Patients’
Needs
Clinical/Financial
Stability and
Patient/Resident/Client
Satisfaction
Vibra,
ARU, SNFs,
HHA, et al
Collaboration for Improved
Clinical Outcomes



Physicians and staff working as partner for
patient care
Value of monitoring utilization of resources
Timely transitions: “Right level of care at the
right time”





The Affordable Care Act of 2010 requires HHS to
establish a readmission reduction program.
20% of Medicare patients are readmitted to a hospital
within one month of discharge
CMS’ goal to transition to value based purchasing-paying for care based on quality and not just quantity
Initial focus- AMI, CHF and pneumonia; 2015
possibilities- MedPAC recommendations of COPD, CABG
and PTCA procedures, and other vascular procedures
Penalties- Oct 2012- 1%; Oct 2013- 2%; Oct 2014- 3%
The Continuum of Healthcare Sites of
Service
High
ACUTE CARE
HOSPITALS
Intensity of patient service
LTACHs
Low
SKILLED
NURSING
FACILITIES
TRANS
CARE
OUTPATIENT
REHAB
TRANS
CARE
ICU
SUBACUTE &
INPATIENT
REHAB
CHRONIC
CARE
ASSISTED
LIVING
HOME
HEALTH
CARE
HOSPICE
ADULT
DAY
CARE
HOME
Low
Severity of patient illness
High
Breakdown of Inpatient Readmission Source
64%
Home w/o
any post
acute care
20%
Skilled
Nursing
Facilities
11%
Home
w/home
health
care
5%
Rehab ,
LTACH or
Psych
Hospitals
Source: Health Care Financing
Review| 2009 data
Current Industry Issues
§ Highly fragmented market of hospitals and PAC providers
§ Economic incentive for acute care providers to increase
PAC patient volume and rapidly discharge
§ No coordination of patients over episode of care
§ No economic penalty for poor performance
Medicare Policy is Rearranging the Post-Acute Landscape
____________________
Source: RTI International, 2009, “Examining Post Acute
Care…” and Avalere Health, LLC, “Change in the SNF
Marketplace” March 2012. Same Source for next slide
National Statistics
23% are Readmitted to Hospital
35% of Hospital Discharges are Admitted to PostAcute for Additional Care (“Post-Acute Admissions”)
48% of Post-Acute Admissions go Home after
Receiving Post-Acute Care
29% are Transferred to a Secondary Post-Acute Venue
for Additional Care
Medicare Statistics
30-day Risk Adjusted Readmission Rates for a Portland Hospital
Measure
Number of
Patients
Readmission
Rate
National Average
Heart Attack
209
18.0%
19.7%
Heart Failure
201
28.0%
24.7%
Pneumonia
109
18.7%
18.5%
Source: America Hospital Directory, 07/01/2008 to 06/30/2011 posted on
04/12/2013
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



Long Term Acute Care- MS DRGs
Skilled Nursing facilities- RUGs and per diem
Foster Home- per diem; Medicare not
accepted
Home Health- DRGs
Hospice- per diem

Present- MS DRGs
◦ MCC
◦ CC
◦ Non-CC


Future
Length of Stay
◦ Short Stay
◦ Long Stay
◦ Medicare median
Opportunities
1. Improved clinical outcomes and patient satisfaction
through coordination of care.
2. Right level of care at the right time for optimal
patient care outcomes.
3. Partnerships for coordination of care
Thank You!
Coming together is a beginning.
Keeping together is progress.
Working together is success.
- Henry Ford