1. Facility Scorecards Improving Outcomes & Telling Your Story Melissa Latter, MSN, RN, NHA Lori Herbig, COO, NHA Jess Weber, NHA Chelsea Retirement Community

2. OBJECTIVES 1. FACILITY SCORECARDS What are they Who has them What’s on them How we use them 2. REDUCING HOSPITAL READMISSIONS Visualizing on the scorecard kept us focused Steps taken to reduce our readmission rate 3. FACILITY REPORT CARD Quality Data Summary A way to “Tell Our Story” to referral sources Market to ACO’s

3. SCORECARDS What are they? Data Tool: Way to look at data collectively Dashboard: How are we doing on our quality measures, etc. Measuring Tool: Are we on track to reach our goals? Who has them? CEO (Organizational Scorecard) Strategic & Operations Teams Department Managers Quality – interdisciplinary / reviewed at the QAPI team meeting

4. SCORECARDS Who decides content to include? Department manager with supervisor (Individual & Department goals) Trickle Down Census/Financial Goals Quality Metrics/Survey Results How are they used? Completed monthly – Reviewed Quarterly Overlap Review On Shared Drive Drive Performance Improvement Projects (PIPS) Living Document – change as/if needed

5. Scorecards So, What do they Look Like? Top= Annual Goals Below = Monthly Measures Color Coding Key Performance Indicators20132014 Goal Annual Goals:Annualized JanFebMar AL- Point of Care ImplementationNA100%10%20%30% AL- Complete Medical Records (EMR) ImplementationNA100%75% 85% Kresge- EMAR (Med Pass) Roll OutNA100%0% Kresge- Physician Orders Roll OutNA100%0% Campus DNR Identification SystemNA100%10% 20% CRC Resident Satisfaction Survey (recommend 1st qtr./distribute 3rd)NA100%10%25%50% UMRC Standards Training - (Sustainability Sessions)NA100%10%25%30% UMRC Accreditation- Research and rec/present what UMRC should pursueNA100%0010% ACO quality readiness SNF Readmission rate (All-cause) 9.0%5.8%12.1% Annualized average<9%<15%9.0%7.6%8.9% AL Readmission rate (All- cause)NA 3%8%9% Annualized averageNA<20%3%5.50%6.70%

6. Scorecards BENEFITS Annual Progress Monthly Trends- Real Time Self Assessment Peer Assessment Performance Evaluation Internal Transparency & Collaboration Keep Focused on Priorities CONSIDERATIONS Culture change needed/ new process Validating data Is this meaningful data?

7. HOSPITAL READMISSION RATES 2011 All-Cause readmission rate = >21% (9 months) Needed to do something NOW to position ourselves for the future of ACOs Began tracking on a Scorecard and it kept it in front of us. We could see it was an issue! CEO, COO, Director of Quality, Executive Director, Administrator, QA Team, Staff Development

8. STEPS TO REDUCE READMISSIONS EMR Implementation Alerts Email notifications of significant events Root-Cause Analysis DOQ attendance at daily stand-up (“live alert system”) Random audits of residents sent out F/U with SNF Administrator and DON

9. STEPS TO REDUCE READMISSIONS 1yr “Look-Back” of all readmissions to trend diagnosis New Tube-Feeding patients #1 cause of readmission Data shared with hospital discharge planners/case managers Guidelines instituted for appropriate hospital to SNF discharge timeframes (post-op)

10. STEPS TO REDUCE READMISSIONS Education with Nursing Staff. Started using the “lingo” with staff- ACO’s, Hospital Readmissions Discussed at EVERY staff meeting leading up to changes we proposed DON and Nurse Managers attended Webinar trainings Hospital readmissions Interact II Tools available (SBAR- Situation/Background/Assessment/Recommend, Change of Condition Cards, Early Warning Tools). *Now using Interact III Annual competency training to increase assessment skills Recognize patient changes before they become a crisis and/or need to be sent to the hospital.

11. STEPS TO REDUCE READMISSIONS Hospital Readmission Team Collaboration with CCH (largest referral source) and other outside entities (home care, etc.) to review readmission rates Reviewed MISTARR initiatives/goals Sub-committee of the readmission collaborative meetings Candid Discussions CCH- what they are doing to reduce admits when they send patients home What the SNF, HHA, etc. see as potential reasons we may send patient back Committee includes reps from other SNF and AL facilities (local competitors)

12. STEPS TO REDUCE READMISSIONS Physician Meeting. Hosted a dinner- ALL physicians & extenders Educated on ACOs- how we want to position ourselves Reviewed our goals for reducing readmission rates. Clarified what we CAN/WILL do in-house Reviewed OUR expectations for physicians Treat in-house when possible Covering physicians (not familiar to CRC) need to be educated Discussed THEIR expectations of us Need valid information when nurse calls Need to feel confident in nurses ability Developed a clinical capabilities check-list and identified meds available (IV’s, Vitamin K, etc.) that can be initiated in the facility by trained staff and do not need hospital visit.

13. HOSPITAL READMISSION RATES >21 % (2011) 9.1 % (2012) 8.3 % (2013)

14. CONTINUED COLLABORATIONS TO REDUCE READMISSIONS Other Collaborations St. Joes Extended Care Collaboration University of Michigan Hospital meetings (ACO focus) Jackson, MI Physician Alliance Group Lab/X-ray Companies/Pharmacy Orthopedic Physician Group- Quarterly Meeting Monthly meeting with our Medical Director Setting (and keeping) expectations

15. CONTINUED COLLABORATIONS TO REDUCE READMISSIONS Surgical Observations with local Orthopedic Physician Group Nurses better understand need for pain control, surgical site observation Annual Physicians Dinner Keeping the dialogue going Look for any opportunity to use your successes (even the smallest ones) to build these relationships Others want to be part of the success- increases opportunities to collaborate