Presentation on theme: "MSPB, IMPACT and The Delivery Model of the Future"— Presentation transcript:
1 MSPB, IMPACT and The Delivery Model of the Future October 16, 2014Josh Luke, Ph.D., FACHEFounder, National Readmission Prevention CollaborativeInterim CEO, Memorial Hospital of GardenaAdjunct Faculty, CSULB Healthcare Administration DepartmentAuthor, Readmission Prevention: Solutions Across The Provider Continuum
2 Presentation Objectives The delivery model of the futureThe New Readmission Penalty: MSPBIMPACT: Who wins???Position yourself as a preferred provider through innovationLet’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., FACHESNF Administrator for KindredCEO for HealthSouth Las Vegas Rehab HospitalHospital CEO (WMCA); and now Interim CEO at Memorial Hospital of GardenaVP, Post Acute at Torrance Memorial Health SystemHome health and Hospice oversightDeveloped award winning Post Acute NetworkSelected to author Readmissions book for ACHE
6 Congestive Heart Failure Grandma BelvaMarch 1920 – July 2002Congestive Heart FailureThe Summer of 2002HomeHemet Valley Medical CenterLTACHNursing HomeHome with Home Health* Hemet Valley Medical CenterAssisted 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 allAll providers win with every admission or caseWho gets paid for utilization?Acute Stay: 1) Doctor, 2) HospitalPost Acute Stay: 1) Doctor (again), 2) SNF/LTACH/IRFHome Health: 1) Doctor (again x 2), 2) HH AgencyFollow- up Doctors Office Visit: 1) Doctor (again x 3)
8 What Does this all mean to us as providers? We must coordinate careThe 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 resortSNF = Second to last resort; increase capability to handle med surg level patientsHome health = Networks will be narrowedPatients 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 nursingAssisted livingWho can position for success?Health systems designed so that hospital is truly the last resortSNF’s who are willing to push for shorter LOS
12 Transitional Care, Wellness & Revenue Streams Everyone is being incentivized to avoid the hospitalDirect to SNF transfers from the EDRemote monitoring at home and in SNFHome visitsExpansion of Home Health to Ambulatory case managersHomeDr. OfficeSNFHospitalHospitalHome Health
13 Obama Alaska Hypothetical New City Health System of the FutureHomeDoctors officeWellness clinic/gymOP/Ancillary ServicesAssisted LivingSNFHospital
14 Obama Alaska The System of Old – The Fee-For-Service Free-for-All HomeDoctors officeWellness clinic/gymOP/Ancillary ServicesAssisted LivingSNFInsert Hospital Here!Hospital
15 Story Time Once Upon a time… Old Hospital = 290 bedsNew Hospital =249 bedsHospital Bed CapacityThe Fee For ServiceFree-for-All EraPost ACA Era
16 Six Reasons to Coordinate Care ACO’s (MSSP incentive)Bundled Payment InitiativesValue based InitiativesReadmission PenaltiesRAC AuditsMSPBFour of the six above have not been relevant enough to get hospitals to react
17 MSPB: The New Readmission Penalty Medicare Spending Per BeneficiaryEffective October 1, 2014An 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 admission2) During the index admission3) 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).
21 MSPB: Hospital Sample Medicare.gov, Hospital Compare During Index Hospital Stay IP $ SpentHospital A: $7, %State $8, %National $8, %Complete Episode (MSPB) Total SpendingHospital A: $26, %State $19, %National $18, %
22 MSPB: Hospital Sample Medicare.gov, Hospital Compare 1-30 days After Inpatient SpendingHospital 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 careThe 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 innovateRisk stratification software & post acute connectivityRemote monitoring unitsFormalize relationships for Care Planning support to reduce workload and provide ambulatory case management servicesCare Patrol Community Integration Model: Designed Specifically to Assist Hospitals with MSPBCare Centrix HomeStar: Home Health management
25 The transformation of the acute hospital: the C-suite must take action Coordinating Care for Improved OutcomesHospitals must act like health systemsHealth systems must act like managed care organizationThus, the hospital must act like a managed care organization as wellHospitalHealth SystemManaged 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 NewsPre-authorizationsShorter LOSReduced reimbursementGood NewsNarrow networks for those committed to qualityIts inevitable that the three midnight requirement go away if managed care can approve a direct from home to SNF admissions
28 Post Acute Expectations POLSTSBARStop and WatchReturn to Acute Log (Emergency Dept)Return to ED Root Cause AnalysisDNA testing for improved Medication ManagementPredictive 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 connectivitySoftware such as RightCare Solutions (UPenn) identifies & connectsRemote monitoring in SNF’s, Home Health and Assisted Living:Shortens acute Length of stayPredictive software (Coms Interactive) in SNF’s:Trains nurses when red flags arise and how to react to warning signsDNA 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 mapThese are all MSPB solutions as well.
33 The Super SNFStop looking at competitors within the SNF industry for the answers and start innovatingHospital 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 monitoringRisk stratification & post acute connectivityGenetic (DNA) testingPredictive softwareInnovate and DifferentiateReadmission Tool KitsFellow in Readmission PreventionCertified Readmission Prevention Partner programOutreach to your referral partners consistentlyOn the 15th of each month: Share the tools above!
35 Northern Cal Readmissions Summit Special NationalReadmissionPrevention.comOur website was created to showcase “Best Practice” case studies online – submit yours todayNorthern Cal Readmissions Summit Special15% discount today only for these products at the registration table – while supplies last!Fellow Certificate in Readmission PreventionCertified Readmission Prevention PartnerHospital, SNF, Home Health Readmission Tool Kits
36 NRPC Conferences in 2015 Readmission Conference Schedule Las Vegas: January 15, 2015San Diego: February 5, 2015Phoenix: February 12, 2015Anaheim: 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., FACHEFounder, National Readmission Prevention CollaborativeInterim CEO, Memorial Hospital of GardenaExecutive Faculty, CSU Long BeachAuthor: Readmission Prevention: Solutions Across the Provider ContinuumNationalReadmissionPrevention.com