Docstoc

ICD-10 Implementation in a 5010 Environment

Document Sample
ICD-10 Implementation in a 5010 Environment Powered By Docstoc
					CMS National Conference
  on Care Transitions


     December 3, 2010




                          1
   How Project RED and
the Care Transitions Project
 Reduced Readmissions in
       South Texas
               Robin Jones, RN
          Quality Care Coordinator
        Valley Baptist Medical Center-
                  Brownsville

          Jennifer Markley, RN, BSN
       Senior Director, Medicare Quality
                  Improvement
         TMF Health Quality Institute


                                           2
CMS Care Transitions Project
 • Project began in August of 2008
 • Data analysis was based on 2007
   Medicare claims data
 • 14 communities in the U.S
 • Reduce hospital readmissions
   through improved quality of
   patient transitions


                                     3
CMS Care Transitions Project
 • Goal is minimum 2% reduction
   30-day rehospitalization rate by
   28th month of the project
   (November 2010)
 • A comprehensive community-
   wide, cross-setting effort
 • Yield sustainable and replicable
   strategies

                                      4
CMS Care Transitions Project




      This map shows the 14 states where Care
        Transitions projects are located.
                                                5
              Baseline Measurements
  TABLE 1: Hospital Disposition After Inpatient
                  Hospitalization
 Quarter 1, 2008 based on Medicare Claims Data

                                                                                                                   Percent of
  Region and                                                Number of       Percentage of All Discharges with Discharges with
   Provider                       S etting                  Discharges         Discharges     a 30-day Readmit a 30-day Readmit
Harlingen Region Home Health Agency (HHA)                           1,109             22.6%               173            15.6%
                 Home                                               2,736             55.7%               648            23.7%
                 Inpatient Rehabilitation Facility (IRF)              281              5.7%                45            16.0%
                 Long-Term Acute Care (LTAC)                          180              3.7%                29            16.1%
                 Skilled Nursing Facility (SNF)                       604             12.3%               189            31.3%
                 All                                                4,910            100.0%             1,084            22.1%

VBM C-B           Home Health Agency (HHA)                           162              22.7%                22            13.6%
                  Home                                               387              54.3%               104            26.9%
                  Inpatient Rehabilitation Facility (IRF)             44               6.2%                 4             9.1%
                  Long-Term Acute Care (LTAC)                         41               5.8%                10            24.4%
                  Skilled Nursing Facility (SNF)                      79              11.1%                26            32.9%
                  All                                                713             100.0%               166            23.3%
                                                                                                                           6
     Valley Baptist Medical
      Center-Brownsville
• A faith based 280 bed licensed, not-
  for-profit acute care hospital,
  including a 37 bed off-campus Psych
  facility
• Level 3 designated trauma center
• JC accredited for hospital & lab and
  stroke-certified
• Located on the southernmost tip of
  Texas, on the border with Mexico
                                         7
  Baseline Measurements –
           VBMC-B
• CT Project hospital baseline rate of
  23.3% all cause 30-day readmission rate
  (Q1 2008)
• 28.1% Hospital Compare heart failure
  readmission rate
   – Data for discharges between July 01,
     2006 and June 30, 2009
   – (http://www.hospitalcompare.hhs.gov)

                                        8
              Solutions
• Implementation of Project RED
   −Initial focus on HF patients,
    Telemetry Unit
   −May 2010, expanded to all diagnoses,
    Telemetry Unit
• Community-wide partnership with
  downstream providers
   −Use of EHR to improve hand-off
    communication
   −Active involvement in Regional
    Workgroup meetings                     9
               Solutions
• Education of medical staff including
  physicians
  – Medication reconciliation
  – Health literacy and patient safety
  – Chronic kidney disease




                                         10
         Implementation
• All components of Project RED were
  implemented and monitored in facility’s
  30 bed Telemetry floor
   −Team approach to administering all
    eleven components
   −Nursing, Care Management,
    Pharmacy and Core Measures Team
    all contributed to process


                                        11
             Teamwork
• Nursing & Care Management
  – Educate the patient about his or her
    diagnosis throughout the hospital
    stay
  – Discuss with the patient any tests or
    studies that have been completed in
    the hospital and discuss who will be
    responsible for following up on the
    results
  – Review the appropriate steps for what
    to do if a problem arises          12
             Teamwork
• Nursing
  – Provide follow-up telephone
    reinforcement
  – Assess degree of understanding
    (teach-back)
  – Provide patient with a written
    discharge plan
  – Make appointments for clinician
    follow-up and post-discharge testing

                                           13
             Teamwork
• Care Management
  – Organize the post-discharge services
  – Expedite transmission of the
    Discharge Resume to the physicians
    and other services accepting
    responsibility for the patient’s care
    after discharge



                                            14
             Teamwork
• Nursing, Pharmacy & Care Management
  – Confirm the Medication Plan

• Nursing/Core Measures
  – Reconcile discharge plan with
    national guidelines




                                    15
Monitoring for Effectiveness
• Patients were asked a total of nine brief yes or no questions
  about their perceptions. Surveys were available in English
  and Spanish.

   – I was taught about my diagnosis during my hospital
     stay.

   – I have follow-up appointments with my physicians.

   – I have been told about test results or studies that have
     not been completed before I go home.

   – If I need home health care, medical equipment or other
     help or services after I go home, it has been arranged.

   – I understand what to do and who to call if a problem
     arises after I am home.                                    16
Monitoring for Effectiveness
• Survey Questions continued:

   – I have received a written discharge plan that is easy to
     read and understand.

   – I have received a written discharge plan that has the
     information I need to take care of myself at home.

   – I have a written list of my discharge medications and
     know which medications are new or changed.

   – When the nurses were teaching me, they asked me to
     explain what I had learned in my own words.


                                                                17
    Administering Patient
          Surveys
• Case Management (CM) runner
  sends out daily Length of Stay (LOS)
  report to identify patients going
  home with no services to Case
  Managers, Tele Supervisor/Charge
  Nurse, and Quality Assurance

• Floor staff is responsible for
  completing all components of RED
  prior to discharge
                                     18
    Administering Patient
          Surveys
• CM runner delivers and retrieves
  patient survey and forwards
  completed surveys to Quality

• CM updates the LOS report daily to
  reflect D/C plan and submit to CM
  runner and Quality



                                       19
        Patient Survey Results
Data Averages based on 273 completed surveys
  between January and September 2010
•   93% of patients surveyed said that they had received education
    about their diagnoses

•   94% of patients surveyed said that they had a follow-up
    appointment. 88% had a follow-up appointment scheduled within
    one week post-discharge

•   99% of patients surveyed said that their written discharge plan
    had the information needed for self care and that it was easy to
    read and understand




                                                                       20
        CT Project Results
 TABLE 2: Hospital Disposition After Inpatient
                 Hospitalization
Quarter 1, 2010 based on Medicare Claims Data




                                            21
           CT Project Results for
              Harlingen HRR
FIGURE 1: Percent of Discharges with a 30-day
  Readmission for HHRR
•   Hospital Disposition After Inpatient Hospitalization
•   Baseline compared to Quarter 1, 2010 based on Medicare Claims Data




                                                                  22
           CT Project Results for
                 VBMC-B
FIGURE 2: Percent of Discharges with a 30-day
  Readmission for VBMC-B
•   Hospital Disposition After Inpatient Hospitalization
•   Baseline compared to Quarter 1, 2010 based on Medicare Claims Data




                                                                  23
             CT Project Outcome
             Measures for VBMC-B
FIGURE 3: Percent of Hospital Readmission Within
  30 Days
•   Semi-annual rate ending in Quarter 1 2010
•   A 3.6% decrease in all cause 30-day readmissions

    26.0%
                                                 23.7%
    24.0%             23.1%                                   23.0%
            21.9%             22.3%   22.2%                                          22.6%   22.3%
                                                                      21.5%
    22.0%

    20.0%

    18.0%                                                                                            19.5%
    16.0%

    14.0%
            CY 2007   Baseline Q2 2008 Q3 2008 Q4 2008 Q1 2009 Q2 2009 Q3 2009 Q4 2009 Q1 2010


                                 VBMC-B       Harlingen HRR       Target (Q1 2010)



                                                                                                             24
           CT Project Outcome
           Measures for VBMC-B
FIGURE 4: O-1a: HCAHPS Medication Management
•   4-quarter rolling rate ending in the listed quarter

    95%

                               87.9%     89.1%
    90%   87.5%      87.5%                         87.5%

    85%
                                                             79.6%     79.6%      81.3%
    80%

    75%

    70%

    65%

    60%
          Baseline   Q3 2008   Q4 2008   Q1 2009   Q2 2009   Q3 2009   Q4 2009   Q1 2010

              Community Average          VBMC-B Target (Q1 2010)       Baseline (Q2 2008)   VBMC-B



                                                                                                     25
                  CT Project Outcome
                  Measures for VBMC-B
FIGURE 5: O-1b: HCAHPS Discharge Planning
•   4-quarter rolling rate ending in the listed quarter

    95%


    90%
                                 85.6%     86.2%     85.7%      86.6%               87.2%
          87.3%
    85%                83.2%                                             83.7%


    80%


    75%


    70%
            Baseline   Q3 2008   Q4 2008   Q1 2009   Q2 2009   Q3 2009   Q4 2009   Q1 2010

                  Community Average        VBMC-B Target (Q1 2010)       Baseline (Q2 2008)   VBMC-B



                                                                                                       26
          CT Project Outcome
          Measures for VBMC-B
 FIGURE 6: O-2: Percent of Patients Seen by a
    Physician Between DC and Readmission

80%

70%

60%
                                                         48.8%
50%   44.8%                                                        45.7%                45.3%
                                               41.5%
40%                                                                           36.5%
                 30.7%     32.0%
30%                                  24.4%
20%
      Baseline   Q2 2008   Q3 2008   Q4 2008   Q1 2009   Q2 2009   Q3 2009    Q4 2009   Q1 2010

              Community Average      VBMC-B Target (Q1 2010)       Baseline (Q1 2008)      VBMC-B



                                                                                                    27
   For more information about
       Project RED, contact
• For more information about Project RED
  research:
https://www.bu.edu/fammed/projectred/index.html

• For additional information about dissemination:
http://www.engineeredcare.com

• For commercial inquiries:
info@engineeredcare.com
For more information, contact:
                          Jennifer Markley, RN, BSN,
    Senior Director, Medicare Quality Improvement
                         TMF Health Quality Institute
                               Phone: 512-334-1663
                   E-mail: jmarkley@txqio.sdps.org
                         Care Transitions Web Site:
                        http://CareTransitions.tmf.org


This material was prepared by TMF Health Quality Institute, the Medicare Quality Improvement Organization for Texas,
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. 9SOW-TX-CT-10-67




                                                                                                                 29

				
DOCUMENT INFO
Shared By:
Categories:
Tags:
Stats:
views:4
posted:9/22/2011
language:English
pages:29