personal careArea Agencies on

AgingHealth plansDurable medical

equipment

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Lessons Learned—Challenges

Patient and family educational needs EHR—helps, but can be burdensome Regional differences:

• Urban—higher indigent population, language and cultural barriers more prevalent

• Rural—can have limited community services Behavioral health care needs Regulatory and payment differences between

levels of care Loss of revenue

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Effective communication. Information sharing – health record exchange. Management of care:

• Transition of care.• Better outcomes.• Engagement of patient and families.• Better planning for chronic and end of life care.

• Use of innovative delivery models, including care in place and effective use of advanced practice professionals.

Measurement/performance indicators that are relevant across the continuum of care.

Understanding of financial performance and implications.

Lessons Learned—Opportunities

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Leadership Strategies to Sustain Quality Improvement and Prevention of Harm

Connecting quality and cost• Align with overall organizational goals and financial incentives

Define clear, measurable aims for improvement• Report out to organization and community, if appropriate

Plan, do, study, act• Multi-disciplinary team• Commit to data collection and reporting

Accountability and transparency• Community regularly with administrative and clinical leadership and

governing body• Show results (good and not-so-good)

Leadership must champion Hardwire the improvements into every day practice

• Everyone held to same standard

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Engaging Patients and Families

Health care consumers:

Expect care to be high quality.

Approach care with a deep sense of uncertainty and vulnerability.

Experience with care is very personal and granular.

See insurance companies as setting the rules.

Want hospitals to see them as people.

Want care to be respectful, professional, and quick.

Want hospitals to be empathetic and to stand up for them.

Source: Findings from HAP Focus Groups – conducted March 2014

PA ranked 40th in HCHAPS scores

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Primary Care

Physicians

Specialty Care

Physicians

Outpatient

Hospital Care and

ASCs

Inpatient Hospital Acute Care

Long Term Acute

Hospital Care

Inpatient Rehab

Hospital Care

Skilled Nursing Facility Care

Home Health Care

Medical Home

Acute Care Bundling

Acute Care Episode with PAC Bundling

Post Acute Care (PAC) Episode Bundling

Using Financing to Reshape the Organization and Outcomes of Care

Accountable Care Organizations

The Hospital & Healthsystem Association of PennsylvaniaMay 2014

Questions