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Changes in Healthcare and the Role of the Respiratory Therapist. John Wilson BSRT, RRT-ACCS. Disclosure. Speaker Bureau – Monaghan Medical. Goals. Have a basic understanding of Value Based Purchasing Have a basic understanding of HCAPS

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changes in healthcare and the role of the respiratory therapist
Changes in Healthcare and the Role of the Respiratory Therapist

John Wilson BSRT, RRT-ACCS

disclosure
Disclosure

Speaker Bureau – Monaghan Medical

goals
Goals
  • Have a basic understanding of Value Based Purchasing
  • Have a basic understanding of HCAPS
  • Have knowledge of CMS’s Readmission Reduction Program
  • Have some specific ideas about how respiratory therapists can play a role in reducing COPD readmissions
  • Leave with hope and encouragement that Respiratory Therapists can be leaders in Healthcare Reform and continue to grow and thrive as a profession
affordable care act
Affordable Care Act

Attempts to reform the healthcare system by:

  • Providing more Americans with affordable quality health insurance
  • Curbing the growth in healthcare spending

Condensed version – 974 pages long

topics addressed in detail

Affordable Care Act

Topics addressed in detail
  • Quality, affordable health care for all Americans
  • The role of public programs
  • Improving the quality and efficiency of health care
  • Preventing chronic disease and improving public health
  • Health care workforce
  • Transparency and program integrity
  • Improving access to innovative medical therapies
  • Community living assistance services and supports
  • Revenue provisions
  • Reauthorization of the Indian Health Care Improvement Act
hospital value based purchasing
Hospital Value-Based Purchasing

Section 3001(a) of the Affordable Care Act

hospital value based purchasing1
Hospital Value-Based Purchasing

Intent:

Link Medicare’s payment system to improve healthcare quality

  • including the quality of care provided in the inpatient hospital setting
what has changed
What has Changed?

Past

  • Diagnosis Related Groups (DRG)
  • Paid for treating

Future

  • Pay for Performance
  • Population Management
hospital value based purchasing2
Hospital Value-Based Purchasing

Purpose

  • Promote better clinical outcomes for hospital patients
  • Improve their experience of care during hospital stays
how will they achieve this
How will they achieve this?
  • Eliminate or reduce occurrence of adverse events (healthcare errors resulting in patient harm)
  • Adopting evidence-based care standards and protocols that result in the best outcomes for the most patients
  • Re-engineering hospital processes that improve patients’ experience of care
measures hospital value based purchasing
Measures:Hospital Value-Based Purchasing

Hospital’s performance will be based on their performance in several areas

measures hospital value based purchasing1
Measures:Hospital Value-Based Purchasing

Fiscal Year (FY) 2013

  • 12 Clinical Process of Care measures
  • 8 Patient Experience of Care dimensions - HCAHPS survey
clinical process of care measures
Clinical Process of Care measures

AMI

Heart Failure

Pneumonia

Surgical Care Improvement

measures hospital value based purchasing2
Measures:Hospital Value-Based Purchasing

Fiscal Year (FY) 2014

  • 13 Clinical Process of Care measures
  • 8 Patient Experience of Care dimensions (HCAHPS)
  • 3 30-Day Outcome Mortality measures:
    • Acute Myocardial Infarction (AMI)
    • Heart Failure (HF)
    • Pneumonia (PN)
measures hospital value based purchasing4
Measures: Hospital Value-Based Purchasing

Fiscal Year (FY) 2015

  • 12 Clinical Process of Care measures
  • 8 Patient Experience of Care dimensions (HCAHPS)
  • 3 - 30-Day Outcome Mortality measures:
    • Acute Myocardial Infarction (AMI)
    • Heart Failure (HF)
    • Pneumonia (PN)
  • 1 Agency for Healthcare Research and Quality (AHRQ) Composite measure:
    • Patient Safety Indicator (PSI-90)]
  • 1 Healthcare Associated Infection:
    • Central Line-Associated Blood Stream Infection (CLABSI)
  • 1 Efficiency measure:
    • Medicare Spending Per Beneficiary (MSPB)
hospital value based purchasing3
Hospital Value-Based Purchasing

Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS)

slide18

How

Can we

Always

Have

Patient

Satisfaction

hcahps intent
HCAHPS - Intent

To provide a standardized survey instrument and data collection methodology for measuring patients\' perspectives on hospital care

Are we comparing Apples-to-Apples?

hcahps goals
HCAHPS - Goals
  • To produce comparable data on the patient\'s perspective on care
  • Designed to create incentives for hospitals to improve their quality of care
  • Increase the transparency of the quality of hospital care provided
hcahps public reporting2
HCAHPS – Public Reporting

There is much more and –

The public is out there shopping

readmissions reduction program
Readmissions Reduction Program

subpart I of 42 CFR part 412 (§412.150 through §412.154)

readmissions reduction program1
Readmissions Reduction Program
  • Requires CMS to reduce payments to hospitals with excess readmissions
  • Effective for discharges beginning on October 1, 2012
  • Provides incentives for hospitals to reduce the number of hospital readmissions
slide27

Readmissions Reduction Program

  • 2,211 American hospitals received reimbursement penalties for high readmission rates
    • Together they forfeited about $280 million in Medicare funds in 2012
  • According to Medicare, 2 out of 3 hospitals evaluated failed to meet its new standards for preventing 30 day readmissions.
slide28

Proposed

Replacements of the hip or knee

readmissions reduction program2
Readmissions Reduction Program
  • I in 5 Medicare beneficiaries are readmitted within 30 days - Which equates to 2.3 million patients
  • National cost of over $17 Billion
  • Half of patients readmitted had no physician contact
  • 70% of surgical readmits were for chronic medical conditions.
  • Potentially 40% of all Readmissions are preventable
  • New England Journal of Medicine
  • Stephen F. Jencks, MD, MPH, Mark Williams, MD and Eric A Coleman, MD MPH.
readmission factors
Readmission Factors
  • 69% were non compliant with meds
  • 51% lacked knowledge: How to use Therapy Devices
  • 45% inadequate knowledge of medications
  • 42% unable to self manage care
  • 37% had no follow up visit with Physician
  • 31% develop infection post discharge

AARC webcast August 28-12 “Hospital to Home-efforts at Reducing Hospital Readmissions”. Greg Spratt BS, RRT; Kimberly Wiles BS, RRT; Becky Anderson RRT.

respiratory therapist in this new era of healthcare
Respiratory Therapist in this new era of healthcare

How will we Add Value?

August - 2013

you don t need to recreate the wheel
You don’t need to recreate the wheel

Look at what others are doing

Network with your peers

readmission factors1
Readmission Factors
  • 69% were non compliant with meds
  • 51% lacked knowledge: How to use Therapy Devices
  • 45% inadequate knowledge of medications
  • 42% unable to self manage care
  • 37% had no follow up visit with Physician
  • 31% develop infection post discharge

AARC webcast August 28-12 “Hospital to Home-efforts at Reducing Hospital Readmissions”. Greg Spratt BS, RRT; Kimberly Wiles BS, RRT; Becky Anderson RRT.

readmission factors2
Readmission Factors
  • 45% inadequate knowledge of medications
readmission factors3
Readmission Factors
  • 51% lacked knowledge: How to use Therapy Devices
readmission factors4
Readmission Factors
  • 51% lacked knowledge: How to use Therapy Devices
readmission factors5
Readmission Factors
  • 42% unable to self manage care
readmission factors6
Readmission Factors
  • 37% had no follow up visit with Physician

WHY only 37%?????

Physicians are inconsistent

  • 21.7% of patients with follow-up with their PCP or pulmonologist had an ED visit with-in 30 days of discharge
  • 26.3% of patients with no post-discharge follow-up had an ED visit with-in 30 days of discharge

Sharma, Kuo, Freeman, Zhang, & Goodwin (2010)

readmission factors7
Readmission Factors
  • 21.7% of patients with follow-up with their PCP or pulmonologist had an ED visit with-in 30 days of discharge
  • 26.3% of patients with no post-discharge follow-up had an ED visit with-in 30 days of discharge

Sharma, Kuo, Freeman, Zhang, & Goodwin (2010)

readmission factors8
Readmission Factors
  • 31% develop infection post discharge
    • Teaching patients early recognition of symptoms is critical
    • Action plan in place?
summary
Summary
  • Healthcare is transforming as we speak
  • Our reimbursement structure is changing
  • We have an awesome opportunity as respiratory therapists but we must embrace the change and get out of our cofort zone
  • Our future is bright if we grow as professionals and practice as engaged members of the healthcare arena
thank you
Thank You!

I appreciate the opportunity to be here with you all today.

John Wilson BSRT, RRT-ACCS, RCP

Respiratory Supervisor

Novant Health Rowan Medical Center

Salisbury, NC [email protected]

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