Readmission Race: Best Practice Showcase
How to Track and Report Readmissions
September 14, 2012
12:00 to 1:30 pm CST
Welcome and Overview
• Welcome, thank you for joining us today!
• Housekeeping
– This webinar is being recorded and will be archived.
– You will receive a PDF of today’s presentation, as well as a
link to fill-out the evaluation and a summary of Q&A.
– For questions: please reach out to your state lead or email
us: HEN@aha.org.
• Agenda
– Hospital Sharing and Coaching
– Readmissions Race Update
– Q&A
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Introductions
• Tasha Gill, MPH, HRET
• Denise Remus, PhD, RN, Cynosure Health
• Sherry Jensen, MSN, RN-BC, CPHQ Saline Memorial
Hospital
• Kathy Beck, RN, MSN, CPHQ, Grenada Lake Medical
Center
• Amy Paul, RN, BSN, CCM, Memorial Hospital of
Rhode Island
• Charisse Coulombe, MS, MBA, CPHQ, HRET
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Readmission Race: Best Practice Showcase
How to Track and Report Readmissions
Sherry L. Jensen, MSN, RN-BC, CPHQ
Quality/Risk Department Manager
Saline Memorial Hospital
Saline Memorial Hospital
Saline Memorial Hospital is a full-service 167-bed facility that has served
Saline County and surrounding areas for over 55 years. The hospital is
located just off of I-30 in Benton, about 20 miles south of Little Rock. In
addition to the hospital, Saline Memorial manages an Internal Medicine
Clinic, General Surgery Clinic and Women’s Clinic.
5
Defining Readmissions
• Readmissions to SMH only
• Looking at Medicare readmissions, along with allpayer source readmissions
• Exclude deaths, those discharged AMA, and those
discharged to psychiatric facility, acute care rehab,
and hospice
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Securing Data
• Information Systems (IS) wrote readmission query
program
• Each admission searched using MR# for previous
IP admissions w/in 30 days
• Readmission report automatically sent each
morning to designated departments
7
Utilizing Readmission Data
• Each readmission is researched for payer source,
diagnosis, discharge/readmission destination, and
case management plan of care for initial admission
• Data is reported in all physician, staff, administrative,
and Board of Director meetings
• Quality/Risk, Case Management, and Nursing use
data to change/revise current processes
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Top 3 Data Challenges and Solutions
Challenges
Solutions
1. Obtaining baseline
data
1. Worked closely w/IS
to define data criteria
2. Overwhelming
feelings r/t data
2. Developed plan of
action w/key leaders
3. Lack of knowledge r/t
readmission
criteria/consequences
3. Education to nursing
staff, physicians, and
administration.
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If I Could, I Would . . .
While readmissions had been tracked and
discussed for many years, I wish we had taken
this more focused approach earlier. Becoming
aware of each readmission is changing our point of view,
changing our processes, and hopefully, changing
our patient outcomes.
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Readmission Race: Best Practice Showcase
How to Track and Report Readmissions
Kathy L. Beck, RN, MSN, CPHQ
Chief Nursing Officer
Grenada Lake Medical Center
Hospital Story – Who We Are…
•
•
•
•
•
Grenada Lake Medical Center, Grenada MS
Kathy Beck, RN, MSN, CPHQ, Chief Nursing Officer
County-owned, rural community hospital
Located halfway between Memphis, TN and Jackson, MS
Licensed for 156 beds
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Defining Readmissions
• Measuring 4 outcome indicators
• All patients readmitted 15 days after discharge.
• All patients readmitted 30 days after discharge.
• Medicare patients readmitted 15 days after
discharge.
• Medicare patients readmitted 30 days after
discharge.
• Measuring 2 process indicators
• Discharge instructions were performed and
included requirements.
• Follow up appointment given to patient.
13
Defining Readmissions
• All DRGs included, but more intensive review of
heart failure, AMI, and pneumonia education.
• Readmitted to our hospital only
14
Securing Data
• Monthly Data collection
• Abstracted by coders directly into coding
module of AS400 (Seimens MedSeries 4).
• Electronic, queried download from AS400 to
Microsoft Access.
• Download automated through NGS IQ Client,
querying software from New Generation
Software, Inc. and Windows Task Scheduler.
• Includes various fields, including
admitting/attending physician, DRG, admission
source, discharge code, POA information, etc.
15
Securing Data
• Monthly Data collection (continued)
• Data analysis and reports through Microsoft
Access
• Graphs in Excel
• Developing automation and original reports
were time consuming, but ongoing monthly
less than 2 hours including entering into HEN
database.
• Do not track across the continuum.
• Do not track specific nursing home routinely
16
Securing Data
• Daily Reports
• Automated patient list to email.
• List developed in NGS IQ Client and automated
through Windows Task Scheduler
• Query uses medical record number and unique
reference number and compares to previous
admission dates (from ADT), if less than 30 days
includes the patient.
• A few false positives on the list because of inhouse transfers to Subacute or Geri-Psych.
17
Utilizing Readmission Data
• Readmissions are analyzed by DRG, admission
source, discharge source, etc.
• Physician and staff report cards are sent monthly,
with quarterly readmission rates by physician
• Physician data is sent to Peer Review and
reappointment chairman
• Weekly update of identified issues to nursing
leadership with monthly rate updates
• Quarterly updates to the Board of Trustees
18
Top 3 Data Challenges and Solutions
Challenges
Solutions
1. Availability of Query
Builders
1. Prioritize the need
and automate as
much as possible
2. Concurrent Patient
Identification
2. Daily List
3. Limitations of data
related to continuum
or other facilities
3. Exploring data
exchanges with
physician offices
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If I Could, I Would . . .
• Create more and better
triggers.
• Data interface across the
continuum
• Add Case Manager hours to
do more post-discharge
follow up calls.
• More community resources
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Readmission Race: Best Practice Showcase
How to Track and Report Readmissions
Amy Paul, RN, BSN, CCM
Director, Continuing Care
Memorial Hospital of Rhode Island
Hospital Story – Who We Are…
• This story is presented by Amy Paul, RN, BSN, CCM – Director
of Continuing Care at Memorial Hospital of Rhode Island.
• Memorial Hospital of Rhode Island (MHRI) is licensed for 294
beds. An affiliate of Brown University’s Warren Alpert
Medical School, we are the chief site for the Medical School’s
primary care academic program. We serve the Blackstone
Valley of Rhode Island, and southeastern Massachusetts. Our
vision: to excel as a primary healthcare network and
community teaching hospital.
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Defining Readmissions
• Unique patients are identified via medical record number
• Exclusions: Transfers to MHRI’s Center for Acute
Rehabilitation; scheduled chemotherapy admissions;
elective surgeries; obstetrical admissions for term
deliveries; newborns; observation episodes of care
• Dashboard highlights fee for service Medicare
readmissions at intervals of <72 hours, 4-7 days, 8-30 days
• Dashboard highlights surgical readmissions to surgical vs.
non surgical settings
• Sorting capability available by payer type, service, unit,
diagnosis, discharge disposition, length of service
23
Securing Data
• Data source: A/D/T system
• Data are extracted from reportable fields and
exported to Excel worksheets
• Initial resource requirement: less than 40 man hours
to develop reporting logic
• Ongoing resource requirement: data analyst
administers, tests / validates report, and distributes
data; less than 20 man hours / month required to
produce a monthly report
24
Securing Data
• Environmental limitation: ADT system has finite
reportable fields; some manual research required
to track specific discharge settings
• Patients are identified for detailed research based
upon number / frequency / intervals between
admissions
• Tools for systems analysis: patient interviews using
IHI STAAR tool; manual review of medical records
25
Utilizing Readmission Data
• Oversight, guidance, and operational support provided
by MHRI’s Transitions of Care Team:
• Chaired by Director of Continuing Care
• Championed by VP of Professional Practice
• Multi disciplinary body comprised of nurses,
physicians, community post acute care providers,
pharmacists, homecare professionals, and acute
rehabilitation professionals
• Meetings are monthly and include presentation of
data and updates on both internal projects and state
/ national initiatives
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Utilizing Readmission Data
• Readmission rate is a measure reported on MHRI’s
Performance Improvement Plan
• Performance Improvement Committee (PIC)
reviews data and action plans quarterly
• Continuous quality improvement is pursued at the
department level
• Cross functional work teams are convened as
needed to address priority measures
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Top 3 Data Challenges and Solutions
Challenges
1. EMR is in pre go-live
stage
Solutions
1. EMR implementation is on
schedule
2. Resources are finite
2. Avoid duplication of
efforts and prioritize
effectively – project
champion is a must
3. MHRI serves one of the
most resource poor
populations in the state
3. Always look to our vision
and mission
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If I Could, I Would . . .
Build desktop reporting capability
on a foundation of integrated
platforms for ADT reporting,
outcomes management, utilization
management, discharge planning,
and financial reporting
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Resources
• Boulding, W., Glickman, W., Manary, M., Schulman, K., and Staelin, R.
(2011) Relationship Between Patient Satisfaction With Inpatient Care and
Hospital Readmission Within 30 Days. The American Journal of Managed
Care. 17 (1) p. 41-48
• Hansen, L.O., Williams, M.V., and Singer, S.J. (2011) Perceptions of
Hospital Safety Climate and Incidence of Readmission. Health Services
Research. 46 (2) p. 596-616
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Readmission Race: Best Practice Showcase
Readmissions Race Update
Charisse Coulombe, MS, MBA, CPHQ
Senior Director, Grants and Projects
Health Research & Educational Trust
Readmission Race
Data Submission
• How?
– LAP 1: Submit baseline data (the total number of
readmissions for January – June 2012 or for 2011).
If you have already entered this data, we are using
the numerator information that you submitted as
your baseline.
– LAP 2: On a monthly basis, submit the total
number of readmissions that you have each
month starting in July
• July’s data can be submitted during the month of
September when .
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How will we submit our
readmission data?
• HRET is looking at reducing the total number of readmissions
(measure selected by the hospital) during the 6 month race.
• Option 1: Continue to submit your outcome 30 day readmission
measure into the Comprehensive Data System. The Encyclopedia of
Measures has the complete list. For example, if your hospital has
been submitting 30 day all cause readmission rates, please continue
to submit that measure (numerator and denominator) monthly
through December, 2012.
• Option 2: If your hospital does not have an outcome readmission
measure selected, there are 2 additional options. They are listed in
the Encyclopedia of Measures and within the Comprehensive Data
System. They are labeled “Readmissions RACE – 15 day
readmissions” and “Readmission RACE – 30 day readmissions”.
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How do I get my data entered?
Log into the CDS. Select Preventable
Readmission. Select your current
outcome readmission measure or select
one of the “Readmission RACE”
measures.
Enter your baseline data timeframe.
Enter your baseline data. Please note
that if the “Readmission Race” measure
is selected, only the numerator is needed
(enter the number in the numerator and
denominator field). Click Submit.
Enter your monitoring data. Please note
that if the “Readmission Race” measure
is selected, only the numerator is needed
(enter the number in the numerator and
denominator field). July monitoring data
can be entered in September.
34
Readmissions by the Numbers
• 267 hospitals submitting 30-day readmissions
rate measure (EOM)
• 8 hospitals submitting 30-day Readmissions
Race measure (numerator only)
• Some hospitals are tracking HF, PN, AMI and
15 day readmissions – we still need that data!
35
Readmission HEN Baseline
• 275
– Number of Hospitals reporting baseline data
• 98,118
– 30 day readmissions occurring in 2011 and/or 1st 6
months of 2012 (Baseline timeframe)
• 42
– Average number of 30 day readmissions per
month for baseline (275 hospitals submitting)
36
Readmission HEN Monitoring
• 104
– Number of Hospitals reporting July’s 30 day
readmissions measure
• 1,777
– Number of 30 day readmissions occurring in July
2012
• 17
– Average number of 30 day readmissions (104
hospitals submitting)
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Questions
?
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Coming Up….
• Upcoming Readmissions Race Events
Speaker
Date and Time
Topic
Dr. Mark Williams
Monday, September 24, 2012
12:00 – 12:45 PM, Central
Conducting Risk Assessments
During the Patient Stay
Dr. Eric Coleman
Wednesday, October 10, 2012
12:00 – 1:30 PM, Central
Best Practice Showcasing Call
Dr. Amy Boutwell
Monday, October 22, 2012
12:00 – 12:45 PM, Central
Improving the Discharge
Planning Process
• Thank you for joining us!
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