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The Clinical and Business Case for Interoperability Direct Trust Mini Conference, Sunday, March 22, 2015 Holly Miller, MD, MBA, FHIMSS CMO MedAllies Copyright,

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Presentation on theme: "The Clinical and Business Case for Interoperability Direct Trust Mini Conference, Sunday, March 22, 2015 Holly Miller, MD, MBA, FHIMSS CMO MedAllies Copyright,"— Presentation transcript:

1 The Clinical and Business Case for Interoperability Direct Trust Mini Conference, Sunday, March 22, 2015 Holly Miller, MD, MBA, FHIMSS CMO MedAllies Copyright, 2015 MedAllies Not for Distribution Source: Holly Miller, MD, not to be used without express permission

2 Agenda Transitions of Care (TOC) Current State Financial Incentives Offered for TOC Improvements Developing a Patient Centered Medical Neighborhood to Enhance Patient Care Transitions and Healthcare Value Patient Centered Medical Neighborhood In Action Copyright, 2015 MedAllies Not for Distribution Source: Holly Miller, MD, not to be used without express permission

3 Transitions of Care: Copyright, 2014 MedAllies Not for Distribution Source: Holly Miller, MD, not to be used without express permission Current State

4 Adverse Events (AE) 1. Forster AJMurff HJPeterson JFGandhi TKBates DW The incidence and severity of adverse events affecting patients after discharge from the hospital. Ann Intern Med2003;138161- 167 2. Forster AJ, Murff HJ, Peterson JF, Gandhi TK, Bates D (2005) Adverse drug events occurring following hospital discharge. Journal of General Internal Medicine 20: 317–323 3. Coleman EASmith JDRaha DMin S Post-hospital medication discrepancies: prevalence, types, and contributing system-level and patient-level factors. Arch Intern Med2005;1651842- 1847 4. Kanaan AQ, Donovan JL, Duchin NP, Field TS, Tjia J, Cutrona SL, Gagne L, Preusse P, Harrold LR, Gurwitz JH. Adverse Drug Events After Hospital Discharge in Older Adults J Am Geriatr Soc. 2013;61(11):1894-1899. 5. Gandhi, TK, Weingart SN, Borus J, Seger AC, Peterson J, Burdick E, Seger SL, Shu K, Federico F, Leape LL, Bates DW. Adverse Drug Events in Ambulatory Care. N Engl J Med 2003;348:1556-64. 6. Gurwitz JH, Field TS, Harrold LR, Rothschild J, Debellie K, Seeger AC, Cadoret C, Fish LS, Garber L, Kelleher M, Bates DW. Incidence and preventability of adverse drug events among older persons in the ambulatory setting. JAMA 2003 Mar 5;289(9):1107-16. 1. Forster AJMurff HJPeterson JFGandhi TKBates DW The incidence and severity of adverse events affecting patients after discharge from the hospital. Ann Intern Med2003;138161- 167 2. Forster AJ, Murff HJ, Peterson JF, Gandhi TK, Bates D (2005) Adverse drug events occurring following hospital discharge. Journal of General Internal Medicine 20: 317–323 3. Coleman EASmith JDRaha DMin S Post-hospital medication discrepancies: prevalence, types, and contributing system-level and patient-level factors. Arch Intern Med2005;1651842- 1847 4. Kanaan AQ, Donovan JL, Duchin NP, Field TS, Tjia J, Cutrona SL, Gagne L, Preusse P, Harrold LR, Gurwitz JH. Adverse Drug Events After Hospital Discharge in Older Adults J Am Geriatr Soc. 2013;61(11):1894-1899. 5. Gandhi, TK, Weingart SN, Borus J, Seger AC, Peterson J, Burdick E, Seger SL, Shu K, Federico F, Leape LL, Bates DW. Adverse Drug Events in Ambulatory Care. N Engl J Med 2003;348:1556-64. 6. Gurwitz JH, Field TS, Harrold LR, Rothschild J, Debellie K, Seeger AC, Cadoret C, Fish LS, Garber L, Kelleher M, Bates DW. Incidence and preventability of adverse drug events among older persons in the ambulatory setting. JAMA 2003 Mar 5;289(9):1107-16. ~ 20% of patients discharged from hospital experience an adverse drug event (ADE) * 1,2,3,4 Similar rates of ADEs in ambulatory patients, particularly among the elderly * 5,6 Copyright, 2014 MedAllies Not for Distribution Source: Holly Miller, MD, not to be used without express permission 1/5

5 Hospital Discharge 1 – 1st Post discharge PCP visit ~ 75% no information about the hospitalization – 4 weeks post discharge 51-77% discharge summary not available 1. Kripalani S, LeFevre F, Phillips CO, et al. Deficits in communication and information transfer between hospital-based and primary care physicians: implications for patient safety and continuity of care. JAMA 2007;297(8):831-41. PCPs and Specialists 2, 3 – PCPs report sending information 70% of time; specialists report receiving the information 35% of the time – Specialists report sending a report 81% of the time; PCPs report receiving it 62% of the time 2 O’Malley, A.S., Reschovsky, J.D. (2011) Referral and consultation communication between primary care and specialist physicians: finding common ground. Arch Intern Med, 171 (1), 56-65. 3. Mehrotra, A., Forrest, C.B., Lin, C.Y. (2011). Dropping the Baton: Specialty Referrals in the United States. The Milbank Quarterly, 89 (1), 39-68. Communication Deficits 5 Copyright, 2015 MedAllies Not for Distribution Source: Holly Miller, MD, not to be used without express permission

6 Adverse Events (AE) 6  Root Cause Analysis of Serious Adverse Events (AEs)  Most frequent attributable cause is ineffective communication  Most vulnerable parts the TOC process are the “hand- offs”  Most frequent AEs are ADEs due to medication errors *Greenes, R. (2007). Clinical Decision Support: The Road Ahead. New York, NY: Elsevier, Inc. Copyright, 2015 MedAllies Not for Distribution Source: Holly Miller, MD, not to be used without express permission

7 Transitions of Care: Copyright, 2015 MedAllies Not for Distribution Source: Holly Miller, MD, not to be used without express permission Financial Incentives

8 Patient Protection and Affordable Care Act – Transitions of Care CPT codes for Transitional Care Management Services – Discharge from Hospital, SNF, Community Mental Health Center, Outpatient Observation, Partial Hospitalization Care Coordination Incentives Copyright, 2015 MedAllies Not for Distribution Source: Holly Miller, MD, not to be used without express permission

9 Patient Protection and Affordable Care Act – Transitions of Care CPT codes for Transitional Care Management Services Care Coordination Incentives Copyright, 2015 MedAllies Not for Distribution Source: Holly Miller, MD, not to be used without express permission CodeMedical Decision Making CommunicationF2F VisitReimbursement 99495Moderate complexity Within 2 business days of discharge Within 14 calendar days of discharge $163.99 99496High complexityWithin 2 business days of discharge Within 7 calendar days of discharge $231.26

10 Care Coordination Incentives Copyright, 2015 MedAllies Not for Distribution Source: Holly Miller, MD, not to be used without express permission Chronic Care Management Fee – Medicare patients 2 or more chronic or episodic health conditions – CPT code 99490 under Part B fee for service $ 41.92 per patient per month Only billed once per month per patient and by one physician > 20 mins clinical staff time directed by a physician spent in CCM services Patient consent required: Medicare pays 80%, patient liable for 20% co-insurance Comprehensive care plan is established, implemented, revised and monitored – Requirements CCM Scope of Service Element Billing Requirement Certified EHR or Other Electronic Technology Requirement Structured recording of demographics, problem list, medications, medication allergies and the creation of a structured clinical summary record must inform the care plan, care coordination and ongoing clinical care Structured recording of demographics, problem list, medications, medication allergies and the creation of a structured clinical summary record using CCM certified technology 24/7 Access to care management services Continuity of care Care management for chronic conditions Creation of a comprehensive care plan for all health and health related issues. Share the care plan as appropriate with other providers Electronic capture of the care plan available 24/7 within the practice and share care plan electronically (not fax) with other providers Provide patient with a written or eCopy of the care planDocument provision in the EHR using CCM certified technology Management of care transitions between and among providers and settings Format and exchange clinical summaries electronically Enhanced patient and provider communication including asynchronous communication Beneficiary consent - for CCM servicesDocument the beneficiary’s written consent and authorization in the EHR using CCM certified technology Beneficiary consent – right to stop the services Beneficiary Consent – only one provider paid during a calendar month

11 Patient Protection and Affordable Care Act, Transitions of Care (Cont.) – Value Based Purchasing Accountable Care Organizations: 1/1/2012 Community-based Care Transitions Program (CBCT): 1/1/2011 Comprehensive Primary Care Initiative (CPC): 2013 – Expanding Authority to Bundle Payments Hospital penalties for preventable 30 day readmissions Care Coordination Incentives Copyright, 2015 MedAllies Not for Distribution Source: Holly Miller, MD, not to be used without express permission

12 American Recovery and Reinvestment Act (ARRA) – Health Information Technology for Economic and Clinical Health Act (HITECH) Meaningful Use Stage 2 Core – More than 10% of patients transitioning or being referred have electronic transmission using CEHRT to recipient Care Coordination Incentives Copyright, 2015 MedAllies Not for Distribution Source: Holly Miller, MD, not to be used without express permission

13 Transitions of Care: Copyright, 2015 MedAllies Not for Distribution Source: Holly Miller, MD, not to be used without express permission Developing a Patient Centered Medical Neighborhood

14 Practice Copyright, 2015 MedAllies Not for Distribution Source: Holly Miller, MD, not to be used without express permission Developing a Patient Centered Medical Neighborhood

15 Copyright, 2015 MedAllies Not for Distribution Source: Holly Miller, MD, not to be used without express permission Practice Developing a Patient Centered Medical Neighborhood

16 Copyright, 2015 MedAllies Not for Distribution Source: Holly Miller, MD, not to be used without express permission Practice Developing a Patient Centered Medical Neighborhood

17 Hospital Behavioral Health Practice SNF HISP Copyright, 2015 MedAllies Not for Distribution Source: Holly Miller, MD, not to be used without express permission Home Health Developing a Patient Centered Medical Neighborhood

18 Copyright, 2015 MedAllies Not for Distribution Source: Holly Miller, MD, not to be used without express permission Clinical Leadership Clinical Trading Partners EHR Configuration Establish Role Based Workflows Training Materials Developing a Patient Centered Medical Neighborhood

19 Identifying Clinical Trading Partners Acute care facilities analyze most frequent: – Discharge destination points – Transfer destination points Ambulatory facilities analyze most frequent: – Referrals or referral sources – Planned admissions to hospitalists Readiness assessment of clinical trading partners – 2014 CEHRT upgrade complete – HISP strategy identified Copyright, 2015 MedAllies Not for Distribution Source: Holly Miller, MD, not to be used without express permission

20 It Has To Be Easy Direct implementation should ENHANCE existing clinical workflow 20 Copyright, 2015 MedAllies Not for Distribution Source: Holly Miller, MD, not to be used without express permission

21 Transitions of Care: Patient Centered Medical Neighborhood in Action Copyright, 2015 MedAllies Not for Distribution Source: Holly Miller, MD, not to be used without express permission

22 Patient Centered Neighborhood in Action: Example Acute Care Patient Discharged from Hospital to Home Direct HISP Direct HISP Hospital Primary Care Discharge C-CDA to PCP Copyright, 2015 MedAllies Not for Distribution Source: Holly Miller, MD, not to be used without express permission

23 Primary Care Patient Centered Neighborhood in Action: Example Acute Care Patient Discharged from Hospital to Home Patient Centered Medical Home Care Manager CCDA Copyright, 2015 MedAllies Not for Distribution Source: Holly Miller, MD, not to be used without express permission

24 Patient Centered Neighborhood in Action: Example Acute Care Patient Discharged from Hospital to Home Direct HISP Direct HISP Hospital Home Primary Care Copyright, 2015 MedAllies Not for Distribution Source: Holly Miller, MD, not to be used without express permission

25 Patient Centered Neighborhood in Action: Example Acute Care Patient Discharged from Hospital to Home Patient at Home Copyright, 2015 MedAllies Not for Distribution Source: Holly Miller, MD, not to be used without express permission

26 Patient Centered Neighborhood in Action: Example Acute Care Patient Discharged from Hospital to Home Patient Centered Medical Home Care Manager Patient at Home Medication Verification Copyright, 2015 MedAllies Not for Distribution Source: Holly Miller, MD, not to be used without express permission

27 Copyright, 2015 MedAllies Not for Distribution Source: Holly Miller, MD, not to be used without express permission Patient Centered Neighborhood in Action: Example Acute Care Patient Discharged from Hospital to Home Primary Care Patient at Home Patient Centered Medical Home Care Manager Discharge Diet and Exercise Instructions

28 Patient Centered Neighborhood in Action: Example Acute Care Patient Discharged from Hospital to Home Patient at Home Copyright, 2015 MedAllies Not for Distribution Source: Holly Miller, MD, not to be used without express permission

29 The Patient Centered Medical Neighborhood Hospital Home Health Home Health Specialist(s) LTPAC Settings (SNF, Other Professionals etc.) Patient Patient Centered Medical Home Integrated Workflow Across the Community 29 Patient Centered Medical Neighborhood Copyright, 2015 MedAllies Not for Distribution Source: Holly Miller, MD, not to be used without express permission

30 Thank You 30 hmiller@medallies.com Copyright, 2015 MedAllies Not for Distribution Source: Holly Miller, MD, not to be used without express permission


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