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Provider implementation of pp rs 3M

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Miguel Mar
Miguel Mar
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[object Object],[object Object],© 3M 2007. All rights reserved. Keith Mitchell PhD and Caroline Piselli, RN, MBA; 3M Health Information Systems
Agenda ,[object Object],[object Object],© 3M 2007. All rights reserved.
Pay for Performance © 3M 2007. All rights reserved.
Readmissions beyond Florida ,[object Object],[object Object],© 3M 2007. All rights reserved. ,[object Object]
Readmissions in the News beyond Florida ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],© 3M 2007. All rights reserved.
Potentially Preventable Hospital Readmission Rates (MedPAC 2007) © 3M 2007. All rights reserved.
Florida: 1 st PPR Public Reporting! ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],© 3M 2007. All rights reserved.
So, What Should Florida Hospitals Do Now? ,[object Object],© 3M 2007. All rights reserved.
State Adoption Process/ Opportunity © 3M 2007. All rights reserved. Today Soon 1. Replicate Reports 2. Understand where you stand and potential opportunities.
Recommended Provider Proactive Approach to PPR Public Reporting © 3M 2007. All rights reserved. Appoint Interdisciplinary Leaders- “ Change Agents” Educate Organization Understand Public Reports (Peer Comparisons) Analyze Impact/ Gaps Communicate Offensively Documentation/ Coding Service Lines Reasons PPRs Internal Stakeholders External Constituents Initiate Focused Quality Improvement Clinical Operations Track, Monitor, Continue Focused Improvement Approach
Recommended Provider Proactive Approach to PPR Public Reporting © 3M 2007. All rights reserved. Appoint Interdisciplinary Leaders- “ Change Agents” Educate Organization Understand Public Reports (Peer Comparisons) Analyze Impact/ Gaps Communicate Offensively Documentation/ Coding Service Lines Reasons PPRs Internal Stakeholders External Constituents Initiate Focused Quality Improvement Clinical Operations Track, Monitor, Continue Focused Improvement Approach
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],© 3M 2007. All rights reserved. Appoint Interdisciplinary Leads- “ Change Agents” Educate Organization Understand Public Reports
Recommended Provider Proactive Approach to PPR Public Reporting © 3M 2007. All rights reserved. Appoint Interdisciplinary Leaders- “ Change Agents” Educate Organization Understand Public Reports (Peer Comparisons) Analyze Impact/ Gaps Communicate Offensively Documentation/ Coding Service Lines Reasons PPRs Internal Stakeholders External Constituents Initiate Focused Quality Improvement Clinical Operations Track, Monitor, Continue Focused Improvement Approach
[object Object],[object Object],[object Object],[object Object],© 3M 2007. All rights reserved. Analyze Impact/ Gaps Documentation/ Coding ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Service Lines Reasons for PPRs
FloridaHealthFinder.gov  New PPR Reports soon © 3M 2007. All rights reserved.
General Guidelines for PPRs © 3M 2007. All rights reserved.
PPR Reason Codes: Medical Readmission ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],© 3M 2007. All rights reserved.
PPR Reason Codes: Surgical Readmissions ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],© 3M 2007. All rights reserved.
Example: Surgical Initial Admission with Surgical PPR © 3M 2007. All rights reserved. Only Admission- 25 days post admission: APR DRG 460- Renal Failure Procedure - Acute renal failure with lesion of tubular necrosis Readmission- 9 days post admission: APR DRG 791- O.R. procedure for other complications of treatment Procedure - Disruption of external operation wound Initial Admission: APR DRG 173- Other Vascular Procedures Procedure - Atherosclerosis of native arteries of the extremities, unspecified ,[object Object],[object Object],[object Object],[object Object]
Example: Medical Admission with Medical PPR © 3M 2007. All rights reserved. Readmission 8 days post admission: APR DRG 133 Pulmonary edema & respiratory failure w/ acute respiratory failure ,[object Object],[object Object],Only Admission 27 days post admission: APR DRG 133 Pulmonary edema & respiratory failure w/ acute respiratory failure ,[object Object],[object Object],Initial Admission: APR DRG 194- Heart Failure w/ CHF followed by Readmission 10 days post admission: APR DRG 1940 Heart Failure w/ CHF ,[object Object],[object Object],Only Admission 22 days post admission: Pulmonary edema & respiratory failure w/ acute respiratory failure ,[object Object],[object Object],Initial Admission: APR DRG 139 Other pneumonia w/ pneumonia, organism unspecified followed by Readmission 7 days post admission: APR DRG 194 Heart failure w/ CHF ,[object Object],[object Object]
Example: Admission Procedure with Medical PPR © 3M 2007. All rights reserved. Readmission 10 days post admission APR DRG 221 Major small & large bowel procedures w/ digestive system complications, not elsewhere ,[object Object],[object Object],Patient 2- Hospital A Initial Admission: APR DRG 221- Major small & large bowel procedures w/ malignant neoplasm of rectum followed by Readmission 0 days post admission: APR DRG 721 Post-operative, post-traumatic, other device infections w/ other postoperative infection followed by Readmission 7 days post admission: APR DRG 252 Malfunction, reaction & complication of GI device or procedure w/ mechanical complication of colostomy and enterostomy ,[object Object],[object Object]
Example: Medical Initial Admission with Surgical PPR © 3M 2007. All rights reserved.
Report #1: Overall Rates of Potentially Preventable Readmission ( PPRs ) © 3M 2007. All rights reserved.
Report #2: PPRs Admissions by Service Line © 3M 2007. All rights reserved.
Report #3: Admission Reasons by Service Line © 3M 2007. All rights reserved.
Report #4: PPRs Admissions by Service Line © 3M 2007. All rights reserved.
Report #5: PPRs Patient-level Details © 3M 2007. All rights reserved.
Recommended Provider Proactive Approach to PPR Public Reporting © 3M 2007. All rights reserved. Appoint Interdisciplinary Leaders- “ Change Agents” Educate Organization Understand Public Reports (Peer Comparisons) Analyze Impact/ Gaps Communicate Offensively Documentation/ Coding Service Lines Reasons PPRs Internal Stakeholders External Constituents Initiate Focused Quality Improvement Clinical Operations Track, Monitor, Continue Focused Improvement Approach
How Will You Proactively Understand PPRs? …eventually prevent PPRs? ,[object Object],© 3M 2007. All rights reserved.
Use of Information on Potentially Preventable Readmissions ,[object Object],[object Object],[object Object],[object Object],[object Object],© 3M 2007. All rights reserved.
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],© 3M 2007. All rights reserved. Initiate Focused Quality Improvement Clinical ,[object Object],[object Object],[object Object],Operations
Example: NQF National Priorities Survey- January 2008 © 3M 2007. All rights reserved. Top 3 Conditions- Lead to most sizeable gains in improvement -- Diabetes -- Healthcare Acquired Infections -- End of Life Care NQF Survey : National Priorities Partners Survey Council Data, Jan 10, 2008; Karen Adams, PhD Councils representing Consumers, Health Plans, Health Professionals, Provider Organizations, Public/Community Health Agencies, Purchasers, QMRI, Supplier,Industry &Other Top 3 Cross-Cutting Strategies: -- Care Coordination -- Health Information Technology -- Medication Reconciliation Top Recommendations: Stakeholders: Broad range across the continuum Implementation : Concrete goals within a roadmap Burden: Include administrative/ documentation Systems Approach : Process/Outcomes coupled w/ human capacity IT: EHRs w/ registries, interoperability, reporting Health Lifestyle/Prevention: Value/reward for early detection/ prevention Episodes of Care: measure across Efficiency: Incorporate w/ effectiveness
P4P- A Provider Proactive Approach (Hypothesis) © 3M 2007. All rights reserved. Success in payment reform …will require unprecedented levels of collaboration across the entire system of care. “Hospitals and physicians have a substantial obligation… to knock down barriers to improving quality and effectiveness. Modern Healthcare, 3/3/08 issue: “A Quality incentive at a crossroads- P4P summit features debate on limits, potential of bonus pay for meeting benchmarks- quote from Tom Priselac, president and CEO of Cedars-Sinai Medical Center, LA, CAL
Example: The Virtuous Circle of Hospital Admissions © 3M 2007. All rights reserved. “ Shifting the focus of services Tackling some typical scenarios Authorities can find themselves trapped in 'vicious circles' of providing crisis-driven services which are neither effective for the service users and carers concerned nor an effective use of their resources. In these circumstances, authorities have to identify how they can inject a different dynamic into the system of care to turn 'vicious' into 'virtuous' circles of activity. “ Source: Improvement and Development Agency: makingendsmeet.idea.gov.uk/idk/aio/5221438, makingendsmeet.idea.gov.uk/idk/core/page.do?p...
Some Additional Challenges © 3M 2007. All rights reserved. **Used with Permission by George Isham, Health Partners Hypothesis: Improvement of Outcomes Measures may positively impact performance across hospitals, physicians, health plans, states, etc……
Recommended Provider Proactive Approach to PPR Public Reporting © 3M 2007. All rights reserved. Appoint Interdisciplinary Leaders- “ Change Agents” Educate Organization Understand Public Reports (Peer Comparisons) Analyze Impact/ Gaps Communicate Offensively Documentation/ Coding Service Lines Reasons PPRs Internal Stakeholders External Constituents Initiate Focused Quality Improvement Clinical Operations Track, Monitor, Continue Focused Improvement Approach
[object Object],[object Object],© 3M 2007. All rights reserved. Communicate Offensively Internal Stakeholders ,[object Object],[object Object],[object Object],External Constituents
Recommended Provider Proactive Approach to PPR Public Reporting © 3M 2007. All rights reserved. Appoint Interdisciplinary Leaders- “ Change Agents” Educate Organization Understand Public Reports (Peer Comparisons) Analyze Impact/ Gaps Communicate Offensively Documentation/ Coding Service Lines Reasons PPRs Internal Stakeholders External Constituents Initiate Focused Quality Improvement Clinical Operations Track, Monitor, Continue Focused Improvement Approach
[object Object],[object Object],[object Object],[object Object],© 3M 2007. All rights reserved. Track, Monitor, Continue Focused Improvement Approach
Questions? © 3M 2007. All rights reserved.

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Provider implementation of pp rs 3M

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  • 3. Pay for Performance © 3M 2007. All rights reserved.
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  • 6. Potentially Preventable Hospital Readmission Rates (MedPAC 2007) © 3M 2007. All rights reserved.
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  • 9. State Adoption Process/ Opportunity © 3M 2007. All rights reserved. Today Soon 1. Replicate Reports 2. Understand where you stand and potential opportunities.
  • 10. Recommended Provider Proactive Approach to PPR Public Reporting © 3M 2007. All rights reserved. Appoint Interdisciplinary Leaders- “ Change Agents” Educate Organization Understand Public Reports (Peer Comparisons) Analyze Impact/ Gaps Communicate Offensively Documentation/ Coding Service Lines Reasons PPRs Internal Stakeholders External Constituents Initiate Focused Quality Improvement Clinical Operations Track, Monitor, Continue Focused Improvement Approach
  • 11. Recommended Provider Proactive Approach to PPR Public Reporting © 3M 2007. All rights reserved. Appoint Interdisciplinary Leaders- “ Change Agents” Educate Organization Understand Public Reports (Peer Comparisons) Analyze Impact/ Gaps Communicate Offensively Documentation/ Coding Service Lines Reasons PPRs Internal Stakeholders External Constituents Initiate Focused Quality Improvement Clinical Operations Track, Monitor, Continue Focused Improvement Approach
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  • 13. Recommended Provider Proactive Approach to PPR Public Reporting © 3M 2007. All rights reserved. Appoint Interdisciplinary Leaders- “ Change Agents” Educate Organization Understand Public Reports (Peer Comparisons) Analyze Impact/ Gaps Communicate Offensively Documentation/ Coding Service Lines Reasons PPRs Internal Stakeholders External Constituents Initiate Focused Quality Improvement Clinical Operations Track, Monitor, Continue Focused Improvement Approach
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  • 15. FloridaHealthFinder.gov  New PPR Reports soon © 3M 2007. All rights reserved.
  • 16. General Guidelines for PPRs © 3M 2007. All rights reserved.
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  • 22. Example: Medical Initial Admission with Surgical PPR © 3M 2007. All rights reserved.
  • 23. Report #1: Overall Rates of Potentially Preventable Readmission ( PPRs ) © 3M 2007. All rights reserved.
  • 24. Report #2: PPRs Admissions by Service Line © 3M 2007. All rights reserved.
  • 25. Report #3: Admission Reasons by Service Line © 3M 2007. All rights reserved.
  • 26. Report #4: PPRs Admissions by Service Line © 3M 2007. All rights reserved.
  • 27. Report #5: PPRs Patient-level Details © 3M 2007. All rights reserved.
  • 28. Recommended Provider Proactive Approach to PPR Public Reporting © 3M 2007. All rights reserved. Appoint Interdisciplinary Leaders- “ Change Agents” Educate Organization Understand Public Reports (Peer Comparisons) Analyze Impact/ Gaps Communicate Offensively Documentation/ Coding Service Lines Reasons PPRs Internal Stakeholders External Constituents Initiate Focused Quality Improvement Clinical Operations Track, Monitor, Continue Focused Improvement Approach
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  • 32. Example: NQF National Priorities Survey- January 2008 © 3M 2007. All rights reserved. Top 3 Conditions- Lead to most sizeable gains in improvement -- Diabetes -- Healthcare Acquired Infections -- End of Life Care NQF Survey : National Priorities Partners Survey Council Data, Jan 10, 2008; Karen Adams, PhD Councils representing Consumers, Health Plans, Health Professionals, Provider Organizations, Public/Community Health Agencies, Purchasers, QMRI, Supplier,Industry &Other Top 3 Cross-Cutting Strategies: -- Care Coordination -- Health Information Technology -- Medication Reconciliation Top Recommendations: Stakeholders: Broad range across the continuum Implementation : Concrete goals within a roadmap Burden: Include administrative/ documentation Systems Approach : Process/Outcomes coupled w/ human capacity IT: EHRs w/ registries, interoperability, reporting Health Lifestyle/Prevention: Value/reward for early detection/ prevention Episodes of Care: measure across Efficiency: Incorporate w/ effectiveness
  • 33. P4P- A Provider Proactive Approach (Hypothesis) © 3M 2007. All rights reserved. Success in payment reform …will require unprecedented levels of collaboration across the entire system of care. “Hospitals and physicians have a substantial obligation… to knock down barriers to improving quality and effectiveness. Modern Healthcare, 3/3/08 issue: “A Quality incentive at a crossroads- P4P summit features debate on limits, potential of bonus pay for meeting benchmarks- quote from Tom Priselac, president and CEO of Cedars-Sinai Medical Center, LA, CAL
  • 34. Example: The Virtuous Circle of Hospital Admissions © 3M 2007. All rights reserved. “ Shifting the focus of services Tackling some typical scenarios Authorities can find themselves trapped in 'vicious circles' of providing crisis-driven services which are neither effective for the service users and carers concerned nor an effective use of their resources. In these circumstances, authorities have to identify how they can inject a different dynamic into the system of care to turn 'vicious' into 'virtuous' circles of activity. “ Source: Improvement and Development Agency: makingendsmeet.idea.gov.uk/idk/aio/5221438, makingendsmeet.idea.gov.uk/idk/core/page.do?p...
  • 35. Some Additional Challenges © 3M 2007. All rights reserved. **Used with Permission by George Isham, Health Partners Hypothesis: Improvement of Outcomes Measures may positively impact performance across hospitals, physicians, health plans, states, etc……
  • 36. Recommended Provider Proactive Approach to PPR Public Reporting © 3M 2007. All rights reserved. Appoint Interdisciplinary Leaders- “ Change Agents” Educate Organization Understand Public Reports (Peer Comparisons) Analyze Impact/ Gaps Communicate Offensively Documentation/ Coding Service Lines Reasons PPRs Internal Stakeholders External Constituents Initiate Focused Quality Improvement Clinical Operations Track, Monitor, Continue Focused Improvement Approach
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  • 38. Recommended Provider Proactive Approach to PPR Public Reporting © 3M 2007. All rights reserved. Appoint Interdisciplinary Leaders- “ Change Agents” Educate Organization Understand Public Reports (Peer Comparisons) Analyze Impact/ Gaps Communicate Offensively Documentation/ Coding Service Lines Reasons PPRs Internal Stakeholders External Constituents Initiate Focused Quality Improvement Clinical Operations Track, Monitor, Continue Focused Improvement Approach
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  • 40. Questions? © 3M 2007. All rights reserved.