Posts Tagged ‘SNF’

Reducing SNF Readmissions: Clinical Targets, Quality Scorecards Elevate Performance

May 23rd, 2017 by Patricia Donovan

reducing SNF readmissions

Michigan’s Tri-County Collaborative holds the line on hospital readmissions from 130 participating SNFs.

Three geographically close Michigan health systems shared more than a concern over escalating readmissions from skilled nursing facilities (SNFs).

As Henry Ford Health System (HFHS), the Detroit Medical Center and St. John’s Providence Health System ultimately discovered from Michigan Quality Improvement Organization (MPRO) data in 2013, they also shared about 30 percent of their patient population.

This revelation, combined with the pinch of new hospital readmission penalties from the Centers for Medicare and Medicaid Services (CMS), prompted the three to set aside competition and siloed strategies and forge a coordinated approach to reducing readmissions from SNFs.

Today, the resulting Tri-County SNF Collaborative operates with a set of clinical and quality targets and metrics created in tandem with more than 130 member SNFs. Tri-County’s dozen participation requirements for SNFs range from regular reporting through a dedicated SNF portal to achievement of specified performance metrics.

“We developed collaborative relationships,” explained Susan Craft, director of care coordination for the family caregiver program in HFHS’s Office of Clinical Quality & Safety. “We wanted to have very open, honest conversations to review issues that were identified and find ways to resolve those.”

Ms. Craft shared the roots, framework and results of the SNF collaborative, which launched in the first quarter of 2015, during Reducing SNF Readmissions: Quality Reporting Metrics Drive Improvements, a May 2017 webcast now available for replay.

Once admitted to the collaborative, member SNFs must report on 14 metrics in four key areas: acuity, care transitions, quality and readmissions. In return, SNFs receive a 13-point unblinded quarterly scorecard with metrics on readmissions and patient acceptance response times, among many others.

A multidisciplinary team within Tri-County Collaborative reviews all SNF metrics bi-annually to determine each facility’s continued participation.

As for the collaborative’s impact since its launch, Henry Ford Health System achieved a nearly 20 percent drop in Medicare SNF readmissions as well as a 28 percent reduction in SNF lengths of stay. The initiative also identified opportunities for improvement, resulting in enhanced outpatient scheduling and nurse-to-nurse handoffs and interventions focused on SNF-specific issues like sepsis, Ms. Craft explained.

Despite these advancements, the collaborative still faces the inherent challenges of competition and transparency, as well as SNFs’ hesitancy to adopt value-based practices. “Our SNFs are still entirely dependent on fee for service [payment models],” said Craft. “They haven’t been impacted by penalties and value-based purchasing, although that is coming for them next year.”

Although not yet referring to participating SNFs as “preferred providers,” the collaboratives hopes to one day equip patients with complete data pictures to guide them in SNF selection. Also on Tri-County Collaborative’s radar are home care agencies, concluded Ms. Craft.

“We know there needs to be a lot of coordination across all post-acute care settings.”

Listen to Susan Craft describe how Michigan’s SNF Collaborative set aside competition to improve quality and readmission rates.

Care Transitions Playbook Sets Transfer Rules for Post-Acute Network Members

July 28th, 2016 by Patricia Donovan

St. Vincent's Health Partners best practices care transitions playbook documents more than 140 patient transfer protocols.

St. Vincent’s Health Partners best practices care transitions playbook documents more than 140 patient transfer protocols.

A primary tool for Saint Vincent’s Health Partners Post-Acute Network is a playbook documenting more than 140 transitions for patients traveling from one care setting to another, including the elements of each transition and ways network members should hold each other accountable during the move. Here, Colleen Swedberg, MSN, RN, CNL, director of care coordination and integration for St. Vincent’s Health Partners, explains the playbook’s data collection process and information storage and describes a typical care transition entry.

The playbook is made up of several sections, including one with current expectations, based on the Michigan Quality Improvement Consortium, which we can review online. From an evidence-based point of view, they’ve listed the evidence for many common conditions patients are seen for in medical management. This is kept up to date. This is an electronic document stored on our Web site that can only be accessed by individuals subscribed to the network. We’ve also put this on flash drives for various partners.

A second section contains actual metrics for any network contracts. The metrics appear in such a way that the highest standard is included. For example, physician providers, as long as they provide the highest level of care in the metric, can be sure they’re meeting all the metrics. Those metrics are based on HEDIS® standards.

The third section is the transition section, laid out in two to three pages. For example, a patient moves from the hospital inpatient setting to a skilled nursing facility, such as Jewish Senior Services. For that transition, the playbook documents all the necessary tools for that patient: a personal health record, a medication list, whatever is needed. Also included is any communication with the primary care physician, if that provider has been identified. Finally, this section identifies the responsibility of the sending setting—in this case, the hospital inpatient staff. What do they need to organize and make sure they’ve done before the patient leaves and starts that transition, and what is the responsibility of the receiving organization?

That framework is the same for every transition: the content and tools change according to the particular transition. A final section of the playbook details all of the tools used for care transitions. For example, in our network, we’re just now working on the use of reviews for acute care transfers, which is an INTERACT (Interventions to Reduce Acute Care Transfers) tool. In fact, many settings, including all of our SNFs, as it turns out historically, have used that tool. This tool is in the playbook, along with the reference and expectation of when that tool would be used.

Source: Post-Acute Care Trends: Cross-Setting Collaborations to Align Clinical Standards and Provider Demands

http://hin.3dcartstores.com/Post-Acute-Care-Trends-Cross-Setting-Collaborations-to-Align-Clinical-Standards-and-Provider-Demands_p_5149.html

Post-Acute Care Trends: Cross-Setting Collaborations to Align Clinical Standards and Provider Demands examines a collaboration between the first URAC-accredited clinically integrated network in the country and one of its partnering PAC providers to map out and enhance a patient’s journey through the network continuum—drilling down to improve the quality of the transition from acute to post-acute care.

Post-Acute Care Improvement: 9 Trends to Know

August 25th, 2015 by Patricia Donovan

post-acute care trends

Healthcare favors a unified cross-setting PAC payment system, according to 2015 PAC metrics from the Healthcare Intelligence Network.


Across the continuum of post-acute care (PAC) providers—defined as skilled nursing facilities (SNFs), home health agencies (HHAs), inpatient rehabilitation facilities (IRFs), and long-term care hospitals (LTCHs)—skilled nursing is the sector most in need of reform, say 40 percent of healthcare organizations who responded to a 2015 survey on Post-Acute Care Trends.

Also in need of revamping are PAC payment models, the Healthcare Intelligence Network survey determined. While 53 percent have already incorporated PAC services into value-based reimbursement methodologies such as an accountable care organization (ACO) or shared savings arrangement, 60 percent of respondents would like to see Medicare adopt a unified cross-setting PAC payment system that would follow the patient across care sites.

Already participating in Models 2 and 3 of CMS’s ongoing Bundled Payments for Care Improvement (BPCI) initiative, PAC providers are also gearing up for closer scrutiny of skilled nursing facility (SNF) readmission rates by Medicare beginning in 2018. The federal payor has been monitoring 30-day hospital readmission rates since 2012, gradually expanding the list of applicable readmissions measures and scaling readmission reimbursement.

The top tactics to improve quality, enhance care coordination and reduce spend associated with post-acute care include care transition management, development of PAC partnerships and integration of all PAC services, say respondents.

Here are five more metrics from HIN’s 2015 Post-Acute Care Trends survey:

  • A case manager helms PAC improvement initiatives for 38 percent of respondents.
  • Patient transitions between care sites is the top PAC challenge, say 25 percent of respondents.
  • Half of responding organizations say heart failure and shock are the most challenging health conditions to manage in PAC settings.
  • Eighty-five percent of respondents said care coordination improved as a result of these efforts, while 36 percent observed a decline in hospital readmissions from PAC facilities.
  • The INTERACT™ (Interventions to Reduce Acute-Care Transfers) program and tools, designed to reduce the frequency of PAC transfers to acute hospitals, are frequently cited by respondents as critical to PAC coordination. The INTERACT tool was initially developed by Joseph G. Ouslander, MD and Mary Perloe, MS, GNP, at the Georgia Medical Care Foundation.

The post-acute care arena is rich with opportunity for improvement, agreed many respondents.

“PAC is the blockbuster drug the U.S. healthcare system has been waiting for,” concluded one survey respondent, noting that post-acute care provides big financial levers for provider organizations to align clinically, financially and operationally. “Forward-thinking providers are organizing to amass large pools of manageable risk and recalibrating to optimize care delivery and share meaningfully in the medical expense reduction associated with better more effective and patient centric care. This is a win all the way around.”

Download an executive summary of 2015 PAC survey results.

Measuring Outcomes Between Hospitals and Long-Term Care Facilities

August 5th, 2014 by Patricia Donovan

As part of its efforts to construct a care coordination network of skilled nursing facilities (SNFs), Summa Health System evaluated outcomes between its hospitals and the long-term care (LTC) facilities it works with, explains Carolyn Holder, manager of transitional care for Summa Health System.

To measure outcomes between hospitals and LTC facilities, we utilized data sent from the Summa Health System database. We found data outcome measures through our own database about these facilities that are working with us. We do limit by group differences. They are depicted by greater than one standard deviation. If they do have low admissions, we did not include them in the comparison. We have many members who don’t have a significant number of admissions to the hospitals, but are still participating in the care coordination network, which is very profound. It shows the dedication to the work regarding improving quality.

Other data that we will include in this measure is the comparison of readmissions, average length of stay (ALOS), percent of admissions and discharges. We have 31-day readmits and a number of one- to seven-day readmissions. We look at the case mix index for the patients we get from these facilities. This data is blinded; there are codes on the report card chosen by the facilities so we could do a comparison but not have that information shared among the competing agencies themselves.

We do the report twice a year because it is an intensive one for our quality department to prepare. The facilities are listed with the number of admissions to Summa, and the number of discharges to that facility for skilled and intermediate care facilities (ICF) level of care. We did an average so that we could compare it to the group itself. If they are doing well, they are better than the mean. If they are in that target area, they are lower in this area in comparison to the large group.

Since we began this initiative in 2003, the ALOS has fluctuated over time. It was still at 7.2 for the full year. Since we do not own these facilities, all we have provided the facilities so far is this data set. We do not have data coming back from the facilities to us with some of these measures, but that is the next task for the group to work on.

Excerpted from Accountable Care Strategies to Improve Hospital-SNF Care Transitions.

Transfer Form Standardizes Communication During Care Transitions

February 11th, 2014 by Patricia Donovan

Clear patient transfer instructions reduce the risk of readmission.

To improve communication and the quality of information accompanying patients during transfer from hospital to nursing home, Summa Health Systems worked with its preferred skilled nursing facilities (SNFs) to develop physician orders and transfer care forms. Mike Demagall, LNHA, LPN, administrator with Bath Manor and Windsong Care Center, two participating SNFs, describes the development process.

This is the first project that we worked on where we identified with surveys that communication was the number one issue. In addition to a nursing facility process and referral, the physicians’ orders and transfer care form was developed by care coordination.

It took some time to develop this program and form. We were able to reduce the amount of information being sent to the nursing home and provide information that was required for the doctors at the nursing home, which is their system of payment. It provides clear and concise physician orders. It provides extra blank areas for consultants and additional information that may go on there. There is nursing documentation of the plan of care and other nursing information on the other side. The front side is for the physician, and the back side has nursing information and a list of the chart forms that must accompany the patient.

This form took about a year to develop, and we have suggestions on how we may want to adjust the form once or twice a year. In addition to our small care coordination network, this went out to the Akron Regional Hospital Association. As the area SNFs and the Summa Hospital collaborated, that was where they met. The form helped standardize the communication. Additionally, we had the buy-in from the Akron Regional Hospital Association, which several of our members from the care coordination are a part of, as well as Summa Hospital.

They were able to implement that form in the community as a whole, not just between form and the care coordination network.

Excerpted from: Accountable Care Strategies to Improve Hospital-SNF Care Transitions

HINfographic: How an Integrated SNF Network Supports Accountable Care

September 23rd, 2013 by Jackie Lyons

In the future, SNF readmission rates could be subject to penalties similar to those CMS has put in place for hospitals, such as when SNF readmissions to a hospital occur for certain conditions, within a particular timeframe. To avoid this, many hospitals and health systems are collaborating with SNF providers to improve care and reduce unplanned 30-day readmissions.

Reducing fragmentation and redundancy of care and reclaiming revenue from diverted admissions are just two reasons to integrate SNF networks into a post-acute strategy, according to a new HINfographic from the Healthcare Intelligence Network. This infographic not only identifies additional reasons to integrate SNF networks, but also breaks down SNFs by the numbers and offers tips for network formation.


How an Integrated SNF Network Supports Accountable Care

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Information presented in this infographic was excerpted from: Accountable Care Strategies to Improve Hospital-SNF Care Transitions. If you would like to learn more about accountable care strategies for care transitions, this resource includes a detailed case study from Summa Health System, and industry thought leaders advise hospitals to monitor what goes on across its care continuum and to partner with facilities it discharges to most often to reduce 30-day readmissions.

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