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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 purchasing3
Measures:Hospital Value-Based Purchasing

Fiscal Year (FY) 2014


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)


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 measures
HCAHPS - Measures


Hcahps public reporting
HCAHPS – Public Reporting


Hcahps public reporting1
HCAHPS – Public Reporting


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


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.


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




Other resources attend meetings
Other Resources - Attend Meetings






In the hospital treating the exacerbation
In the Hospital – Treating the Exacerbation


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 jwwilson@novanthealth.org