1. MSPB, IMPACT and The Delivery Model of the Future
October 16, 2014
Josh Luke, Ph.D., FACHE
Founder, National Readmission Prevention Collaborative
Interim CEO, Memorial Hospital of Gardena
Adjunct Faculty, CSULB Healthcare Administration Department
Author, Readmission Prevention: Solutions Across The Provider Continuum

2. Presentation Objectives
The delivery model of the future
The New Readmission Penalty: MSPB
IMPACT: Who wins???
Position yourself as a preferred provider through innovation
Let’s get off the starting line and skate to where the puck will be!
Its time to innovate and transform!

3. So Cal Readmissions Update Summit – 10/16/2014
Josh Luke, PhD., FACHE
SNF Administrator for Kindred
CEO for HealthSouth Las Vegas Rehab Hospital
Hospital CEO (WMCA); and now Interim CEO at Memorial Hospital of Gardena
VP, Post Acute at Torrance Memorial Health System
Home health and Hospice oversight
Developed award winning Post Acute Network
Selected to author Readmissions book for ACHE

4. 1998…….It was a very good year

5. 1998…….It was a very good year

6. Congestive Heart Failure
Grandma Belva
March 1920 – July 2002
Congestive Heart Failure
The Summer of 2002
Home
Hemet Valley Medical Center
LTACH
Nursing Home
Home with Home Health
* Hemet Valley Medical Center
Assisted Living with Home Health
*Hemet Valley Medical Center
* Readmission $0
$48,000
$52,000
$12,000
$4,000
$36,000
$18,000
$42,000
$24,000
$58,000
$298,000

7. Delivery Model of the Past
The Fee For Service free for all
All providers win with every admission or case
Who gets paid for utilization?
Acute Stay: 1) Doctor, 2) Hospital
Post Acute Stay: 1) Doctor (again), 2) SNF/LTACH/IRF
Home Health: 1) Doctor (again x 2), 2) HH Agency
Follow- up Doctors Office Visit: 1) Doctor (again x 3)

8. What Does this all mean to us as providers?
We must coordinate care
The Affordable Care Act is not a request, but a mandate with significant penalties if we do not.
What does this mean for the acute hospital sector?

9. Are you Ready for the truth?
The goal is to find a better way for individuals to age and heal at home.
The truth is that my job is not to teach you how to prevent re-admissions, its to teach you to prevent….Admissions.
Welcome to the world of…
ADMISSION PREVENTION

10. What does this mean for you?
Hospitals = Last resort
SNF = Second to last resort; increase capability to handle med surg level patients
Home health = Networks will be narrowed
Patients will be directed to lower levels of care and care paid privately (ALF, home care, remote monitoring)

11. Winning! So who is winning? Who can position for success? Home Care
Private duty nursing
Assisted living
Who can position for success?
Health systems designed so that hospital is truly the last resort
SNF’s who are willing to push for shorter LOS

12. Transitional Care, Wellness & Revenue Streams
Everyone is being incentivized to avoid the hospital
Direct to SNF transfers from the ED
Remote monitoring at home and in SNF
Home visits
Expansion of Home Health to Ambulatory case managers
Home
Dr. Office
SNF
Hospital
Hospital
Home Health

13. Obama Alaska Hypothetical New City
Health System of the Future
Home
Doctors office
Wellness clinic/gym
OP/Ancillary Services
Assisted Living
SNF
Hospital

14. Obama Alaska The System of Old – The Fee-For-Service Free-for-All
Home
Doctors office
Wellness clinic/gym
OP/Ancillary Services
Assisted Living
SNF
Insert Hospital Here!
Hospital

15. Story Time Once Upon a time…
Old Hospital = 290 beds
New Hospital =
249 beds
Hospital Bed Capacity
The Fee For Service
Free-for-All Era
Post ACA Era

16. Six Reasons to Coordinate Care
ACO’s (MSSP incentive)
Bundled Payment Initiatives
Value based Initiatives
Readmission Penalties
RAC Audits
MSPB
Four of the six above have not been relevant enough to get hospitals to react

17. MSPB: The New Readmission Penalty
Medicare Spending Per Beneficiary
Effective October 1, 2014
An MSPB episode includes all Medicare Part A and Part B claims paid during the period from 3 days prior to a hospital admission through 30 days after discharge.

18. IMPACT Here Comes Reason #7 to Coordinate Care
Improving Medicare Post-Acute Transformation Act of 2014 IMPACT Act of 2014 takes a crucial step toward the modernization of Medicare payments to post-acute care (PAC) providers Who wins? Maybe no one: It appears to be more documentation to prove medical necessity

19. MSPB: The New Readmission Penalty
Each hospital’s average episode spending levels are separated into three time periods:
1) During the 3 days prior to the index admission
2) During the index admission
3) During the 30 days after hospital discharge.
Within these three time periods, the average episode spending levels are further broken down into seven provider types (e.g., inpatient, outpatient).

20. MSPB: Hospital Sample Medicare.gov, Hospital Compare
3 days Prior SNF $ Spent
Hospital A: $ %
State $3 .02%
National $2 .01%
30 days after discharge SNF $ Spent
Hospital A: $3, %
State $3, %
National $2, %

21. MSPB: Hospital Sample Medicare.gov, Hospital Compare
During Index Hospital Stay IP $ Spent
Hospital A: $7, %
State $8, %
National $8, %
Complete Episode (MSPB) Total Spending
Hospital A: $26, %
State $19, %
National $18, %

22. MSPB: Hospital Sample Medicare.gov, Hospital Compare
1-30 days After Inpatient Spending
Hospital A: $8, %
State $2, %
National $2, %
Inpatient includes LTACH, IRF and Readmissions.
Readmission rate is only .04% - so there is LTACH and IRF utilization.

23. MSPB: The Feds Finally Got it Right!
What Does this all mean to us as providers?
We must coordinate care
The Affordable Care Act is not a request, but a mandate with significant penalties if we do not.
What does this mean for the acute hospital sector?

24. Connectivity and Care Planning
Hospitals must be connected to their post acute providers and innovate
Risk stratification software & post acute connectivity
Remote monitoring units
Formalize relationships for Care Planning support to reduce workload and provide ambulatory case management services
Care Patrol Community Integration Model: Designed Specifically to Assist Hospitals with MSPB
Care Centrix HomeStar: Home Health management

25. The transformation of the acute hospital: the C-suite must take action
Coordinating Care for Improved Outcomes
Hospitals must act like health systems
Health systems must act like managed care organization
Thus, the hospital must act like a managed care organization as well
Hospital
Health System
Managed care

26. SNF Providers: Are You Ready for the New Normal?
What if, on December 31, 2014 you received a notification from CMS advising you that…

27. Duals: Something Has Got to Give
Bad News
Pre-authorizations
Shorter LOS
Reduced reimbursement
Good News
Narrow networks for those committed to quality
Its inevitable that the three midnight requirement go away if managed care can approve a direct from home to SNF admissions

28. Post Acute Expectations
POLST
SBAR
Stop and Watch
Return to Acute Log (Emergency Dept)
Return to ED Root Cause Analysis
DNA testing for improved Medication Management
Predictive software/electronic quality data *
* Only tactic requiring investment; small price to pay to be preferred provider

29. Four examples of Value-Added Innovation
Risk Stratification in acute and post acute connectivity
Software such as RightCare Solutions (UPenn) identifies & connects
Remote monitoring in SNF’s, Home Health and Assisted Living:
Shortens acute Length of stay
Predictive software (Coms Interactive) in SNF’s:
Trains nurses when red flags arise and how to react to warning signs
DNA Testing in SNF’s, Home Health and Assisted Living:
To improve outcomes, reduce med usage, med errors and overall costs (MSPB) based on a persons genetic map
These are all MSPB solutions as well.

33. The Super SNF
Stop looking at competitors within the SNF industry for the answers and start innovating
Hospital based SNF’s within a mile of your facility get paid $800-$1100 a day for SNF patients; why don’t you?

34. Key Action Items Find value added opportunities to differentiate
Remote monitoring
Risk stratification & post acute connectivity
Genetic (DNA) testing
Predictive software
Innovate and Differentiate
Readmission Tool Kits
Fellow in Readmission Prevention
Certified Readmission Prevention Partner program
Outreach to your referral partners consistently
On the 15th of each month: Share the tools above!

35. Northern Cal Readmissions Summit Special
NationalReadmissionPrevention.com
Our website was created to showcase “Best Practice” case studies online – submit yours today
Northern Cal Readmissions Summit Special
15% discount today only for these products at the registration table – while supplies last!
Fellow Certificate in Readmission Prevention
Certified Readmission Prevention Partner
Hospital, SNF, Home Health Readmission Tool Kits

36. NRPC Conferences in 2015 Readmission Conference Schedule
Las Vegas: January 15, 2015
San Diego: February 5, 2015
Phoenix: February 12, 2015
Anaheim: March 2015
(free readmissions book to first 100 to register!)

37. My Legacy: Going Purple for My Mom
As my mother enters her golden years and struggles with the effects of Alzheimer’s Disease, It is my hope and goal that we as a healthcare community can continue the movement towards a patient centered delivery system.
- Josh Luke

38. Go Purple to fight Alzheimer’s Disease!
Josh Luke, Ph.D., FACHE
Founder, National Readmission Prevention Collaborative
Interim CEO, Memorial Hospital of Gardena
Executive Faculty, CSU Long Beach
Author: Readmission Prevention: Solutions Across the Provider Continuum
NationalReadmissionPrevention.com