Partnership for Patients: Reducing Readmissions and Hospital Acquired Conditions . Dennis Wagner & Paul McGann, MD Co-Directors, Partnership for Patients US Department of Health & Human Services and Centers for Medicare & Medicaid Services AHRQ Annual Conference September 10, 2012.
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Partnership for Patients: Reducing Readmissions and Hospital Acquired Conditions
Dennis Wagner & Paul McGann, MD
Co-Directors, Partnership for Patients
US Department of Health & Human Services
and Centers for Medicare & Medicaid Services
AHRQ Annual Conference
September 10, 2012
…we want your answers too
40% Reduction in Preventable Hospital Acquired Conditions
20% Reduction in 30-Day Readmissions
Up to $35 Billion Dollars Saved
Partnership for Patients is About All of Us Doing Things Differently
We have unprecedented Federal action and coordination.
We have an unprecedented CMMI Investment in taking proven practices to scale.
We are calling for continued unprecedented action and alignment by CBOs, hospitals, clinicians, private partners and others.
American Hospital Association
Premier Healthcare Alliance
NC Hospital Assoc
GA Hospital Assoc
TX Hospital Assoc
MN Hospital Assoc
Healthcare Assoc of NY State
IA Healthcare Collaborative
PA Hospital Assoc
WA Hospital Assoc
OH Hospital Assoc
NJ Hospital Assoc
TN Hospital Assoc
MI Health & Hospital Assoc
National Public Hospital & Health Institute
LifePoint Hospitals, Inc
Joint Commission Resources
OCHSPS National Children’s Network
NV Hospital Assoc
Carolinas Health Care
Hosp A Hosp B Hosp C System
Baseline, Prior Year:
Oct. 2009 – May 2010
Oct. 2010 – May 2011
Oct. 2010 – May 2011
Prior to Intervention: 159/515
Post Without Intervention :165/558
Post With Intervention: 36/184
Improve transitions of beneficiaries from the inpatient hospital setting to home or other care settings
Improve quality of care
Reduce readmissions for high risk beneficiaries
Document measureable savings to the Medicare program
For more information, visit: http://innovations.cms.gov/initiatives/Partnership-for-Patients/CCTP
Now 47 Sites: CBOs with 200+ hospitals serving 185,500 beneficiaries in 21 states
PfP Readmissions Aim: A Network of Networks for Nationwide Results
QIO-Recruited Communities, CCTP Sites, & ADRC Option D Grantees
(as of July 31, 2012)
CCTP Sites, QIO-Recruited Communities, ADRC Grantees
ZIP Code Level Readmissions per 1000 Medicare Beneficiaries
(January 1, 2011 – December 31, 2011)
30-day Readmissions per 1000 beneficiaries
Convene community partners to improve transitions across the continuum of care, including social and HCBS providers, hospitals, pharmacy, nursing homes, home health, primary care, other post-acute care providers
Identify major drivers of readmissions and ideal target population through community-specific Root Cause Analysis
Select interventions best suited to address those drivers and implement for target population identified as at high risk of readmission (in CCTP, with monthly payment for services)
Use PDSA, rapid-cycle measurement for improvement (e.g., run charts), learning collaboratives and change packages to share successful practices, other continuous improvement tools to adjust target population and/or intervention strategy and improve along the way
Partner with multiple payers if possible, to serve more patients and reduce more readmissions
• Community Coalition Formation
• Community-specific Root Cause Analysis
• Intervention Selection and Implementation
• Assist with an Application for a Formal Care Transitions Program
Access a comprehensive Toolkit, Learning Sessions, and locate your QIO care transitions contact at: http://cfmc.org/integratingcare under “Contact Us”
Build on and spread success within and across networks, including CCTP, QIO, HEN, private efforts, and so on
Hospitals team with the larger community
Work closely with QIOs and align with state/local efforts
Target patient-level interventions to highest risk patients
Conduct a thorough Root Cause Analysis (RCA) to determine major readmissions drivers, not just top diagnoses
Make greater patient engagement and enhanced role of family caregivers a core focus
Choose your interventions based RCA findings
Target High-Risk but Measure All-Cause Readmissions
Federal Partners and Programs Are Aligned & Generating Results on Partnership for Patients
* CLABSI rate calculated as sum of infections divided by sum of line-days for all reporting ICUs
40% Reduction (1.91 CLABSIs per 1,000 line-days
Data are for six cohorts that started collecting baseline data from May 2008 to April 2009. Q1 varies from May-Jul 2009 to Apr-Jun 2010. Q1 to Q4 covers all six cohorts; Q5 to Q8 covers three to five cohorts.
Data are from 44 States, DC and PR; with a total of 1142 participating ICUs.
We estimate that 27 percent of hospitals with an adult ICU in the nation are participating in CUSP for CLABSI. See: www.onthecuspstophai.org.
The project is led by HRET, Johns Hopkins’ Armstrong Institute, and Michigan’s Keystone Center.
ADRC Evidence Based Care Transition Program
Source: ACL Semi Annual Report Data October 2010- March 2012
Success Story: Pennsylvania
*Data provided by Crozer Keystone Health System
Be a part of the largest public or private sector investment in patient safety & readmissions reduction
Access to real-time data and cutting-edge discoveries from hospitals and communities participating in the work of improvement
Opportunity to see your research used in real-time to influence community –based care and/or drive patient and family engagement
Become an important coordinator of care beyond hospital walls by establishing new cross-setting collaborations
Ease the burden of HACs and re-hospitalization on patients and the community
Build “communities of scale” by tapping into efforts already going on right in your backyard
Take 1 Minute
Talk to Your Neighbor
What are your answers?
How Can You Contribute?
efforts already going on in your own backyard
How Can You Contribute?
Make a note….30 Seconds
What is your answer
to this question?
Sharing Insight, Possibility and Action
AHRQ Annual Meeting
My biggest insight about how my organization can benefit from the Partnership for Patients initiative is: ___________________________________
The possibilities I see for our organization to act on or contribute to the Partnership for Patients are:
My main advice to CMS and AHRQ about how they can be most helpful in achieving the bold aims of the Partnership:_____________________________
Name, Organization, Email:_______________________________________