Changes in Healthcare and the Role of the Respiratory Therapist

1. Changes in Healthcare and the Role of the Respiratory Therapist John Wilson BSRT, RRT-ACCS

2. Disclosure Speaker Bureau – Monaghan Medical

3. 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

4. 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

5. 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

6. Hospital Value-Based Purchasing Section 3001(a) of the Affordable Care Act

7. 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

8. What has Changed? Past • Diagnosis Related Groups (DRG) • Paid for treating Future • Pay for Performance • Population Management

9. Hospital Value-Based Purchasing Purpose • Promote better clinical outcomes for hospital patients • Improve their experience of care during hospital stays

10. 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

11. Measures:Hospital Value-Based Purchasing Hospital’s performance will be based on their performance in several areas

12. Measures:Hospital Value-Based Purchasing Fiscal Year (FY) 2013 • 12 Clinical Process of Care measures • 8 Patient Experience of Care dimensions - HCAHPS survey

13. Clinical Process of Care measures AMI Heart Failure Pneumonia Surgical Care Improvement

14. 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)

15. Measures:Hospital Value-Based Purchasing Fiscal Year (FY) 2014

16. 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)

17. Hospital Value-Based Purchasing Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS)

18. How Can we Always Have Patient Satisfaction

19. 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?

20. 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

21. HCAHPS - Measures

22. HCAHPS – Public Reporting

23. HCAHPS – Public Reporting

24. HCAHPS – Public Reporting There is much more and – The public is out there shopping

25. Readmissions Reduction Program subpart I of 42 CFR part 412 (§412.150 through §412.154)

26. 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

27. 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.

28. Proposed Replacements of the hip or knee

29. 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.

30. 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.

31. Respiratory Therapist in this new era of healthcare How will we Add Value? August - 2013

32. You don’t need to recreate the wheel Look at what others are doing Network with your peers

33. Other Resources – Connect Online

34. Other Resources – Connect Online

35. Other Resources - Attend Meetings

36. Other Resources - Attend Meetings

37. COPD Readmissions – What can WE do?

38. Chronic Care Model

39. Chronic Care Model

40. In the Hospital – Treating the Exacerbation

41. 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.

42. Readmission Factors • 45% inadequate knowledge of medications

43. Readmission Factors • 51% lacked knowledge: How to use Therapy Devices

44. New Products

45. Readmission Factors • 51% lacked knowledge: How to use Therapy Devices

46. Readmission Factors • 42% unable to self manage care

47. Readmission Factors – Self Management

48. Readmission Factors – Self Management

49. 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)

50. 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)