HOME IS THE HUBAn Initiative to Accelerate Progress to Reduce Readmissions in Virginia

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WELCOME AND OVERVIEW

Abraham Segres VHHAVice President, Quality & Patient Safety

asegres@vhha.com (804) 965-1214

VIRGINIA HOSPITAL & HEALTHCARE ASSOCIATION

An association of 30 member health systems representing 107 community, psychiatric, rehabilitation and specialty hospitals throughout Virginia.

VisionThrough the power of collaboration, the association will be the recognized driving force

behind making Virginia the healthiest state in the nation by 2020.

MissionWorking with our members and other stakeholders, the association will transform Virginia’s health care system to achieve top-tier performance in safety, quality, value, service and population health. The association’s leadership is focused on: principled, innovative and effective advocacy; promoting initiatives that improve health care safety, quality, value

and service; and aligning forces among health care and business entities to advance health and economic opportunity for all Virginians.

VHHA 2015-2020 IMPROVEMENT PRIORITIES

1. Hospital readmissions1a. Hospital-wide1b. Post-acute transfers1c. Total hip/Total knee Replacement 30-day readmissions

2. Clostridium difficile – Healthcare-acquired Infections3. Patient Experience – HCAHPS 4. Serious Safety Events

SCHEDULE OF EVENTS

June 16 - Overview of Virginia Statewide Readmission Reduction High Leverage Strategies

August 16 - Data & Analytics to Support Readmissions Reduction Efforts

September 8 - Post-Acute Readmissions Reduction Strategies

October 19 - High-Utilizer Readmissions Reduction Strategies

November TBD- In-Person Workshop with Dr. Boutwell

*All webinars begin at 10am

DATA AND ANALYTICS TO SUPPORT REDUCING ALL PAYER READMISSIONS

Amy Boutwell, MD, MPP Collaborative Healthcare Strategies

Presidentamy@collaborativehealthcarestrategies.com

(617) 710-5785

AGENDA

1. Describe the high-leverage target populations

2. Discuss measurement specifications for the target populations

3. Present analyses of VA data for the target populations

4. Learn about VHHA analytics support services

OBJECTIVES

• Help readmission reduction teams know how to define the “high leverage” readmission reduction target populations:

• All payer• Post-acute care• High utilizer

• Encourage readmission reduction teams to examine their own data

• Calculate the goal: how many is a 20% reduction in readmissions• What’ is the impact of reducing readmissions for high-leverage groups?

NOTES• These definitions are recommendations

• Reflect feasible measures for hospital teams• Reflect general alignment with VHHA (all payer), VHQC (Medicare) methods• Hospital teams may have preferences for other conventions, which is fine• Our objectives are to ensure you have the data you need to support your efforts

to reduce hospital-wide readmissions by 20% by 2020

• These definitions support quality improvement • They are not intended to replicate methods used by “penalty” programs• The most important thing is to pick a definition, understand it, and trend over

time to demonstrate impact of your efforts

DATA-INFORMED STRATEGIC FOCUS AREAS

Expanding our focus to reduce readmissions by 20% by 2020

READMISSIONS IN VIRGINIA• Virginia ranked #46 in US for average readmission penalties in 2015

• FY 2016, there were $21M in readmissions penalties state-wide

• Expansion of penalty conditions to COPD, THR/TKR substantially increased impact of penalties for VA hospitals

• $11M of the $21M in penalties were due to THR/TKR • VA ranked #49 for THR/TKR readmission rates

GOAL

In response to these readmission statistics, the VHHA Board has set a goal:

Reduce all-payer readmissions by 20% by 2020

Key elements of this goal:• All-payer: preparing hospitals by looking forward to the future market realities• All-condition: forward-looking to risk-based contracting and alternative payments• Dedicated focus areas: THR/TKR, post-acute, and hospital-wide readmissions

ALL CAUSE READMISSIONS

Source: VA Medicare FFS data, courtesy of VHQC

Top 10 diagnoses only account for ~25% of all readmissions……missing 75% of opportunity by case finding for diagnoses

READMISSIONS BY DISCHARGE DISPOSITION

Q1 Q2 Q3 Q4Home 16.4 16.4 15.5 15.8HHA 20.2 20 21.3 20.6SNF 19.9 20.6 20.1 20State Avg 18.6 18.5 18.7 18.6

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Axis

Titl

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Medicare FFS Readmission Rates, by Discharge Setting: Home, SNF, HH

20% PAC

15% HOME

Source: VA Medicare FFS data, courtesy of VHQC

HU Readmission Rate = 40%Non-HU Readmission Rate = 8%

Source: 2016 MA All Payer State-wide Readmission Analysis

Readmission rate HU: 36%Readmission rate non-HU: 8%

HOW DO WE DEFINE AND MEASURE

15-part all payer and payer-specific readmission analysis.

For more information see AHRQ Hospital Guide to Reducing Medicaid Readmissions

(Data analysis tool in Version 2 to be released September 9 2016)

DEFINITION: ALL CAUSE ALL PAYER READMISSIONS

• All cause, all payer readmissions• Adult 18+

• To date, the focus has been on reducing adult readmissions• Pediatric readmission rates are low and dilute an “adult med/surg” readmission rate• Children’s hospitals would of course not use this definition

• Non-obstetric (exclude childbirth related DRGs)• Consistent with the Yale/CMS “hospital wide readmission” measure• Volume is so high and readmissions so low, including OB distorts the measure

• Exclusions: discharges deceased, transfers to acute inpatient, acute rehab• Might also exclude discharges AMA (~1% discharges)

• “All payer”• All payers

• Also examine “payer specific” • “Medicare” • “Medicaid” • “Commercial”• “Other”

DEFINITION: ALL CAUSE ALL PAYER READMISSIONS

DEFINITION: ALL CAUSE ALL PAYER READMISSIONS

• Readmission• Admission for any reason following inpatient discharge within 30 days• Every discharge can be followed by a readmission• A patient can be readmitted more than once in a month

• Denominator• All discharges in the calendar month (less exclusions)

• Numerator• All admissions that occurred within 30 days of a discharge in the denominator• Not limited to a calendar month

DEFINITION: READMISSIONS BY DISCHARGE DISPOSITION

• Discharge disposition• Typically hospitals can’t measure readmissions from post acute care• But we can measure readmissions following a discharge to post acute care• The patient may or may not have been receiving post acute care when they were

readmitted (may have refused home health, or left the SNF)• Readmission rate for this subgroup is ~20%

• Denominator• Discharges to skilled nursing, home health, others as desired (eg hospice, LTAC)

• Numerator• Admission that occurred with 30 days of a discharge to skilled nursing, home health

VA STATE-WIDE ALL PAYER DISCHARGE DISPOSITION, 2015

Discharge Disposition Number of Discharges % of DischargesHome 264, 289 57%Home Health 99.135 22%Skilled Nursing Facility 76,137 17%Other 20,105 4%

Source: VHHA analysis

DEFINITION: READMISSIONS AMONG HIGH UTILIZERS

• High Utilizers• Patients with a history of repeated hospitalizations in a given time period• No universally accepted definition of “high utilizer”• Seek a thresh hold that identifies a small percentage of people who account for a

high percentage of readmissions• Recommend 4 hospitalizations in a 12 month period• At that definition, the readmission rate is usually ~40%

• Denominator• Number of discharges among high utilizers

• Numerator• Number of admissions that occurred within 30 days of discharges in denominator

CALCULATE THE GOAL: READMISSIONS FROM PAC

Formula ExampleTotal hospital discharges A 1000Total hospital readmissions B 150Hospital readmission rate =B/A 15%Total PAC discharges C 400Total PAC readmissions D 8020% reduction PAC readmissions = .20 x D 16New hospital readmissions = B – (.2C) = E 150-16= 134New hospital readmission rate = E/A 13.4%

*PAC = Home Health or SNF

CALCULATE THE GOAL: READMISSIONS AMONG HU

Formula ExampleTotal hospital discharges A 1000Total hospital readmissions B 150Hospital readmission rate =B/A 15%Total HU discharges C 250Total HU readmissions D 10020% reduction HU readmissions = .20 x D 20New hospital readmissions = B – (.2C) = E 150-20= 130New hospital readmission rate = E/A 13%

*HU = Patients with 4 or more admissions in past 12 months

CALCULATE THE GOAL: HOSPITAL-WIDE READMISSIONS

Formula ExampleTotal hospital discharges A 1000Total hospital readmissions B 150Hospital readmission rate =B/A 15%20% reduction HU readmissions = .20 x B 30New hospital readmissions = .8 x B = C 150-30= 120New hospital readmission rate = C/A 12%

SUMMARY

1. Expand your hospital’s readmission analysis to include: • All payer all cause (hospital-wide) • Post acute care (SNF + HH)• High utilizers (4 or more hospitalizations in the past 12 months)• THR/TKR (as per CMS definitions and existing VHHA reports)

2. Understand how to define and measure the above• Adult non-OB discharges; exclude deaths, inpatient transfers• Readmission is an admission within 30 days of a discharge

3. Calculate what success looks like• Calculate how many readmissions avoided hospital wide if reduced by 20%• Calulate impact on hospital-wide readmissions if reduce PAC and/or HU readmissions by 20%

QUESTIONS?

VHHA DATA & ANALYTICS TEAM

Barbara Brown, PhD VP, Data & AnalyticsDavid Vaamonde, MPH Director of ResearchIan Oommen Analyst

A RESOURCE FOR VHHA MEMBERSVHHA Analytics

Primary Data Sources

○ Virginia Inpatient Database○ Readmissions Database○ Virginia All Payer Claims

Database○ Inpatient, outpatient, physician office

claims, ED & prescription claims

○ County Health Rankings○ EIG○ Centers for Medicare and

Medicaid Services (CMS)○ Virginia Department of Health○ & more

2

○ Developed at VHHA○ Cloud based○ HIPAA Compliance

○ All data is AES-256 encrypted○ SSL○ Dedicated Instance (Amazon AWS)○ Network & User Monitoring

○ Powered by the Tableau Analytics Engine○ Customizable User Experience○ Compatible on all browsers○ Built for scalability○ Simple, clean & colorful interface

Development2

VHHA AnalyticsA secure place where hospitals and health system staff can access, interact, download and share analyses

VHHA Research & DevelopmentVHHA staff programs, tests, and publishes guided and visual dashboards which aim to answer hospital challenges

Data Marts & Database AdministrationHospital databases are merged with other databases in order to enhance our understanding of healthcare issues

Member Hospital EngagementThe VHHA research teams engages with various hospital leaders to address challenges that could be solved with data

Hospital & Patient Level DataThe foundation of VHHA Analytics is composed of the statewide databases available in Virginia (IP & APCD)

Hospital & Patient Level Data

Member Hospital Collaborators

Data Marts & Database Administration

VHHA Research & Development

VHHA Analytics

VHHA Analytics Approach3

Questions Posed by Members4

1. Help me understand the readmitted patients in my facility. Where can I improve?

1. What do I need to do to prevent a readmission penalty? What is my estimated penalty?

Question 2: Help me understand the readmitted patients in my facility. Where can I improve?4

Question 4: What do I need to do to prevent a readmission penalty? What is my estimated penalty?4

Licensing and Trial Period

Non-APCD Subscriber

Price: $900/yr

● Limited Access to VHHA Analytics reports (APCD data excluded)

● Quarterly Refreshes● Analyze, share,

download and subscribe to any dashboard

● Access to VHHA Analytics Support

APCD Subscriber

Price: $900/yr

● Full Access to all VHHA Analytics reports

● Quarterly Refreshes● Analyze, share,

download and subscribe to any dashboard

● Access to VHHA Analytics Support

Trial Period

Limited Time Trial

● 1 Trial Licence per Health System

● Trial Period Ends August 1st

● Individual Licenses Available for Purchase After Trial Period

Individual User Licenses

AfterAugust 1st

THANK YOU!Contact Information:

ANALYTICS@VHHA.COM