HOSPITAL READMISSION REDUCTION’S IMPACT ON ASSISTED LIVING JOYCE CLARK www.achievisseniorliving.com 405.812.9089

WHAT IS HRRP? Affordable Care Act. Medicare withhold 1% of hospital’s reimbursement for readmissions that take place within 30 days of discharge and are deemed to be excessive. 2% in 2014 and 3% in 2015.

Acute Myocardial Infarction (AMI) INITIAL FOCUS ON: Pneumonia (PN) Heart Failure (HF) Acute Myocardial Infarction (AMI)

FORECASTED ADDITIONS: Cardiac Bypass Surgery Cardiac Stinting Other Vascular Procedures Oncology Related Diabetes

MONEY MOTIVATORS: ~20% Medicare patients return to hospital within 30 days, costing gov’t extra $17,500,000,000 in 2010. Medicare estimates will recoup $280,000,000+ in 2013 from penalties. $1,900,000,000 annual savings to Medicare if readmission rates lowered to best performance.

CMS DEFINES READMISSION: Admission to a subsection (d) hospital within 30 days of a discharge from same OR another subsection (d) hospital. General, acute care, short term hospitals. 2,217 hospitals first year.

GAME CHANGER FOR LTC PROVIDERS As local hospitals feel impact they will begin looking at post-acute providers in new ways.

ACCOUNTABLE CARE ORGANIZATIONS (ACOs): Network of doctors, hospitals, ambulance, & other health providers. Manage all health-care needs of 5,000+ Medicare beneficiaries for 3 yr minimum. CMS will share savings with participating ACO providers. ACO may pay penalty to CMS if no savings achieved. Parts A & B.

NURSING HOMES HARDEST HIT… Up to 66% of admits from NH are considered inappropriate. Pushing of acuity down continuum will increase as gov’t looks for ways to further reduce costs. QAPI  (Quality Assurance & Performance Improvement program) and other demands. Home-based services will grow as alternative to LTC. NH can be a part of ACO.

Currently ALFs cannot officially join ACOs but can subcontract. AL may become Medicare provider in near future as America moves to managed care. Performance based relationships will grow.

SYNERGY BETWEEN ALFs AND ACOs Assisted living is low cost alternative. Steady increase in AL acuity is developing competency to handle people previously treated in more acute settings. Home health is payor conduit for ACO services. Medicaid Waiver and managed LTC programs.

BE PROACTIVE Demonstrate ability to provide quality care and keep re- admissions to lowest possible safe levels. Collect, analyze, track, trend readmission data to identify opportunities for improvement. Target key referral sources.

ASSISTED LIVING STRATEGIES: Installing electronic medical records system. Enhancing staff levels. Adding clinical capabilities. Renovating to accommodate new services and levels of care.

Offering short-term stay units and 24-hour nursing services in states with regulations allowing high levels of medical care. Partnering with therapy and home health companies to provide more medical components. On-site and virtual nurse practioners or physician assistant who obtain diagnostic tests, administer IVs, etc..

Using resident assessment data for quality improvement. Staff training to identify and address early resident status changes. Using advanced care directives to steer care choices. Family care conferences.

Fall prevention programs. Palliative care and hospice. Increased therapy screening and involvement. Care plans based on diagnosis.

Document and describe best practices. STARTING POINT: Document and describe best practices. Collect data to quantify accomplishments. Low rate of falls and incidents necessitating emergency calls or hospitalizations.

INTERACT Interventions to Reduce Acute Care Transfers. Quality improvement program to help nursing staff identify, assess, communicate, and document changes in resident conditions before a decision on hospitalization is made. Clinical & educational tools & strategies for LTC.

LONG-TERM CARE DEVELOPMENT, MARKETING, & MANAGEMENT Joyce Clark 405.812.9089 www.achievisseniorliving.com