1. Tracking Readmissions HomeTown Medicare Meeting
Kerry Dunning, MHA, MSH, CPAR, RAC-CT
GPS Healthcare Consultants
March 2016

2. Set Goals? Track your hospital penalties
Track readmissions from YOUR swing bed or SNF
Reducing readmissions from skilled nursing by _____%
How are you doing that?
What’s next? 2 2

3. Why? Somebody else is looking at your data
Hospitalization puts elderly at greater risk for complications and infections
Rehospitalization increases likelihood for confusion, continuing decline, increased depression
Hospitalization also increases the likelihood of reduced functioning on return to the skilled nursing facility
Safety and falls
Medication changes

4. What?
CMS is offering financial incentives to reduce potentially avoidable hospital transfers OR penalties for those who don’t
CMS is moving from volume to value mode (ACOs, bundled payments, preferred partners)
CHF, Pneumonia, AMI, COPD, elective Hip and knee replacements
Moving toward all condition readmissions

5. Looking at your penalties

6. Watching your readmissions

7. Looking for Preferred Partners

8. Measure your Rates Based on claims
Does not include ER visits or Observation stays
Excludes Medicare Advantage/Insurance
% = # of persons sent to hospital
# of persons admitted to the SNF/SWB

9. Why the Readmissions? EXCEL SPREADSHEET Discharges – Tracking Log
Physician discharges? Nursing?
Track by physician, NP, PA
Time of day, certain day?
Lack of education/lack of home evaluation
INTERACT tools?
Preventable or not?
EXCEL SPREADSHEET

10. Graph and Review

11. Quality “GRADES” SNF Hospital metrics may be different
Five Star
Nursing Home Compare
Facility Satisfaction on Survey
QIS/Traditional Survey
Hospital metrics may be different
By diagnoses
By discharge
Managed Care/Insurance Contracts

12. Stop Unnecessary Readmissions
Resident condition meeting
Early changes in condition
Teach back method
Stop and Watch Tool
eMR – alerts for change in condition
Telemedicine
Discharge planning /Education process/ How the patient can manage the disease at home

13. Contact:
Kerry Dunning, MHA, MSH, CPAR, RAC-CT Chief Senior Services Officer GPS Healthcare Consultants