http://www.mayoclinic.

org/about-mayo-clinic/quality/qualitymeasures/readmission-rates
Readmission rates
Tracking the number of patients who experience unplanned readmissions to a
hospital after a previous hospital stay is one category of data used to evaluate the
quality of hospital care.
One example of an unplanned readmission would be someone who is readmitted to
the hospital for a surgical wound infection that occurred after his or her initial
hospital stay.
It's important to note that unplanned hospital readmissions may or may not be
related to the previous visit, and some unplanned readmissions aren't preventable.
Whatever the reason, insurance companies and other payers sometimes view
unplanned hospital readmissions as wasteful spending.
How hospital readmissions are measured and evaluated
Mayo Clinic defines hospital readmission as patient admission to a hospital within
30 days after being discharged from an earlier hospital stay.
The standard benchmark used by the Centers for Medicare & Medicaid Services
(CMS) is the 30-day readmission rate. Rates at the 80th percentile or lower are
considered optimal by CMS.
Patients transferred to another hospital for longer term care won't count as a
readmission.
Translet
tarif pendaftaran kembali
Pelacakan jumlah pasien yang mengalami readmissions tidak direncanakan ke
rumah sakit setelah tinggal di rumah sakit sebelumnya adalah salah satu kategori
data yang digunakan untuk mengevaluasi kualitas perawatan di rumah sakit.
Salah satu contoh diterima kembali direncanakan akan seseorang yang kembali ke
rumah sakit untuk infeksi luka bedah yang terjadi setelah nya tinggal di rumah sakit
awal.
Sangat penting untuk dicatat bahwa readmissions rumah sakit yang tidak
direncanakan mungkin atau mungkin tidak terkait dengan kunjungan sebelumnya,
dan beberapa readmissions direncanakan tidak dapat dicegah. Apa pun alasannya,
perusahaan asuransi dan pembayar lain kadang-kadang melihat readmissions
rumah sakit yang tidak direncanakan belanja sebagai boros.

Bagaimana readmissions rumah sakit diukur dan dievaluasi

Mayo Clinic mendefinisikan rumah sakit diterima kembali sebagai masuk pasien ke rumah sakit

dalam waktu 30 hari setelah keluar dari rumah sakit tinggal sebelumnya.
patokan standar yang digunakan oleh Centers for Medicare & Medicaid Services (CMS) adalah
tingkat pendaftaran kembali 30-hari. Tarif di persentil ke-80 atau lebih rendah dianggap optimal
oleh CMS.
Pasien dipindahkan ke rumah sakit lain untuk perawatan jangka panjang tidak akan dihitung
sebagai diterima kembali a.
https://translate.google.com/#en/id/Readmissions%20Reduction%20Program
%20%28HRRP%29%
Readmissions Reduction Program (HRRP)
Background
Section 3025 of the Affordable Care Act added section 1886(q) to the Social Security Act
establishing the Hospital Readmissions Reduction Program, which requires CMS to reduce
payments to IPPS hospitals with excess readmissions, effective for discharges beginning on
October 1, 2012. The regulations that implement this provision are in subpart I of 42 CFR part
412 (412.150 through 412.154).
News on the Hospital Readmissions Reduction Program
CMS has posted the FY 2016 IPPS/LTCH PPS final rule. For more information on these
payment-related policies, please refer to the FY 2016 IPPS Final Rule in the Downloads section
below.
Readmission Measures
In the FY 2012 IPPS final rule, CMS finalized the following policies with regard to the
readmission measures under the Hospital Readmissions Reduction Program:
Defined readmission as an admission to a subsection (d) hospital within 30 days of a discharge
from the same or another subsection (d) hospital;
Adopted readmission measures for the applicable conditions of acute myocardial infarction
(AMI), heart failure (HF), and pneumonia (PN);
Established a methodology to calculate the excess readmission ratio for each applicable
condition, which is used, in part, to calculate the readmission payment adjustment. A hospitals
excess readmission ratio is a measure of a hospitals readmission performance compared to the
national average for the hospitals set of patients with that applicable condition.
Established a policy of using the risk adjustment methodology endorsed by the National
Quality Forum (NQF) for the readmissions measures to calculate the excess readmission ratios,
which includes adjustment for factors that are clinically relevant including certain patient
demographic characteristics, comorbidities, and patient frailty.
Established an applicable period of three years of discharge data and the use of a minimum of
25 cases to calculate a hospitals excess readmission ratio for each applicable condition.
In the FY 2014 IPPS final rule, CMS adopted the application of an algorithm to account for
planned readmissions to the readmissions measures. In addition, CMS finalized the expansion of
the applicable conditions beginning with the FY 2015 program to include: (1) patients admitted
for an acute exacerbation of chronic obstructive pulmonary disease (COPD); and (2) patients
admitted for elective total hip arthroplasty (THA) and total knee arthroplasty (TKA).
In the FY 2015 IPPS final rule, CMS finalized the expansion of the applicable conditions
beginning with the FY2017 program to include patients admitted for coronary artery bypass graft
(CABG) surgery in the calculation of a hospitals readmission payment adjustment factor.

In the FY 2016 IPPS final rule, CMS finalized an update to the pneumonia readmission measure
by expanding the measure cohort to include additional pneumonia diagnoses: (i) patients with
aspiration pneumonia; and (ii) sepsis patients coded with pneumonia present on admission (but
not including severe sepsis).
For more information on these readmission measure-related policies, please refer to the IPPS
Final Rules in the Downloads section below.
Payment Adjustment
In the FY 2013 IPPS final rule, CMS finalized the following policies with regard to the payment
adjustment under the Hospital Readmissions Reduction Program:
Which hospitals are subject to the Hospital Readmissions Reduction Program;
The methodology to calculate the hospital readmission payment adjustment factor;
What portion of the IPPS payment is used to calculate the readmission payment adjustment
amount; and
A process for hospitals to review their readmission information and submit corrections to the
information before the readmission rates are to be made public.
For more information on these payment-related policies, please refer to the FY 2013 IPPS Final
Rule in the Downloads section below.
Formulas to Calculate the Readmission Adjustment Factor
Excess readmission ratio = risk-adjusted predicted readmissions/risk-adjusted expected
readmissions
Aggregate payments for excess readmissions = [sum of base operating DRG payments for AMI x
(excess readmission ratio for AMI-1)] + [sum of base operating DRG payments for HF x (excess
readmission ratio for HF-1)] + [sum of base operating DRG payments for PN x (excess
readmission ratio for PN-1)] + [sum of base operating DRG payments for COPD x (excess
readmission ratio for COPD-1)] + [sum of base operating payments for THA/TKA x (excess
readmission ratio for THA/TKA -1)]
*Note, if a hospitals excess readmission ratio for a condition is less than/equal to 1, then there
are no aggregate payments for excess readmissions for that condition included in this calculation.
Aggregate payments for all discharges = sum of base operating DRG payments for all discharges
Ratio = 1 - (Aggregate payments for excess readmissions/ Aggregate payments for all
discharges)
Readmissions Adjustment Factor = the higher of the Ratio or 0.97 (3% reduction).
(For FY 2013, the higher of the Ratio or 0.99% (1% reduction), and for FY 2014, the higher of
the Ratio or 0.98% (2% reduction).)
Formulas to Compute the Readmission Payment Adjustment Amount
Wage-adjusted DRG operating amount* = DRG weight x [(labor share x wage index) + (nonlabor share x cola, if applicable)]
*Note, If the case is subject to the transfer policy, then this amount includes an applicable
payment adjustment for transfers under 412.4(f).
Base Operating DRG Payment Amount = Wage-adjusted DRG operating amount + new
technology payment, if applicable.
Readmissions Payment Adjustment Amount = [Base operating DRG payment amount x
readmissions adjustment factor] - base operating DRG payment amount.
*The readmissions adjustment factor is always less than 1.0000, therefore, the readmissions
payment adjustment amount will always be a negative amount (i.e., a payment reduction).

Trnslet
Program Pengurangan readmissions (HRRP)
latar belakang
Bagian 3025 dari Undang-Undang Perawatan Terjangkau menambahkan bagian
1886 (q) UU Jamsostek menetapkan Program Pengurangan Rumah Sakit
readmissions, yang membutuhkan CMS untuk mengurangi pembayaran kepada
rumah sakit IPPS dengan kelebihan readmissions, efektif untuk pembuangan yang
dimulai pada tanggal 1 Oktober 2012. Peraturan yang menerapkan ketentuan ini
berada di sub bagian I dari 42 CFR bagian 412 (412.150 melalui 412.154).
Berita tentang Program Rumah Sakit readmissions Reduction
CMS telah diposting TA 2016 IPPS / LTCH PPS aturan final. Untuk informasi lebih
lanjut tentang kebijakan terkait pembayaran tersebut, silahkan lihat TA 2016 IPPS
Peraturan Final di bagian Download di bawah ini.
Tindakan diterima kembali
Dalam TA 2012 IPPS aturan akhir, CMS diselesaikan kebijakan berikut berkaitan
dengan langkah-langkah diterima kembali di bawah Program Pengurangan Rumah
Sakit readmissions:
Ditetapkan diterima kembali sebagai masuk ke subbagian (d) rumah sakit dalam
waktu 30 hari dari debit dari sama atau ayat (d) rumah sakit lain;
langkah-langkah pendaftaran kembali diadopsi untuk kondisi yang berlaku infark
miokard akut (AMI), gagal jantung (HF), dan pneumonia (PN);
Didirikan metodologi untuk menghitung rasio pendaftaran kembali kelebihan
untuk setiap kondisi yang berlaku, yang digunakan, sebagian, untuk menghitung
penyesuaian pembayaran diterima kembali. Rasio penerimaan kembali kelebihan
Sebuah rumah sakit adalah ukuran kinerja diterima kembali rumah sakit
dibandingkan dengan rata-rata nasional untuk ditetapkan rumah sakit pasien
dengan kondisi yang berlaku.
Menetapkan kebijakan menggunakan metodologi penyesuaian risiko didukung
oleh Forum Mutu Nasional (NQF) untuk langkah-langkah readmissions untuk
menghitung rasio pendaftaran kembali kelebihan, yang mencakup penyesuaian
untuk faktor yang relevan secara klinis termasuk karakteristik tertentu pasien
demografi, komorbiditas, dan kelemahan pasien.
Didirikan periode yang berlaku tiga tahun data debit dan penggunaan minimal 25
kasus untuk menghitung rasio diterima kembali kelebihan rumah sakit untuk setiap
kondisi yang berlaku.
Dalam TA 2014 IPPS aturan akhir, CMS mengadopsi penerapan algoritma untuk
memperhitungkan readmissions direncanakan langkah-langkah readmissions. Selain
itu, CMS diselesaikan perluasan kondisi yang berlaku dimulai dengan program TA
2015 meliputi: (1) pasien dirawat untuk eksaserbasi akut penyakit paru obstruktif

kronik (PPOK); dan (2) pasien mengaku untuk elektif artroplasti total pinggul (THA)
dan artroplasti lutut total (TKA).
Dalam TA 2015 IPPS aturan akhir, CMS diselesaikan perluasan kondisi yang berlaku
dimulai dengan FY2017 program untuk mencakup pasien dirawat untuk operasi
bypass arteri koroner graft (CABG) dalam perhitungan faktor diterima kembali
penyesuaian pembayaran rumah sakit.
Dalam TA 2016 IPPS aturan akhir, CMS diselesaikan update untuk ukuran
pneumonia diterima kembali dengan memperluas ukuran kohort untuk
memasukkan tambahan diagnosis pneumonia: (i) pasien dengan pneumonia
aspirasi; dan (ii) pasien sepsis dikodekan dengan pneumonia hadir pada
penerimaan (tetapi tidak termasuk sepsis berat).
Untuk informasi lebih lanjut tentang kebijakan terkait ukuran diterima kembali
tersebut, silahkan lihat Aturan Akhir IPPS di bagian Download di bawah ini.
Penyesuaian pembayaran
Dalam TA 2013 IPPS aturan akhir, CMS diselesaikan kebijakan berikut berkaitan
dengan penyesuaian pembayaran di bawah Program Pengurangan Rumah Sakit
readmissions:
rumah sakit yang tunduk pada Program Pengurangan Rumah Sakit readmissions;
metodologi untuk menghitung faktor dirawat di rumah sakit penyesuaian
pembayaran;
Apa porsi pembayaran IPPS digunakan untuk menghitung jumlah pendaftaran
kembali penyesuaian pembayaran; dan
Sebuah proses untuk rumah sakit untuk meninjau informasi pendaftaran kembali
dan menyampaikan koreksi informasi sebelum tarif pendaftaran kembali harus
dibuat publik.
Untuk informasi lebih lanjut tentang kebijakan terkait pembayaran tersebut,
silahkan lihat TA 2013 IPPS Peraturan Final di bagian Download di bawah ini.
Rumus Menghitung diterima kembali Penyesuaian Factor
rasio penerimaan kembali kelebihan = risiko disesuaikan diprediksi readmissions /
risiko-disesuaikan readmissions diharapkan
pembayaran agregat untuk kelebihan readmissions = [jumlah pembayaran DRG
operasi dasar untuk AMI x (rasio penerimaan kembali kelebihan untuk AMI-1)] +
[jumlah pembayaran DRG operasi dasar untuk HF x (rasio penerimaan kembali
kelebihan untuk HF-1)] + [sum dasar pembayaran DRG operasi untuk PN x (rasio
penerimaan kembali kelebihan untuk PN-1)] + [jumlah pembayaran DRG operasi
dasar untuk COPD x (rasio penerimaan kembali kelebihan untuk COPD-1)] + [jumlah
pembayaran basis operasi untuk THA / TKA x (rasio penerimaan kembali kelebihan
untuk THA / TKA -1)]
* Catatan, jika rasio diterima kembali kelebihan rumah sakit untuk kondisi kurang
dari / sama dengan 1, maka tidak ada pembayaran agregat untuk kelebihan
readmissions untuk kondisi yang termasuk dalam perhitungan ini.
pembayaran agregat untuk semua pembuangan = jumlah pembayaran DRG basis

operasi untuk semua pembuangan

Rasio = 1 - (pembayaran Agregat untuk kelebihan readmissions / pembayaran
Agregat untuk semua pembuangan)
Readmissions Adjustment Factor = semakin tinggi dari Rasio atau 0,97
(pengurangan 3%).
(Untuk TA 2013, lebih tinggi dari Rasio atau 0,99% (pengurangan 1%), dan untuk TA
2014, lebih tinggi dari Rasio atau 0,98% (penurunan 2%).)
Rumus untuk Hitunglah diterima kembali Penyesuaian Pembayaran Jumlah
Upah disesuaikan DRG jumlah operasi * = DRG berat x [(share indeks tenaga kerja x
upah) + (non-tenaga kerja pangsa x cola, jika berlaku)]
* Catatan, Jika kasus ini tunduk pada kebijakan transfer, maka jumlah ini termasuk
penyesuaian pembayaran yang berlaku untuk transfer di bawah 412,4 (f).
Jumlah Pembayaran Operating Base DRG = Upah-disesuaikan jumlah DRG operasi +
pembayaran teknologi baru, jika berlaku.
Readmissions Penyesuaian Pembayaran Jumlah = [Basis operasi pembayaran DRG
jumlah x readmissions faktor penyesuaian] - operasi dasar jumlah pembayaran
DRG.
* Faktor penyesuaian readmissions selalu kurang dari 1,0000, oleh karena itu,
jumlah penyesuaian pembayaran readmissions akan selalu menjadi jumlah negatif
(yaitu, pengurangan pembayaran).
https://www.medicare.gov/hospitalcompare/Data/30-day-measures.html
30-day unplanned readmission and death measures

The 30-day unplanned readmission measures are estimates of unplanned readmission for any
cause to any acute care hospital within 30 days of discharge from a hospitalization. CMS chose
to measure unplanned readmission within 30 days instead of over longer time periods (like 90
days), because readmissions over longer periods may be impacted by factors outside hospitals
control like other complicating illnesses, patients own behavior, or care provided to patients
after discharge. Hospital Compare reports the following 30-day readmission measures:
Medical Conditions

30-day unplanned readmission for chronic obstructive pulmonary diease

(COPD) patients

30-day unplanned readmission for heart attack (AMI) patients

30-day unplanned readmission for heart failure (HF) patients

30-day unplanned readmission for pneumonia patients

30-day unplanned readmission for stroke patients

Surgical Procedures

30-day unplanned readmission for coronary artery bypass graft (CABG)

surgery patients

30-day unplanned readmission for hip/knee replacement patients

Hospital-Wide

30-day overall rate of unplanned readmission after discharge from the

hospital (hospital-wide readmission). Note: This measure includes patients
admitted for internal medicine, surgery/gynecology, cardiorespiratory,
cardiovascular, and neurology services. It is not a composite measure.

The 30-day death (mortality) measures are estimates of deaths from any cause within 30 days of
a hospital admission, for patients hospitalized with one of several medical conditions or surgical
procedures. The 30-day death rate for coronary artery bypass graft (CABG) surgery patients
measure counts deaths from any cause within 30 days of the date of the surgery date. Deaths can
be counted in the measures regardless of whether the patient dies while still in the hospital or
after discharge. CMS chose to measure death within 30 days instead of inpatient deaths to use a
more consistent measurement time window because length of hospital stay varies across patients
and hospitals. Also, death over longer time periods (like 90 days) may have less to do with the
care gotten in the hospital and more to do with other complicating illnesses, patients own
behavior, or care provided to patients after hospital discharge. Hospital Compare reports on the
following 30-day mortality measures:
Medical Conditions

30-day death rate for chronic obstructive pulmonary disease (COPD) patients

30-day death rate for heart attack (acute myocardial infarction [AMI])
patients

30-day death rate for heart failure (HF) patients

30-day death rate for pneumonia patients

30-day death rate for stroke patients

Surgical Procedures

30-day death rate for coronary artery bypass graft (CABG) surgery patients

Which patients are included

The 30-day unplanned readmission and death (mortality) measures include hospitalizations for
Medicare beneficiaries 65 or older who were enrolled in Original Medicare for the entire 12
months prior to their hospital admission (and for readmissions, for 30 days after their original
admission). The heart attack, heart failure, and pneumonia death and unplanned readmission
measures also include patients 65 or older who were admitted to Veterans Health Administration
(VA) hospitals. Beneficiaries enrolled in Medicare managed care plans aren't included. The
unplanned readmission measures do not include patients who died during the index admission, or
who left the hospital against medical advice.
Where the information comes from

CMS calculates hospital-specific 30-day unplanned readmission and mortality rates using
Medicare claims and eligibility information. The heart attack, heart failure, and pneumonia death
and readmission measures are also calculated using VA administrative data. Using administrative
data makes it possible to calculate death and readmission rates without having to do medical
chart reviews or requiring hospitals to report additional information to CMS. Research conducted
during development of the heart attack, heart failure, and pneumonia readmission and death
measures showed that statistical models based on claims data performed well in estimating
hospital mortality rates compared to models that are based on information from medical chart
reviews.
Risk adjustment

To accurately compare hospital performance fair and level the playing field, the 30-day
unplanned readmission and death measures adjust for patient characteristics that may make death
or unplanned readmission more likely, even if the hospital provided higher quality of care. These
characteristics include the patients age, past medical history, and other diseases or conditions
(comorbidities) the patient had when they were admitted that are known to increase the patients
risk of dying or of having an unplanned readmission.
Significance testing

The statistical model used to calculate 30-day unplanned readmission and 30-day death measures
also determines how precise the estimates are, and provides the upper and lower bounds of the
95% interval estimates for each hospitals risk-adjusted mortality and unplanned readmission
rates. Interval estimates, which are like confidence intervals, describe the level of uncertainty
around the estimated mortality and readmission rates.
Comparing individual hospital rates to the national rate

To assign hospitals to performance categories, the hospitals interval estimate is compared to the
national 30-day observed unplanned readmission rate or 30-day observed death rate. If the 95%
interval estimate includes the national observed rate for that measure, the hospitals performance
is in the No Different than National Rate category. If the entire 95% interval estimate is below
the national observed rate for that measure, then the hospital is performing Better than National
Rate. If the entire 95% interval estimate is above the national observed rate for that measure, its
performance is Worse than National Rate. Hospitals with fewer than 25 eligible cases are
placed into a separate category that indicates that the hospital did not have enough cases to
reliably tell how well the hospital is performing.
Additional information

For more detail on how the 30-day unplanned readmission rates are calculated, please refer to
QualityNet - Readmission Measures- Opens in a new window External Link icon. For other
questions regarding the 30-day unplanned readmission measures, please email
cmsreadmissionmeasures@yale.edu. External Link icon
For more detail on how the 30-day death (mortality) rates are calculated, please refer to
QualityNet - Mortality Measures- Opens in a new window External Link icon. For other
questions regarding the 30-day death (mortality) measures, please email
cmsmortalitymeasures@yale.edu. External Link icon

30-hari pendaftaran kembali tidak direncanakan dan kematian tindakan

Langkah-langkah pendaftaran kembali direncanakan 30-hari merupakan perkiraan
dari penerimaan kembali direncanakan untuk alasan untuk setiap rumah sakit
perawatan akut dalam waktu 30 hari dari debit dari rumah sakit a. CMS memilih
untuk mengukur diterima kembali yang tidak direncanakan dalam waktu 30 hari,
bukan selama periode waktu yang lebih lama (seperti 90 hari), karena readmissions
lebih waktu yang lebih lama mungkin terkena dampak oleh faktor di luar rumah
sakit 'control seperti penyakit komplikasi lainnya, pasien perilaku sendiri, atau
perawatan yang diberikan kepada pasien setelah debit. Rumah sakit Bandingkan
laporan tindakan pendaftaran kembali 30-hari berikut:
Kondisi medis
30-hari pendaftaran
(PPOK) pasien
30-hari pendaftaran
30-hari pendaftaran
30-hari pendaftaran
30-hari pendaftaran

kembali direncanakan untuk diease paru obstruktif kronik

kembali
kembali
kembali
kembali

direncanakan
direncanakan
direncanakan
direncanakan

untuk
untuk
untuk
untuk

serangan jantung (AMI) pasien

gagal jantung (HF) pasien
pasien pneumonia
pasien stroke

Prosedur operasi
30-hari pendaftaran kembali direncanakan untuk koroner artery bypass graft
(CABG) pasien operasi
30-hari pendaftaran kembali direncanakan untuk pasien pinggul / penggantian
lutut
Rumah sakit-lebar
tingkat keseluruhan 30-hari pendaftaran kembali tidak direncanakan setelah
keluar dari rumah sakit (pendaftaran kembali rumah sakit-lebar). Catatan: Langkah
ini termasuk pasien mengaku untuk penyakit dalam, bedah / ginekologi,
kardiorespirasi, kardiovaskular, dan layanan neurologi. Ini bukan ukuran gabungan.
30-hari kematian (mortalitas) tindakan adalah perkiraan kematian dari setiap
penyebab dalam waktu 30 hari dari masuk rumah sakit, pasien dirawat di rumah
sakit dengan salah satu dari beberapa kondisi medis atau prosedur bedah. Tingkat
kematian 30-hari untuk koroner artery bypass graft (CABG) operasi pasien ukuran
menghitung kematian dari setiap penyebab dalam waktu 30 hari dari tanggal
tanggal operasi. Kematian dapat dihitung dalam langkah-langkah terlepas dari
apakah pasien meninggal saat masih di rumah sakit atau setelah debit. CMS
memilih untuk mengukur kematian dalam 30 hari, bukan kematian rawat inap untuk
menggunakan lebih konsisten waktu pengukuran jendela karena lamanya tinggal di
rumah sakit bervariasi di pasien dan rumah sakit. Juga, kematian selama periode
waktu yang lebih lama (seperti 90 hari) mungkin memiliki lebih sedikit untuk
melakukan dengan hati-hati mendapatkan di rumah sakit dan lebih berkaitan
dengan komplikasi penyakit lain, pasien perilaku sendiri, atau perawatan yang
diberikan kepada pasien setelah keluar rumah sakit. Rumah Sakit Bandingkan
laporan tentang langkah-langkah kematian 30 hari berikut:
Kondisi medis
Tingkat kematian 30-hari untuk penyakit paru obstruktif kronik (PPOK) pasien
Tingkat kematian 30-hari untuk serangan jantung (infark miokard akut [AMI])
pasien
Tingkat kematian 30-hari untuk gagal jantung (HF) pasien
Tingkat kematian 30-hari untuk pasien pneumonia
Tingkat kematian 30-hari untuk pasien stroke
Prosedur operasi
Tingkat kematian 30-hari untuk koroner artery bypass graft (CABG) pasien
operasi
Mana pasien termasuk
30-hari pendaftaran kembali tidak direncanakan dan kematian (mortalitas) langkahlangkah termasuk rawat inap untuk Medicare penerima manfaat 65 tahun atau lebih
yang terdaftar dalam Asli Medicare untuk seluruh 12 bulan sebelum masuk rumah
sakit mereka (dan untuk readmissions, selama 30 hari setelah penerimaan asli
mereka). Serangan jantung, gagal jantung, dan kematian pneumonia dan
penerimaan kembali direncanakan langkah-langkah ini juga mencakup pasien 65

atau lebih tua yang dirawat di Veterans Administration Kesehatan (VA) rumah sakit.
Penerima terdaftar di Medicare dikelola rencana perawatan tidak termasuk.
Langkah-langkah pendaftaran kembali direncanakan tidak termasuk pasien yang
meninggal selama masuk indeks, atau yang meninggalkan rumah sakit terhadap
nasihat medis.
Di mana informasi berasal dari
CMS menghitung 30 hari tidak direncanakan pendaftaran kembali dan mortalitas di
rumah sakit-spesifik menggunakan Medicare klaim dan informasi kelayakan.
Serangan jantung, gagal jantung, dan kematian pneumonia dan penerimaan
kembali langkah-langkah juga dihitung menggunakan VA data administrasi.
Menggunakan data administratif memungkinkan untuk menghitung tingkat
kematian dan penerimaan kembali tanpa harus melakukan tinjauan medis grafik
atau membutuhkan rumah sakit untuk melaporkan informasi tambahan untuk CMS.
Penelitian yang dilakukan selama pengembangan dari serangan jantung, gagal
jantung, dan radang paru-paru penerimaan kembali dan kematian tindakan
menunjukkan bahwa model statistik berdasarkan data klaim dilakukan baik dalam
memperkirakan tingkat kematian di rumah sakit dibandingkan dengan model yang
didasarkan pada informasi dari ulasan medis grafik.
penyesuaian risiko
Untuk secara akurat membandingkan kinerja rumah sakit adil dan tingkat lapangan
bermain, 30-hari yang tidak direncanakan pendaftaran kembali dan kematian
tindakan menyesuaikan karakteristik pasien yang dapat membuat kematian atau
diterima kembali yang tidak direncanakan lebih mungkin, bahkan jika rumah sakit
memberikan kualitas perawatan yang lebih tinggi. Karakteristik ini meliputi usia
pasien, riwayat kesehatan masa lalu, dan penyakit lain atau kondisi (komorbiditas)
pasien memiliki ketika mereka mengakui bahwa diketahui meningkatkan risiko
pasien sekarat atau memiliki diterima kembali yang tidak direncanakan.
pengujian signifikansi
Model statistik yang digunakan untuk menghitung 30 hari pendaftaran kembali
tidak direncanakan dan tindakan kematian 30-hari juga menentukan bagaimana
tepatnya perkiraan yang, dan memberikan batas atas dan batas bawah dari
perkiraan selang 95% untuk kematian risiko disesuaikan setiap rumah sakit dan tarif
pendaftaran kembali tidak direncanakan. Perkiraan Interval, yang seperti interval
keyakinan, menggambarkan tingkat ketidakpastian sekitar tingkat kematian dan
diterima kembali perkiraan.
Membandingkan tarif rumah sakit individu untuk tingkat nasional
Untuk menetapkan rumah sakit untuk kategori kinerja, perkiraan interval rumah
sakit dibandingkan dengan 30 hari diamati tingkat pendaftaran kembali
direncanakan nasional atau 30-hari tingkat kematian diamati. Jika estimasi selang
95% termasuk tingkat yang diamati nasional untuk ukuran itu, kinerja rumah sakit
dalam "No Berbeda dari Tingkat Nasional" kategori. Jika seluruh 95% estimasi
interval di bawah tingkat yang diamati nasional untuk ukuran itu, maka rumah sakit
berkinerja "Lebih baik dari Tingkat Nasional." Jika seluruh 95% estimasi interval di
atas tingkat yang diamati nasional untuk ukuran itu, kinerja adalah " lebih buruk

dari Tingkat Nasional. "Rumah sakit dengan kurang dari 25 kasus yang layak
ditempatkan dalam kategori terpisah yang menunjukkan bahwa rumah sakit tidak
memiliki cukup kasus untuk andal memberitahu seberapa baik rumah sakit kinerja.
Informasi tambahan
Untuk detail lebih lanjut tentang bagaimana 30 hari tarif pendaftaran kembali
direncanakan dihitung, silakan lihat QualityNet - diterima kembali Measures- Dibuka
di jendela External Link ikon baru. Untuk pertanyaan lain mengenai langkah-langkah
pendaftaran kembali direncanakan 30 hari, silahkan email
cmsreadmissionmeasures@yale.edu. Tautan ikon eksternal
Untuk detail lebih lanjut tentang bagaimana kematian (mortalitas) tarif 30 hari
dihitung, silakan lihat QualityNet - Kematian Measures- Dibuka di jendela ikon
External Link baru. Untuk pertanyaan lain mengenai kematian 30-hari (mortalitas)
tindakan, silahkan email cmsmortalitymeasures@yale.edu. Tautan ikon eksternal

https://translate.google.com/#en/id/Hospital%20Readmissions
%20Reduction%20Program%0A%0AIn%20October%202012Hospital
Readmissions Reduction Program

In October 2012, CMS began reducing Medicare payments for Inpatient

Prospective Payment System (IPPS) hospitals with excess readmissions.
Excess readmissions are measured by a ratio, by dividing a hospitals
number of predicted 30-day readmissions for heart attack, heart failure,
pneumonia, hip/knee replacement, and COPD by the number that would be
expected, based on an average hospital with similar patients. A ratio
greater than 1 indicates excess readmissions.
More information on how payments are adjusted.
More on the calculations.
Hospital Readmissions Reduction Program data
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https://translate.google.com/#en/id/12%20Ways%20to%20Reduce%20Hospital
%20Readmissions
12 Ways to Reduce Hospital Readmissions
Cheryl Clark, December 27, 2010
Time flies. In just 21 months, the federal government will start penalizing hospitals
with higher than expected readmission rates. And even though much about the
regulations-to come remains unclear, clinicians along the care continuum are
scrambling to get ready.

Or they should be. It's not just important for a hospital's bottom line. It's important
for the patient.
We've been talking with some of the nation's experts on the subject, including
Stephen F. Jencks, M.D., whose April, 2009 article in the New England Journal of
Medicine set the tone for today's readmission prevention energy. His review of
nearly 12 million beneficiaries discharged from hospitals between 2003 and 2004
found that nearly 21%, or one in five, were re-hospitalized within 30 days and 34%
were readmitted within 90 days.
We also spoke with Amy Boutwell, MD, an internist at Newton-Wellesley Hospital in
Newton, MA and Director of Health Policy Strategy for the Institute for Healthcare
Improvement; Timothy Ferris, MD, medical director of the Massachusetts General
Physicians Organization, and Estee Neuhirth, director of field studies at Kaiser
Permanente in California.
Some of these strategies aren't yet proven to work in all settings, of course. And
many are still in the demonstrations phase. But with national readmission rates as
high one in five, and higher for certain diseases, many providers are trying anything
that sounds plausible.
Here are some of the prevention strategies that these and other experts think might
be worth a shot. Many involveto a greater or lesser degree following the patient
out of the hospital, either in-person, electronically, or by phone, but others involve
upside-down introspection and re-evaluation by providers along the care continuum.
1. Discharge Summaries
Dictate discharge summaries within 24 hours of discharge. Boutwell says that
standard practice and policy at most hospitals is that discharge summaries are
completed within 30 days of the discharge. "I was trained that the summary is a
retrospective report of what happened in hospitalization. But what we need today is
anticipatory guidance. Patients get discharged and go home. They can't fill their
meds, insurance doesn't cover the med or they have questions. They're nervous
and worried. They call their primary care provider, who didn't even know they were
admitted.
Boutwell says that 30-day-discharge summary policies "might have sufficed in a
time gone by. But that doesn't work anymore. Information needs to be available at
the time of discharge. There's a growing recognition of this need, but staff bylaws
haven't changed."

2.Lengthen the Handoff Process

At every juncture in patient care process, especially discharge, have teams talk to each other
about the patient. And by the way, don't call them discharges. Call them "transitions."
Standardize them for a variety of providers, from hospital to rehabilitation facility to skilled
nursing facility to home and back.
Boutwell says that "taking this person-centered approach shifts the concept from discharge,
which is a moment in time and you're done with it, to a transitiona shared accountability. We
need to make sure the receiving providers understand who this patient is, with a 360-degree
view.

Jencks adds that "senders and receivers, for example hospital discharge planners and skilled
nursing facility staff and home health" meet often enough so they can learn about the realities of
the transitions they initiate and receive.
3.Provide Medication on Discharge
Send the patient home with 30-day medication supply, wrapped in packaging that clearly
explains timing, dosage, frequency, etc. Some health centers with Medicaid patients may be
trying this strategy, which is difficult for hospitals to do with Medicare patients because of
distinctions between Part A and Part B payment. Still, for some high-risk populations, such as
patients with congestive heart failure and those who have been readmitted before, it might be
worth it for the hospital to absorb the cost.
4. Make a Follow-up Plan Before Discharge
Have hospital staff make follow-up appointments with patient's physician and don't discharge
patient until this schedule is set up. A key is to make sure the patient has transportation to the
physician's office, understands the importance of meeting that time frame, and following up with
a phone call to the physician to assure that the visit was completed.
5. Telehealth
We couldn't find anyone using video monitors to communicate on a daily basis with the use of
such software as Skype, for example, but some readmission experts say it's an interesting
approach to keep up visual as well as verbal communication with patients, especially those that
are high risk for readmission.
On a more practical scale, Home Healthcare Partners in Dallas uses health coaches, intensive
care clinicians, and wireless technology to record vital signs on a daily basis for about 2100
discharged Medicare fee-for-service beneficiaries for between 60 to 120 days. So far, they have
done this for about 7,000 unduplicated patients in the last two years, for several hundred
hospitals in Dallas and Louisiana, says HHP's CEO, Wayne Bazzle.
The target population for intense monitoring includes those with four or five co-morbidities and
who have a primary diagnosis of congestive heart failure, chronic obstructive pulmonary disease,
diabetes, Alzheimer's and hypertension.
Bazzle says that the effort involves phone calls of between five and 15 minutes, and is frequent
enough with the same team "so we have their trust. We can help them stay out of the hospital if
they're more truthful with us about what's going on, and if we see some deterioration, we can
help them cope. Normally it's a medication management issue, or they've become a little too
relaxed with their diet."

Translet
12 Cara untuk Mengurangi Sakit readmissions
Cheryl Clark, 27 Desember 2010
Waktu berlalu. Hanya dalam 21 bulan, pemerintah federal akan mulai menghukum
rumah sakit dengan lebih tinggi tingkat pendaftaran kembali dari yang diharapkan.
Dan meskipun banyak tentang peraturan-datang masih belum jelas, dokter di
sepanjang kontinum perawatan berebut untuk bersiap-siap.
Atau mereka harus. Ini bukan hanya penting untuk bottom line rumah sakit. Sangat
penting bagi pasien.
Kami telah berbicara dengan beberapa ahli bangsa pada subjek, termasuk Stephen
F. Jencks, gelar M.D., yang April 2009 artikel di New England Journal of Medicine
mengatur nada untuk energi pencegahan diterima kembali hari ini. ulasannya
hampir 12 juta penerima manfaat dipulangkan dari rumah sakit antara 2003 dan
2004 menemukan bahwa hampir 21%, atau satu dari lima, re-rumah sakit dalam
waktu 30 hari dan 34% yang diterima kembali dalam waktu 90 hari.
Kami juga berbicara dengan Amy Boutwell, MD, seorang internis di NewtonWellesley Rumah Sakit di Newton, MA dan Direktur Strategi Kebijakan Kesehatan
untuk Institute for Healthcare Improvement; Timothy Ferris, MD, direktur medis dari
Dokter Organisasi Massachusetts General, dan Estee Neuhirth, direktur studi
lapangan di Kaiser Permanente di California.
Beberapa strategi ini belum terbukti untuk bekerja di semua pengaturan, tentu saja.
Dan banyak yang masih dalam tahap demonstrasi. Tapi dengan tarif pendaftaran
kembali nasional setinggi satu dari lima, dan lebih tinggi untuk penyakit tertentu,
banyak penyedia mencoba sesuatu yang terdengar masuk akal.
Berikut adalah beberapa strategi pencegahan yang ini dan ahli lainnya berpikir
mungkin layak dicoba. Banyak melibatkan-untuk yang lebih besar atau lebih kecil
-following pasien keluar dari rumah sakit, baik di-orang, elektronik, atau melalui
telepon, tetapi yang lain melibatkan terbalik introspeksi dan evaluasi ulang oleh
penyedia sepanjang kontinum perawatan.
1. Ringkasan Discharge
Mendikte ringkasan debit dalam waktu 24 jam debit. Boutwell mengatakan bahwa
praktek standar dan kebijakan di kebanyakan rumah sakit adalah bahwa ringkasan
debit selesai dalam waktu 30 hari dari debit. "Saya dilatih bahwa ringkasan adalah
laporan retrospektif tentang apa yang terjadi di rumah sakit. Tapi apa yang kita
butuhkan saat ini adalah bimbingan antisipatif. Pasien mendapatkan habis dan
pulang. Mereka tidak dapat mengisi meds mereka, asuransi tidak menutupi med
atau mereka memiliki pertanyaan. mereka gugup dan khawatir. mereka
menghubungi penyedia perawatan primer mereka, yang bahkan tidak tahu mereka
mengakui.
Boutwell mengatakan bahwa kebijakan Ringkasan 30-hari-discharge "mungkin
sudah cukup dalam waktu berlalu. Tapi itu tidak bekerja lagi. Informasi harus
tersedia pada saat debit. Ada pengakuan yang berkembang dari kebutuhan ini,
tetapi staf peraturan tidak berubah. "
2.Lengthen Proses Handoff
Pada setiap titik dalam proses perawatan pasien, terutama debit, memiliki tim
berbicara satu sama lain tentang pasien. Dan omong-omong, tidak menyebut

mereka pembuangan. Menyebut mereka "transisi." Standarisasi mereka untuk

berbagai penyedia, dari rumah sakit ke fasilitas rehabilitasi untuk fasilitas
perawatan terampil untuk pulang dan kembali.
Boutwell mengatakan bahwa "mengambil pendekatan orang-berpusat ini
menggeser konsep dari debit, yang merupakan momen dalam waktu dan Anda
selesai dengan itu, untuk transisi-akuntabilitas bersama. Kita perlu memastikan
penyedia penerima memahami siapa pasien ini adalah, dengan pemandangan 360
derajat.
Jencks menambahkan bahwa "pengirim dan penerima, misalnya rumah sakit
perencana debit dan staf fasilitas perawatan terampil dan kesehatan di rumah"
bertemu cukup sering sehingga mereka dapat belajar tentang realitas transisi
mereka memulai dan menerima.
Obat
3.Provide di Discharge
Kirim rumah pasien dengan 30-hari pasokan obat-obatan, dibungkus dalam
kemasan yang jelas menjelaskan waktu, dosis, frekuensi, dll Beberapa pusat
kesehatan dengan pasien Medicaid dapat mencoba strategi ini, yang sulit untuk
rumah sakit untuk dilakukan dengan pasien Medicare karena perbedaan antara
Bagian A dan pembayaran Part B. Namun, untuk beberapa populasi berisiko tinggi,
seperti pasien dengan gagal jantung kongestif dan mereka yang telah diterima
kembali sebelum, mungkin layak untuk rumah sakit untuk menyerap biaya.
4. Membuat Rencana Tindak Lanjut Sebelum Discharge
Memiliki staf rumah sakit membuat janji tindak lanjut dengan dokter pasien dan
tidak melepaskan pasien sampai jadwal ini sudah diatur. Kunci adalah untuk
memastikan pasien memiliki transportasi ke kantor dokter, memahami pentingnya
memenuhi kerangka waktu, dan menindaklanjuti dengan panggilan telepon ke
dokter untuk memastikan bahwa kunjungan selesai.
5. Telehealth
Kami tidak dapat menemukan siapa saja yang menggunakan monitor video untuk
berkomunikasi setiap hari dengan menggunakan software seperti Skype, misalnya,
tetapi beberapa ahli diterima kembali mengatakan itu pendekatan yang menarik
untuk menjaga serta komunikasi verbal visual yang dengan pasien, khususnya
mereka yang berisiko tinggi untuk diterima kembali.
Pada skala yang lebih praktis, Home Partners Healthcare di Dallas menggunakan
pelatih kesehatan, dokter perawatan intensif, dan teknologi nirkabel untuk
merekam tanda-tanda vital setiap hari selama sekitar 2100 dibuang Medicare feefor-service penerima manfaat bagi antara 60 sampai 120 hari. Sejauh ini, mereka
telah melakukan ini selama sekitar 7.000 pasien digandakan dalam dua tahun
terakhir, untuk beberapa ratus rumah sakit di Dallas dan Louisiana, kata CEO HHP
ini, Wayne Bazzle.
Populasi target untuk pemantauan intens termasuk orang-orang dengan empat atau
lima komorbiditas dan yang memiliki diagnosis utama gagal jantung kongestif,
penyakit paru obstruktif kronik, diabetes, Alzheimer dan hipertensi.
Bazzle mengatakan bahwa upaya melibatkan panggilan telepon dari antara lima
dan 15 menit, dan cukup sering dengan tim yang sama "sehingga kami memiliki
kepercayaan mereka. Kami dapat membantu mereka tetap keluar dari rumah sakit
jika mereka lebih jujur dengan kami tentang apa yang terjadi , dan jika kita melihat
beberapa kerusakan, kita dapat membantu mereka mengatasi. Biasanya itu

masalah manajemen obat, atau mereka telah menjadi sedikit terlalu santai dengan
diet mereka.
https://www.healthcatalyst.com/healthcare-data-warehouse-hospital-readmissionsreduction
Hospital Readmissions Reduction Program: Keys to Success
, Vice President of Financial Engagement

Avoidable readmissions are a major financial problem for the nations healthcare system. In fact,
a single preventable return trip to the hospital more than doubles the cost of care for Medicare
patients. For example, Medicare pays, on average, $15,000 for an episode of care without a
readmission incident, but that number increases to $33,000 for a single readmission.
CMS first tried to tackle this problem back in 2009 by publicly reporting hospital readmission
rates on the Hospital Compare website. CMS claimed the public reporting of readmission metrics
would increase the transparency of hospital care, help consumers choose a care venue, and
provide a benchmark for hospitals in their quality improvement efforts.
Then CMS pulled out the big guns in 2012 by launching the Hospital Readmissions Reduction
Program (HRRP). Under HRRP, hospitals with high rates of readmissions for acute myocardial
infarction, heart failure, and pneumonia will see a one percent reduction in Medicare payment in
2013. Penalties will continue to incrementally increase over the next two yearstwo percent in
2014 and three percent in 2015. In 2015, the rate caps at three percent. The penalty applies to the
Medicare base rate.
Results of the Hospital Readmissions Reduction Program

For fiscal year 2013, Medicare levied the maximum penalty of one percent against 276 hospitals.
The average penalty, though, amounted to a .4 percent reduction in paymentor as a Medicare
Payment Advisory Commission (MedPAC) report estimates, about $125,000 per hospital.
As much as Id like to have an extra 125K in my wallet, its a drop in a bucket compared to
overall Medicare expenditures and the massive budgets of many of the health systems affected.
Absorbing these losses may not be a challenge for some hospitals.
At the same time, there is no question that CMSs readmissions program is going to accelerate.
In fact, CMS already plans to add more conditions to the program. Beginning in 2015, CMS will
expand the number of conditions to include chronic obstructive pulmonary disease (COPD) and
elective hip and knee replacements.

Even if hospitals can absorb the financial hit, they still need to track reporting metricsand
doing so will become increasingly complex.
Keeping Pace with Rising Tracking and Reporting Demands

Hospitals face numerous tracking and reporting demands from many entities, not just CMS. State
and federal regulations, licensing, private payer initiatives, and accreditation bodies all require
reports. Plus, consumers expect more transparency in the Digital Age. In turn, the new standard
of transparency provides additional reported metrics consumers use to make care decisions.
Payers and providers also rely on these reports to make business decisions.
Enterprise Data Warehouse

So what can a hospital do to keep up with it all? The answer is straightforward: adopt a
healthcare enterprise data warehouse (EDW) to meet the many reporting demands. Here are a
few examples of how an EDW helps solve the reporting burden:

Users can access integrated views of financial, clinical, and operational data
from throughout the enterprise.

Data collection and the analysis process become automated. Manual data
collection and tracking simply wont work in the future. These manual
processes are time- and resource- consuming and often result in inaccurate
or missing information.

Users can collect data from across the enterprise, integrating clinical,
financial, and operational data from inpatient and outpatient settings.

Reports are generated automatically, ensuring that the right data gets to the
right audience at the right time.

The benefits of an EDW dont end with reporting, though. An EDW delivers the business
intelligence tools a hospital needs to drive real cost and quality improvement initiatives. In
specific, an EDW enables health systems to:

Establish a baseline for all quality measures

Perform analytics to pinpoint opportunities for improving quality

Track the success of improvement interventions

Measure and sustain results over the long term

Analytics Applications

Once an EDW is in place, the organization has a foundation in place to adopt analytics
applications. Analytics are powerful tools that enable non-technical users to make sense of the
data and discover the best areas to make changes.
From foundational to discovery to advanced applications, there are different types of analytics
that provide varying depths of solutions. For example, foundational applications enable users to
automate the distribution of reports. They also provide dashboards, reports, and basic registries
across clinical and operational areas. Discovery applications go one step further by allowing
users to discover patterns and trends within the data that inform prioritization, inspire new
hypotheses, and define populations for management. Advanced applications provide deep
insights into evidence-based metrics. Workers then use this knowledge to drive cost and quality
improvement initiatives.
Even though there are many types of analytics solutions, they all share one important trait: nontechnical users gain an easy and intuitive way to ask complex questions of the data stored within
the EDW. Nobody needs to be a programmer or wait weeks or months in a queue for a custombuilt report.
Reducing Heart Failure Readmissions with an EDW and Analytics

From improved reports to driving improvements, the benefits of an EDW and analytics
applications are many. In fact, one large health system reduced heart failure readmissions by
using an EDW as a foundation for their advanced analytics applications.
First, the system implemented an EDW to quickly pool financial, operational, patient
satisfaction, and clinical data from the inpatient EHR and other major information systems. With
the technology infrastructure in place, the team in charge of the initiative crafted a specific,
measurable objective: to achieve and sustain a 30 percent reduction in the 30-day and a 15
percent reduction in the 90-day all-cause readmission rates for patients with heart failure by
October 2014 and sustained reduction in readmission rates through 2016.
Next, the team outlined specific interventions based on best practices that would move them
toward their goal. Interventions included:

Medication reconciliation. Within 48 hours of discharge, a physician

reviews a list of the patients medications with explicit instructions to the
patient about how to properly take them.

Post-discharge appointments. Before being discharged, nurses schedule

patients for follow-up care. When possible, patients at high risk for
readmission are scheduled to be seen within seven days of discharge.

Post-discharge phone calls. Within a specified time frame following

discharge, a member from the care team calls patients to assess their
condition and answer any questions.

An integrated dashboard was created in the healthcare EDW platform for each of the three
interventions. This enabled clinicians and administrators to track where the interventions were
and were not being applied. They could also track the impact the changes were having on
readmissions. Even more, the EDW and analytics applications allowed the team to assess the
impact of the interventions on costs and patient satisfaction.
The results have been impressive. Just six months after implementing the EDW, the health
system achieved:

A 21 percent seasonally adjusted reduction in 30-day HF readmissions

A 14 percent seasonally adjusted reduction in 90-day HF readmissions

A 63 percent increase in post-discharge medication reconciliation

They are well on their way to meetingand even exceedingtheir objective.

Does your hospital have a readmissions reduction program in place? Which solutions do you
have in place to help you track, drive, and sustain improvement initiatives?
How to Survive CMSs Most Recent 3% Hospital Readmissions Penalties Increase

Bobbi Brown
, Vice President of Financial Engagement

Posted in Regulatory Measures.

On October 1, 2014, the final payment and policy changes for hospital readmissions from CMS
went live. Just weeks into the change, thousands of hospitals across the United States are feeling
the financial pressures of the increased penalty.
While the penalty itself isnt a surprise, the increase in the maximum penalty up from two
percent to three percent means there has already been a decrease in payments from Medicare
for health systems with high readmissions rates. CMS applies the penalty to the base operating
DRG (diagnosis-related group) payment.
Health systems also now need to track two more 30-day readmission rates: chronic obstructive
pulmonary disease (COPD) and total hip arthroplasty/total knee arthroplasty (THA/TKA). These

rates are in addition to the following patient cohorts hospitals already track: heart attack (AMI),
heart failure, and pneumonia.
CMSs reduced payments start in October of 2014 for Fiscal Year (FY) 2015. For health systems
already struggling with other improvement initiatives, such as Meaningful Use and value-based
purchasing, this additional financial burden presents a call to action for health systems to work
closely with clinicians to improve their measures.
Why the Need to Levy Hospital Readmissions Penalties?

CMS policy makers started the Hospital Readmission Reduction Program back in 2012 with the
goal to improve healthcare. They believed that health systems with excess readmissions for
patients with high-risk conditions, such as heart failure or pneumonia, were providing low
quality patient care and if those health systems reduced their readmissions numbers, the decrease
would signify improved patient care.
During the first year of the program (FY 2013), the conditions CMS focused on improving were
pneumonia, heart failure, and acute myocardial infarction. The penalty for excess readmissions
that year was one percent. In the second year of the program (FY 2014), conditions remained the
same, but CMS increased withheld reimbursements to 2 percent of regular reimbursements.
Fiscal year 2015 is now in full swing, and the maximum penalty is three percent. This increase
impacts 75.8 percent of hospitals across the United States with decreased payments. CMSs
calculations for the increased three percent penalty are based on a three-year period of discharges
from July 1, 2010 to June 30, 2013. Because of a previous miscalculation of payment adjustment
factors, the U.S. government republished an updated ruling on October 3, 2014.
The results of the program are positive to date. In fact, CMS has estimated that hospital
readmissions declined by a total of 150,000 from January 2012 to December 2013, a significant
improvement.

Zero-to-3% penalty breakout relative to the number of hospitals affected by the 2015
readmissions penalty increase.
Public Concerns about Risk Adjustments for Socioeconomic Status

There have been many public comments concerning a risk adjustment for SES (socioeconomic
status). Yet despite the concerns, CMS isnt adding any risk adjustments because it already
monitors the impact of SES on hospital results. Whats more, CMSs research shows that
hospitals caring for large proportions of patients with low SES are actually capable of
performing well on the measures.
Future CMS Readmission Penalty Measures and What They Mean

CMS does not have any plans to expand the conditions in 2016. However, it does have data that
suggests the reduction of the readmit rate following coronary artery bypass graft surgery
(CABG) is an important target for future quality improvement initiatives. As a result, CMS will
add CABG to monitored conditions in 2017. This measure aligns with the strategy to promote
successful transitions of care from the hospital setting to the outpatient setting. The measure also
meets the criteria of high cost, high volume. The data for 2017 will be based on the period of
July 1, 2012 to June 30, 2015.
This means a hospitals current activities and interventions for CABG and the other five
conditions will be reflected in the 2017 penalty file. The 2009 median rate for Medicare CABG
30-day, risk standardized readmission is 17.2 percent, and the range goes from 13.9 percent to
22.1 percent.

Strategies to Reduce Readmission Rates

If you search the web, there are many articles on strategies to reduce the readmission rates,
especially for the heart failure population. But in my experience, there is generally not one single
strategy that produces results. Instead, hospitals need to implement several strategies and monitor
for success.
As reported by the authors of an article from the July 2013 issue of Circulation: Cardiovascular
Quality and Outcomes, Hospital Strategies Associated with 30-Day Readmission Rates for
Patients with Heart Failure, there are six strategies that are associated with significantly reduced
readmissions rates. The authors surveyed data from 599 hospitals to determine the hospitals
methods for reducing readmission rates. The six strategies the hospitals employed included:

Partnering with community physicians and physician groups

Partnering with local hospitals

Having nurses responsible for medication reconciliation

Arranging for follow-up visits before discharge

Having a process in place to send all discharge summaries to primary care

physician

Assigning staff to follow-up on test results after discharge

How One Large Health System Achieved Reduced Readmissions

Achieving reduced readmissions is possible when the right systems to capture data are in place.
For example, one large health system used four key interventions to lower their 30-day heart
failure readmission rates by 29 percent. They were able to achieve these results by using the
following evidence-based interventions:
1. Medication reconciliation: Physicians reviewed the patients medications
and gave them explicit instructions on how to properly take the medications.
2. Post-discharge appointments: Patients were scheduled for follow-up care
before being discharged. Patients with a high risk for readmission received
appointments to return within seven days of discharge; others were
scheduled to return within 14 days.
3. Post-discharge phone calls: Within a specified time frame
following discharge based on the patients risk for readmission
a member from a coordinated care team called each patient to assess
their condition and to see if they have any questions or are having any
problems with their medications.

4. Teach back interventions: Patients needed to show their comprehension of

the information they were being given by being asked to explain it.

Eight months after implementing the four evidence-based interventions, the health system
experienced a:

29 percent reduction in 30-day HF readmissions

14 percent reduction in 90-day HF readmissions

120 percent increase in follow-up appointments

78 percent increase in pharmacist medication reconciliation

87 percent increase in follow-up phone calls

84 percent increase in teach-back interventions

3 Ways to Achieve Significant Heart Failure Readmission Rates

In order for interventions to be successful, however, strategies and tools need to be in place to
collect and analyze the pertinent data that will help clinicians find the answers theyre looking
for. For the health system in the example above, three critical solutions were implemented. The
solutions were as follows:
1. A data warehouse to provide a single source of truth

The health system knew that data needed to be at the core of their improvement efforts, but
merely collecting the data wouldnt be enough providers also needed to be able to access the
data. If they had gone the route of deploying a traditional data warehouse, they could end up
spending years before it was fully deployed.
Instead, the health system chose an alternative solution a late-binding data warehouse. The
late-binding data warehouse was able to overcome the limitations of a traditional data warehouse
because of its agile platform. (An agile platform supports the fast-changing rules and use cases of
healthcare data, and also delivers value in a matter of weeks.) In fact, the health system was able
to fully deploy their data warehouse within a few months versus years because of the latebinding architecture.
2. Engaged multidisciplinary team to lead improvement efforts

To be successful, the health system knew they needed to engage physicians and build a culture of
trust through transparency and collaboration and align on the vision of improved
outcomes. They could choose to go fast, without clinician engagement. But they knew they could

go further with the support of clinicians. So they organized a multidisciplinary team that included
physicians, nurses, informaticists, quality, analytics, IT, operations, and finance.
3. Analytics to drill down into each episode of care

After the health system implemented a sophisticated analytics platform, clinicians had the ability
to drill down into each episode of care and assess the timeliness of interventions and to ensure
the interventions were taking place. For example, clinicians were able to determine if patients
came back for their follow up appointments and how many days after the original appointment.
Tracking data like this manually was time consuming and expensive. But with an analytics
solution, clinicians had access to near-real-time data that identified variations in care all the
way down to each individual provider. In addition, clinicians didnt need to wait for someone in
IT to complete their request, increasing time to value. This was because the analytics platform
included an easy-to-use visualization tool that didnt require complicated queries for clinicians to
get the answers they needed.
Readmission Penalties Are Here to Stay

The U.S. healthcare system is in the midst of a massive transformation to improve patient care
and reduce costs. Its a daunting task for healthcare organizations, especially when additional
reporting measures are required as CMS rolls out regular updates to the Hospital Readmission
Reduction Program. The challenges become even greater for health systems facing increased
penalties because they havent yet found ways to reduce their readmissions rates. This leaves
them susceptible to higher penalties and greater public scrutiny.
While many health systems believe a traditional EDW will help them achieve the improvements
necessary to comply with CMS mandates, the technology isnt adequate. The best data
architecture should be late-binding. But in addition to the right architecture, teams need to want
to interact with the data and see the value in using it for improvement initiatives. An analytics
system that provides near-real-time analytics gives clinicians and analysts the data theyve been
asking for, and enables them to not just ask but to also answer questions about how to gain
significant improvements in readmissions rates.
How did your hospital fare when the readmissions penalties increased to three percent? If youre
facing a financial burden, do you have any questions about how a Late-Binding Data
Warehouse can help you avoid future penalties?

Powerpoint Slides

Would you like to use or share these concepts? Download this presentation highlighting the key
main points.

Click Here to Download the Slides

CMS Reporting Requirements 4 Changes Hospitals Need to Know for 2014

Bobbi Brown
, Vice President of Financial Engagement

Michael Barton
, Engagement Executive, VP

Posted in Regulatory Measures.

If hospitals want to survive the new healthcare environment, they cant simply brace themselves
for the Centers for Medicare & Medicaid Services (CMS) new reporting measures they must
proactively improve their quality scores. Why? Because significant changes to the existing rules
will take place this summer and if health systems arent prepared to meet the new performance
standards set by CMS, they will experience severe financial set-backs or even go out of
business.
For example, a rule proposed by CMS on April 30, 2014, seeks to update Medicare payment
policies for inpatient care in fiscal year 2015 (October 2014 September 2015). This action is a
continuation of the governments effort to improve the quality of healthcare while slowing the
long-term cost growth.
Each new version of the CMS reporting measures clearly demonstrates CMSs long-term
strategy to cut reimbursements for facilities that dont meet quality benchmarks. Its critical that
health systems not only understand the upcoming changes to CMS hospital quality-improvement
programs but proactively prepare for them. Here are the four proposed CMS changes for 2014.
1. Hospital Value-Based Purchasing Program

Established by the Affordable Care Act, the hospital value-based purchasing (VBP) program
adjusts payments (in the form of penalties and bonuses) to hospitals based on the quality of care
they provide. Hospitals are rewarded for best clinical practices and how well they enhance the
patient experience of care.

For fiscal year 2015, the portion of Medicare payments available to fund the value-based
incentive payments will increase to 1.5 percent of the base operating diagnosis-related group
(DRG) payment. In other words, all hospitals will have payments decreased by 1.5 percent with
the potential to earn a bonus, rewarding those hospitals that perform well. According to CMS
estimates, the total amount available for value-based incentive payments in FY 2015 will be
approximately $1.4 billion.
There will also be two new outcomes measures for 2015: AHRQ Patient Safety Indicators (PSI)
composite and central line-associated blood steam infection (CLABSI). An efficiency measure of
Medicare cost per beneficiary will similarly be added. Then the total performance score for each
hospital will be calculated by using the following weights (percentages) to determine the
performance for the top four domains:

Clinical process: 20 percent

Patient experience: 30 percent

Outcomes: 30 percent

Efficiency: 20 percent

2. Hospital Readmissions Reduction Program

The Hospital Readmissions Reduction Program is the governments attempt to reduce hospital
readmissions for patients whove recently been admitted for certain conditions or procedures.
Currently, hospitals must measure and report on readmissions for the following conditions: heart
failure (HF), acute myocardial infarction (AMI), and pneumonia (PN). For FY 2015, however,
CMS proposed the addition of two new conditions to their readmissions reporting meaures:
chronic obstructive pulmonary disease (COPD) and total hip arthroplasty/total knee arthroplasty
(THA/TKA). To better determine which THA/TKA patients underwent nonelective surgeries,
CMS issued a revised definition for THA and is proposing to exclude hip fractures coded as
either a principal or secondary diagnosis.
For 2015, the Hospital Readmissions Reduction Program is proposing a maximum penalty for
readmissions of 3 percent. Its currently set at 2 percent. CMS estimates from January 2012 to
December 2013 already show significant improvement as a result of the program: hospital
Medicare readmissions declined by a total of 150,000.

Health Catalysts Readmission Explorer tool displays easy-to-understand trends, comparisons, and detailed,
patient-level data through an uncluttered user interface.

3. Hospital Inpatient Quality Reporting

The Hospital Inpatient Quality Reporting (IQR) Program, established in 2003, requires hospitals
to submit quality reporting measurements for health conditions specific to the Medicare
population. With the latest proposed rule, however, CMS is seeking to revise measures for this
program. In specific, for 2015 and 2016, CMS proposes to align the reporting and submission
timelines for clinical quality measures for the Medicare Electronic Health Record (EHR)
Incentive Program with the reporting and submission timelines of the Hospital IQR Program. If
hospitals dont submit these reports, theyll risk an increased payment reduction of 2 percent (up
from 0.4 percent). The proposed changes represent CMSs effort to align the different reporting
mechanisms.
4. Hospital-Acquired Condition (HAC) Reduction Program

The Hospital-Acquired Condition (HAC) Reduction Program is the newest CMS quality
program. This program penalizes hospitals for high HAC rates. CMS wants to encourage
hospitals to improve their quality processes as a way to prevent patients from contracting costly,
hospital-acquired conditions when theyre being treated for a primary concern. The HAC
Reduction Program penalty begins in October 2014.
Under the HAC Reduction Program, hospitals with the highest rate of HACs specifically,
those in the top 25 percent will receive a 1 percent reduction in Medicare inpatient payments.
CMS estimates 753 hospitals will be subject to the one percent reduction and overall payments
will decrease by $330 million or 0.3 percent.
Hospitals are not in the dark as to where they stand in terms of HAC rates. CMS has released a
file with the scores for each facility. The preliminary analysis is available on the CMS web site.
CMS has categorized HAC measurements in two domains:

Domain 1 includes the AHRQ PSI-90 composite measure, which consists of

eight component indicators:
o

PSI 3 Pressure ulcer rate

PSI 6 Latrogenic pneumothorax rate

PSI 7 Central venous catheter-related blood stream infection rate

PSI 8 Postoperative hip fracture rate

PSI 12 Postoperative pulmonary embolism (PE) or deep vein

thrombosis rate (DVT)

PSI 13 Postoperative sepsis rate

PSI 14 Wound dehiscence rate

PSI 15 Accidental puncture and laceration rate

Domain 2 consists of the Center for Disease Control and Preventions NHSN
(National Healthcare Safety Network) CAUTI and CLABSI measures. CAUTI is
catheter-associated urinary tract infection and CLABSI is central-line
associated blood stream infection.

For Domain 1 in FY 2015, hospitals were measured on their performance from July 1, 2011 to
June 30, 2012. The time period for Domain 2 was during the calendar year of 2012 to 2013. To
calculate the scores, CMS weights Domain 1 at 35 percent and Domain 2 at 65 percent.
To read about four ways to reduce your risk of receiving any HAC penalties, read this article.
Needed: A Systematic Approach to Improve Quality and Cost

Changes from the government will be ongoing and CMS will continue to relentlessly increase
their cost and penalty measures through various improvement programs. And while it may seem
like a 1 percent reduction isnt a huge hit on a hospitals margin, when you look at the individual
programs and add up the reductions, you can see theres a tremendous financial disadvantage to
not improving quality. In fact, these reductions can exceed the average margin for most hospital
systems and cause significant financial hardship. The traditional method of just squeezing out
cost wont be enough for hospitals to survive; they will need a different method a systematic
and ongoing approach to improve quality and cost to keep up with these yearly mandates.
The key to successfully improving quality performance and meeting all of these measures is by
using the right information and the right processes at a system level to drive improvement. An
analytics system that can track performance and then measure any improvements made based on
targeted quality interventions is essential. Such a reporting system, combined with getting
clinical teams in place to solve quality issues, can change a hospitals culture. In the big picture
of healthcare reform, the government is using its purchasing power as a lever to change our
culture of care delivery. Hospitals that dont successfully and systematically change wont
survive.
Have you prepared for CMSs new reporting measures? If so, what have you done? Do you have
an analytics system in place to be able to measure your improvements? What are your greatest
concerns about CMSs reporting measures?

Powerpoint Slides

Would you like to use or share these concepts? Download this CMS Reporting Changes
presentation highlighting the key main points.
Click Here to Download the Slides

CMS Reporting Requirements 4 Changes Hospitals Need to Know for 2014

Michael Barton
, Engagement Executive, VP

Posted in Regulatory Measures.

If hospitals want to survive the new healthcare environment, they cant simply brace themselves
for the Centers for Medicare & Medicaid Services (CMS) new reporting measures they must
proactively improve their quality scores. Why? Because significant changes to the existing rules
will take place this summer and if health systems arent prepared to meet the new performance
standards set by CMS, they will experience severe financial set-backs or even go out of
business.
For example, a rule proposed by CMS on April 30, 2014, seeks to update Medicare payment
policies for inpatient care in fiscal year 2015 (October 2014 September 2015). This action is a
continuation of the governments effort to improve the quality of healthcare while slowing the
long-term cost growth.
Each new version of the CMS reporting measures clearly demonstrates CMSs long-term
strategy to cut reimbursements for facilities that dont meet quality benchmarks. Its critical that
health systems not only understand the upcoming changes to CMS hospital quality-improvement
programs but proactively prepare for them. Here are the four proposed CMS changes for 2014.
1. Hospital Value-Based Purchasing Program

Established by the Affordable Care Act, the hospital value-based purchasing (VBP) program
adjusts payments (in the form of penalties and bonuses) to hospitals based on the quality of care
they provide. Hospitals are rewarded for best clinical practices and how well they enhance the
patient experience of care.
For fiscal year 2015, the portion of Medicare payments available to fund the value-based
incentive payments will increase to 1.5 percent of the base operating diagnosis-related group

(DRG) payment. In other words, all hospitals will have payments decreased by 1.5 percent with
the potential to earn a bonus, rewarding those hospitals that perform well. According to CMS
estimates, the total amount available for value-based incentive payments in FY 2015 will be
approximately $1.4 billion.
There will also be two new outcomes measures for 2015: AHRQ Patient Safety Indicators (PSI)
composite and central line-associated blood steam infection (CLABSI). An efficiency measure of
Medicare cost per beneficiary will similarly be added. Then the total performance score for each
hospital will be calculated by using the following weights (percentages) to determine the
performance for the top four domains:

Clinical process: 20 percent

Patient experience: 30 percent

Outcomes: 30 percent

Efficiency: 20 percent

2. Hospital Readmissions Reduction Program

The Hospital Readmissions Reduction Program is the governments attempt to reduce hospital
readmissions for patients whove recently been admitted for certain conditions or procedures.
Currently, hospitals must measure and report on readmissions for the following conditions: heart
failure (HF), acute myocardial infarction (AMI), and pneumonia (PN). For FY 2015, however,
CMS proposed the addition of two new conditions to their readmissions reporting meaures:
chronic obstructive pulmonary disease (COPD) and total hip arthroplasty/total knee arthroplasty
(THA/TKA). To better determine which THA/TKA patients underwent nonelective surgeries,
CMS issued a revised definition for THA and is proposing to exclude hip fractures coded as
either a principal or secondary diagnosis.
For 2015, the Hospital Readmissions Reduction Program is proposing a maximum penalty for
readmissions of 3 percent. Its currently set at 2 percent. CMS estimates from January 2012 to
December 2013 already show significant improvement as a result of the program: hospital
Medicare readmissions declined by a total of 150,000.

Health Catalysts Readmission Explorer tool displays easy-to-understand trends, comparisons, and detailed,
patient-level data through an uncluttered user interface.

3. Hospital Inpatient Quality Reporting

The Hospital Inpatient Quality Reporting (IQR) Program, established in 2003, requires hospitals
to submit quality reporting measurements for health conditions specific to the Medicare
population. With the latest proposed rule, however, CMS is seeking to revise measures for this
program. In specific, for 2015 and 2016, CMS proposes to align the reporting and submission
timelines for clinical quality measures for the Medicare Electronic Health Record (EHR)
Incentive Program with the reporting and submission timelines of the Hospital IQR Program. If
hospitals dont submit these reports, theyll risk an increased payment reduction of 2 percent (up
from 0.4 percent). The proposed changes represent CMSs effort to align the different reporting
mechanisms.
4. Hospital-Acquired Condition (HAC) Reduction Program

The Hospital-Acquired Condition (HAC) Reduction Program is the newest CMS quality
program. This program penalizes hospitals for high HAC rates. CMS wants to encourage
hospitals to improve their quality processes as a way to prevent patients from contracting costly,

hospital-acquired conditions when theyre being treated for a primary concern. The HAC
Reduction Program penalty begins in October 2014.
Under the HAC Reduction Program, hospitals with the highest rate of HACs specifically,
those in the top 25 percent will receive a 1 percent reduction in Medicare inpatient payments.
CMS estimates 753 hospitals will be subject to the one percent reduction and overall payments
will decrease by $330 million or 0.3 percent.
Hospitals are not in the dark as to where they stand in terms of HAC rates. CMS has released a
file with the scores for each facility. The preliminary analysis is available on the CMS web site.
CMS has categorized HAC measurements in two domains:

Domain 1 includes the AHRQ PSI-90 composite measure, which consists of

eight component indicators:
o

PSI 3 Pressure ulcer rate

PSI 6 Latrogenic pneumothorax rate

PSI 7 Central venous catheter-related blood stream infection rate

PSI 8 Postoperative hip fracture rate

PSI 12 Postoperative pulmonary embolism (PE) or deep vein

thrombosis rate (DVT)

PSI 13 Postoperative sepsis rate

PSI 14 Wound dehiscence rate

PSI 15 Accidental puncture and laceration rate

Domain 2 consists of the Center for Disease Control and Preventions NHSN
(National Healthcare Safety Network) CAUTI and CLABSI measures. CAUTI is
catheter-associated urinary tract infection and CLABSI is central-line
associated blood stream infection.

For Domain 1 in FY 2015, hospitals were measured on their performance from July 1, 2011 to
June 30, 2012. The time period for Domain 2 was during the calendar year of 2012 to 2013. To
calculate the scores, CMS weights Domain 1 at 35 percent and Domain 2 at 65 percent.
To read about four ways to reduce your risk of receiving any HAC penalties, read this article.
Needed: A Systematic Approach to Improve Quality and Cost

Changes from the government will be ongoing and CMS will continue to relentlessly increase
their cost and penalty measures through various improvement programs. And while it may seem
like a 1 percent reduction isnt a huge hit on a hospitals margin, when you look at the individual
programs and add up the reductions, you can see theres a tremendous financial disadvantage to
not improving quality. In fact, these reductions can exceed the average margin for most hospital
systems and cause significant financial hardship. The traditional method of just squeezing out
cost wont be enough for hospitals to survive; they will need a different method a systematic
and ongoing approach to improve quality and cost to keep up with these yearly mandates.
The key to successfully improving quality performance and meeting all of these measures is by
using the right information and the right processes at a system level to drive improvement. An
analytics system that can track performance and then measure any improvements made based on
targeted quality interventions is essential. Such a reporting system, combined with getting
clinical teams in place to solve quality issues, can change a hospitals culture. In the big picture
of healthcare reform, the government is using its purchasing power as a lever to change our
culture of care delivery. Hospitals that dont successfully and systematically change wont
survive.
Have you prepared for CMSs new reporting measures? If so, what have you done? Do you have
an analytics system in place to be able to measure your improvements? What are your greatest
concerns about CMSs reporting measures?

Powerpoint Slides

Would you like to use or share these concepts? Download this CMS Reporting Changes
presentation highlighting the key main points.
Click Here to Download the Slides

How to Reduce Heart Failure Readmission Rates: One Hospitals Story

Health Catalyst

Posted in Customer Success Stories.

Download

HEART FAILURE READMISSION RATES

Heart failure (HF) affects an estimated 5.3 million people, mostly the elderly, and is the
underlying cause for 12 to 15 million office visits and 6.5 million hospital days each year.1
Because of inadequate treatment, discharge guidance, and follow-up, an estimated 24 percent of
patients who are discharged are readmitted to the hospital within 30 days.2
Like most healthcare systems facing the transition to value-based reimbursement, this large
healthcare system found it necessary to assess its overall quality improvement program.
Leadership realized it needed to be able to analyze and better manage specific patient
populations, especially patients with chronic conditions and those at greatest risk for
readmission.
PRIORITIZING QUALITY IMPROVEMENT INITIATIVES

The Health Catalyst Key Process Analysis (KPA) Application identified heart failure as one of
their highest cost care processes. The decision to begin its cardiac services improvement
initiative by focusing on heart failure was a logical choice based on the KPA results and The
Centers for Medicare & Medicaid Services (CMS) readmissions reduction program (Figure 1
sample visualization).
In 2014, CMS withheld up to 2 percent of regular reimbursements for hospitals that have too
many 30-day readmissions for HF. The proposed rule for 2015 would increase the maximum
penalty under the program to 3 percent. The healthcare system was determined to improve HF
care for its patients and avoid CMS penalties.

Figure 1: Sample Key Process Analysis visualization

USING ANALYTICS TO HELP REDUCE HEART FAILURE READMISSION RATES

The healthcare system initially deployed a traditional enterprise data warehouse (EDW) to help
them in their quality improvement initiatives. But it found that this type of EDW took years to
fully deploy and failed to enable the near-real-time analysis of clinical data required for success
under value-based care. The healthcare system then turned to Health Catalysts Late-Binding
Data Warehouse, an agile platform that not only supports the fast- changing rules and use
cases of healthcare data, but delivers value in a matter of weeks. The healthcare EDW was fully
deployed within just 12 weeks.
The new healthcare EDW quickly pooled clinical, patient satisfaction, operational and other
relevant data. To be successful, the Associate Chief Medical Offi and the Vice President of
Business Intelligence knew they needed to engage physicians and build a culture of trust
through transparency and collaboration and align on the vision of improved outcomes. They
could choose to go fast, without clinician engagement. But they knew they could go further with
the support of clinicians.

They organized a multidisciplinary team that included physicians, nurses, informaticists, quality,
analytics, IT, operations and finance. The multidisciplinary team analyzed the pooled data using
the Health Catalyst Key Process Analysis (KPA) Application. Armed with that insight and its
new analytics capabilities, the healthcare system applied for and received a grant from a major
foundation to support a transitional care program for heart failure patients. The center borrowed
the grants objectives to defi its long-term AIM statement:
To achieve and sustain a 30 percent reduction in the 30- day and a 15 percent reduction in the
90-day all-cause readmission rates for patients with HF by [date] and sustained reduction in
readmission rates through [date].
EVIDENCE-BASED PRACTICES HELP ACHIEVE GOALS

To achieve the goals set forth in its AIM statement, the multidisciplinary team worked together to
define the patient cohort and to define four evidence-based, HF-specific best practice
interventions, which were rolled out over a few months:

Medication reconciliation Physicians review a list of the patients

medications with explicit instructions on how to properly take them.

Post-discharge appointments Before being discharged, patients are

scheduled for follow-up care. When possible, patients at high risk for
readmission are scheduled to be seen within seven days of discharge; others
are scheduled to be seen within 14 days.

Post-discharge phone calls Within a specified time frame following

discharge (again based on the patients level of risk for readmission), a
member from the coordinated care team calls patients to assess their
condition and see if they have any questions or are having any problems with
their medications.

Teach back interventions Patients are asked to explain the information

that is presented to them to confirm the patient comprehends the
information.

An integrated dashboard (Figure 2 sample visualization) was created in the healthcare EDW
platform for each of the four interventions so clinicians and administrators could easily visualize
the impact the changes were having on readmissions. Additionally, the healthcare EDW and the
Population Health Heart Failure Advanced Application allowed the multidisciplinary team to
assess the interventions impact on costs and patient satisfaction.

Figure 2: Sample Population Health Heart Failure Advanced Application dashboard

To ensure that the focus on reducing readmissions did not have an unintentional effect in other
areas, such as an increase in emergency department (ED) visits or a decrease in patient
satisfaction, the center built in balance measures including the tracking of ED encounters,
observation stays, length of stay and patient satisfaction rates.
Eight months after implementing the four evidence-based interventions, the medical center had
experienced a:

29 percent reduction in 30-day HF readmissions

14 percent reduction in 90-day HF readmissions

120 percent increase in follow-up appointments

Figure 3: Sample Population Health Heart Failure Advanced Application med rec
visualization

78 percent increase in medication reconciliation (Figure 3 sample

visualization)

87 percent increase in follow-up phone calls

84 percent increase in teach-back interventions

Population Health Heart Failure Advanced Application also includes tabs for Hospital
Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey results, length of
stay (LOS) and cost analysis, and the ability to drill to the individual patient level.
LEVERAGING THEIR SUCCESS

As a result of these successes, the healthcare system is deploying the healthcare EDW, Health
Catalyst Population Health Advanced Application, evidence-based practices and its executive
performance improvement governance structure and multidisciplinary team approach to manage
the health of its employees and the patients it serves and to drive and sustain performance

improvement in a number of care processes including sepsis and infectious disease, and its
general medicine, surgical and oncology clinical programs.
REFERENCES
1. Institute for Healthcare Improvement. (2014). Congestive heart failure.
Retrieved from http://www.ihi.org/Topics/CHF/Pages/default.aspx.
2. Desai, A.S., & Stevenson, L.W. (2012). Rehospitalization for heart failure.
Circulation. 126, 501-506. Retrieved from
http://circ.ahajournals.org/content/126/4/501.full.

ABOUT HEALTH CATALYST

Health Catalyst is a mission-driven data warehousing and analytics company that helps
healthcare organizations of all sizes perform the clinical, financial, and operational reporting and
analysis needed for population health and accountable care. Our proven enterprise data
warehouse (EDW) and analytics platform helps improve quality,add efficiency and lower costs in
support of more than 30 million patients for organizations ranging from the largest US health
system to forward-thinking physician practices. Faster and more agile than data warehouses from
other industries, the Health Catalyst Late- Binding EDW has been heralded by KLAS as a
newer and more effective way to approach EDW.
For more information, visit, www.healthcatalyst.com,and follow us on Twitter, LinkedIn, and
Facebook.
Read More About This Topic:
Hospital Readmissions Reduction Program for Heart Failure: A Healthcare System Case
Study (case study)
Community Care Physicians Deliver Effective Population Health Management with
Clinical Analytics (case study)
Leveraging Healthcare Analytics to Reduce Heart Failure Readmission Rates
Kathleen Merkley, APRN, NP, VP, Engagement Executive
Defining Patient Populations Using Analytical Tools: Cohort Builder and Risk
Stratification
Kathleen Merkley, APRN, NP, VP, Engagement Executive
Heart Failure Readmissions (product demo) Watch a 7-minute demo of our heart failure
readmission analytics application
Download

4 Ways to Reduce Penalties Under the Hospital-Acquired Condition Reduction

Program

Bobbi Brown
, Vice President of Financial Engagement

Michael Barton
, Engagement Executive, VP

Posted in Regulatory Measures.

In our previous blog, we discussed Centers for Medicare and

Medicaid Services (CMS) Hospital-Acquired Condition (HAC) Reduction Program as well as

changes to the reporting measures you need to know about 2014. For this blog, however, well
focus on four tips you can use to decrease your risk of receiving penalties for high HAC rates.
While this new HAC Reducation Program may seem overwhelming, you can improve your HAC
scores by using the right analytics tools and following these four tips.
Four Tips to Decrease Penalties Under the HAC Reduction Program
1. Proactively evaluate, measure, and optimize critical care processes
and outcomes. As Don Berwick, MD, past president and CEO of the Institute
for Healthcare Improvement says: Every system is perfectly designed to
achieve exactly the results it gets. For example, due to high morbidity,
mortality, and cost, a hospital may choose to initially focus on CLABSI by
measuring the rate of CLABSI and then evaluating the process for central line
insertion. Ensure the process is optimized to deliver CLIP (central line
insertion practices) compliant line insertions each and every time by
measuring process and outcome metrics. Once the process is optimized,
monitor and maintain it while you tackle the next HAC prevention critical care
process.
2. Put the right coding processes in place to accurately capture your
patients POA (present on admission) data. These processes will help
hospitals avoid financial penalties that would otherwise occur if a pre-existing
condition was not coded as POA and counted in the HAC Reduction Program.
3. Apply what youve learned to create a culture of safety. Review cases
of HAC to discover the source of the problem. Then apply what youve
learned to improve your systems of care delivery. Yes, this is easier to say
rather than to do because it will take organizational focus and commitment to
create a culture of safety. Once the culture is in place, everyone on the team
will be committed to improving care delivery and keeping patients safe.
4. Consider active surveillance systems to identify HACs and potential
patient harm. Most hospital and health systems still use passive reporting
systems for HACs. But for over 20 years, the literature has demonstrated
that active surveillance systems detect more HACs (7-10 xs more) and
detect them earlier, allowing potential for prevention or harm mitigation.
Active surveillance systems increase an organizations ability to learn from
mistakes and intervene to deliver safer care and more rapid improvements
compared to passive reporting systems.

Do you have high rates of HACs at your hospital? What have you done to prevent them?
Have you tried any of these solutions to reduce your HACs? If so, what were your results?

Powerpoint Slides

Would you like to use or share these concepts? Download this presentation highlighting the key
main points.
Click Here to Download the Slides

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Jack Thompson

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translet
Program Pengurangan readmissions rumah sakit: Kunci Sukses
Bobbi Brown
Bobbi Brown
, Wakil Presiden Keterlibatan Keuangan
rumah sakit readmissions pengurangan readmissions programAvoidable
adalah masalah keuangan utama bagi sistem kesehatan bangsa. Bahkan,
satu perjalanan kembali dicegah ke rumah sakit lebih dari dua kali lipat biaya

perawatan bagi pasien Medicare. Misalnya, Medicare membayar, rata-rata $

15.000 untuk sebuah episode perawatan tanpa insiden diterima kembali,
namun jumlah itu meningkat menjadi $ 33.000 untuk diterima kembali
tunggal.
CMS pertama kali mencoba untuk mengatasi masalah ini kembali pada tahun
2009 dengan melaporkan publik tarif rumah sakit diterima kembali di Rumah
Sakit Bandingkan situs. CMS mengklaim pelaporan publik metrik diterima
kembali akan meningkatkan transparansi perawatan di rumah sakit,
membantu konsumen memilih tempat perawatan, dan memberikan patokan
untuk rumah sakit dalam upaya peningkatan kualitas mereka.
Kemudian CMS mengeluarkan senjata besar pada tahun 2012 dengan
meluncurkan Program Pengurangan readmissions Rumah Sakit (HRRP). Di
bawah HRRP, rumah sakit dengan tingginya tingkat readmissions untuk infark
miokard akut, gagal jantung, dan radang paru-paru akan melihat penurunan
satu persen pembayaran Medicare pada tahun 2013. Hukuman akan terus
secara bertahap meningkat selama dua tahun dua depan persen pada tahun
2014 dan tiga persen pada tahun 2015. pada 2015, topi tingkat di tiga
persen. Hukuman ini berlaku untuk tingkat dasar Medicare.
Hasil dari Program Rumah Sakit readmissions Reduction
Untuk tahun fiskal 2013, Medicare dikenakan hukuman maksimum satu
persen terhadap 276 rumah sakit. Hukuman rata, meskipun, sebesar
penurunan 0,4 persen pada pembayaran-atau sebagai Medicare Pembayaran
Komisi Penasehat (MedPAC) perkiraan laporan, sekitar $ 125.000 per rumah
sakit.
Seperti aku ingin memiliki 125k ekstra di dompet saya, itu penurunan ember
dibandingkan dengan pengeluaran Medicare secara keseluruhan dan
anggaran besar-besaran dari banyak sistem kesehatan terpengaruh.
Menyerap kerugian ini mungkin tidak menjadi tantangan bagi beberapa
rumah sakit.
Pada saat yang sama, tidak ada pertanyaan bahwa CMS Program
readmissions akan mempercepat. Bahkan, CMS sudah berencana menambah
kondisi yang lebih ke program. Mulai tahun 2015, CMS akan memperluas
jumlah kondisi untuk menyertakan penyakit paru obstruktif kronik (PPOK) dan
elektif pinggul dan lutut.
Bahkan jika rumah sakit dapat menyerap hit keuangan, mereka masih perlu
untuk melacak metrik-dan pelaporan demikian akan menjadi semakin
kompleks.
Menjaga Pace dengan Meningkatnya Tracking dan Pelaporan Tuntutan

Rumah sakit menghadapi berbagai pelacakan dan pelaporan tuntutan dari

banyak entitas, bukan hanya CMS. Negara bagian dan federal peraturan,
perizinan, inisiatif pembayar swasta, dan badan akreditasi semua
memerlukan laporan. Plus, konsumen mengharapkan lebih transparan di Era
Digital. Pada gilirannya, standar baru transparansi memberikan tambahan
metrik dilaporkan konsumen gunakan untuk membuat keputusan perawatan.
Pembayar dan penyedia juga mengandalkan laporan tersebut untuk
membuat keputusan bisnis.
Perusahaan Data Warehouse
Jadi apa yang dapat rumah sakit lakukan untuk menjaga dengan itu semua?
Jawabannya adalah sederhana: mengadopsi sebuah gudang perusahaan
kesehatan data (EDW) untuk memenuhi berbagai tuntutan pelaporan. Berikut
adalah beberapa contoh bagaimana sebuah EDW membantu memecahkan
beban pelaporan:
Pengguna dapat mengakses tampilan yang terintegrasi dari data
keuangan, klinis, dan operasional dari seluruh perusahaan.
pengumpulan data dan proses analisis menjadi otomatis. pengumpulan
data manual dan pelacakan hanya tidak akan bekerja di masa depan. Ini
proses manual yang memakan waktu dan sumberdaya mengkonsumsi dan
sering mengakibatkan informasi yang tidak akurat atau hilang.
Pengguna dapat mengumpulkan data dari seluruh perusahaan,
mengintegrasikan data klinis, keuangan, dan operasional dari pengaturan
rawat inap dan rawat jalan.
Laporan dibuat secara otomatis, memastikan bahwa data yang benar
sampai ke pemirsa yang tepat pada waktu yang tepat.
Manfaat dari EDW tidak berakhir dengan pelaporan, meskipun. Sebuah EDW
memberikan alat intelijen bisnis rumah sakit perlu mendorong biaya riil dan
inisiatif peningkatan kualitas. Secara khusus, sebuah EDW memungkinkan
sistem kesehatan untuk:
Membentuk dasar untuk semua ukuran kualitas
Melakukan analisis untuk menentukan peluang untuk meningkatkan
kualitas
Melacak keberhasilan intervensi perbaikan
Mengukur dan mempertahankan hasil dalam jangka panjang
Aplikasi Analytics
Setelah EDW di tempat, organisasi memiliki dasar di tempat untuk
mengadopsi aplikasi analisis. Analytics adalah alat yang kuat yang

memungkinkan pengguna non-teknis untuk memahami data dan menemukan

daerah terbaik untuk membuat perubahan.
Dari dasar untuk penemuan untuk aplikasi canggih, ada berbagai jenis
analisis yang menyediakan berbagai kedalaman solusi. Misalnya, aplikasi
dasar memungkinkan pengguna untuk mengotomatisasi distribusi laporan.
Mereka juga menyediakan dashboard, laporan, dan pendaftar dasar di bidang
klinis dan operasional. aplikasi penemuan melangkah lebih jauh dengan
memungkinkan pengguna untuk menemukan pola dan tren dalam data yang
menginformasikan prioritas, menginspirasi hipotesis baru, dan menentukan
populasi untuk manajemen. aplikasi canggih memberikan wawasan jauh ke
dalam metrik berbasis bukti. Pekerja kemudian menggunakan pengetahuan
ini untuk mendorong inisiatif biaya dan peningkatan kualitas.
Meskipun ada banyak jenis solusi analisis, mereka semua berbagi satu sifat
penting: pengguna non-teknis mendapatkan cara yang mudah dan intuitif
untuk mengajukan pertanyaan yang kompleks dari data yang disimpan dalam
EDW. Tidak ada yang perlu menjadi seorang programmer atau menunggu
minggu atau bulan dalam antrian untuk laporan custom-built.
Mengurangi readmissions Gagal Jantung dengan EDW dan Analytics
Dari ditingkatkan laporan perbaikan mengemudi, manfaat dari EDW dan
analisis aplikasi banyak. Bahkan, salah satu sistem kesehatan yang besar
dikurangi readmissions gagal jantung dengan menggunakan EDW sebagai
dasar untuk aplikasi analisis canggih mereka.
Pertama, sistem menerapkan EDW untuk cepat pool keuangan, operasional,
kepuasan pasien, dan data klinis dari EHR rawat inap dan sistem informasi
besar lainnya. Dengan infrastruktur teknologi di tempat, tim yang
bertanggung jawab atas inisiatif dibuat tujuan spesifik, terukur: untuk
mencapai dan mempertahankan penurunan 30 persen dalam 30 hari dan
pengurangan 15 persen dalam 90 hari tarif pendaftaran kembali semua
penyebab untuk pasien dengan gagal jantung pada bulan Oktober 2014 dan
penurunan berkelanjutan dalam tingkat pendaftaran kembali sampai 2016.
Selanjutnya, tim diuraikan intervensi spesifik berdasarkan praktik terbaik
yang akan memindahkan mereka ke tujuan mereka. Intervensi termasuk:
rekonsiliasi obat. Dalam waktu 48 jam debit, dokter ulasan daftar obat
pasien dengan instruksi eksplisit untuk pasien tentang bagaimana benar
membawa mereka.
janji pasca-discharge. Sebelum dibuang, perawat menjadwalkan pasien
untuk perawatan tindak lanjut. Bila mungkin, pasien yang berisiko tinggi
untuk diterima kembali dijadwalkan untuk dilihat dalam waktu tujuh hari dari

debit.
Pasca-discharge panggilan telepon. Dalam jangka waktu tertentu setelah
debit, anggota dari tim asuhan panggilan pasien untuk menilai kondisi
mereka dan menjawab pertanyaan.
Dashboard terintegrasi diciptakan dalam platform EDW kesehatan untuk
masing-masing tiga intervensi. Hal ini memungkinkan dokter dan
administrator untuk melacak di mana intervensi itu dan tidak diterapkan.
Mereka juga bisa melacak dampak perubahan sedang di readmissions.
Bahkan lebih, EDW dan analisis aplikasi memungkinkan tim untuk menilai
dampak dari intervensi pada biaya dan kepuasan pasien.
Hasilnya sangat mengesankan. Hanya enam bulan setelah menerapkan EDW,
sistem kesehatan dicapai:
Sebuah 21 persen disesuaikan secara musiman pengurangan 30 hari
readmissions HF
Sebuah 14 persen disesuaikan secara musiman pengurangan 90 hari
readmissions HF
Peningkatan 63 persen dalam rekonsiliasi obat pasca-discharge
Mereka baik dalam perjalanan mereka untuk memenuhi-dan bahkan
melebihi-mereka objektif.
Apakah rumah sakit Anda memiliki program pengurangan readmissions di
tempat? solusi yang Anda miliki di tempat untuk membantu Anda melacak,
mendorong, dan mempertahankan inisiatif perbaikan?
Cara Bertahan Hidup Kebanyakan 3% Rumah Sakit readmissions Hukuman
Meningkatkan Terbaru CMS
Bobbi Brown
Bobbi Brown
, Wakil Presiden Keterlibatan Keuangan
Posted in Langkah-Langkah Peraturan.
Pada tanggal 1 Oktober 2014, pembayaran dan kebijakan akhir perubahan
untuk readmissions rumah sakit dari CMS pergi hidup. Hanya beberapa
minggu ke perubahan, ribuan rumah sakit di seluruh Amerika Serikat
merasakan tekanan keuangan hukuman meningkat.
Sementara hukuman itu sendiri bukan kejutan, peningkatan hukuman
maksimal - naik dari dua persen hingga tiga persen - berarti ada telah terjadi
penurunan pembayaran dari Medicare untuk sistem kesehatan dengan tarif
readmissions tinggi. CMS berlaku hukuman ke DRG basis operasi (kelompok

diagnosis terkait) pembayaran.

sistem kesehatan juga sekarang perlu untuk melacak dua 30-hari tarif
pendaftaran kembali: penyakit paru obstruktif kronik (PPOK) dan artroplasti
total pinggul / lutut total artroplasti (THA / TKA). Angka ini berada di samping
rumah sakit kohort pasien berikut sudah melacak: serangan jantung (AMI),
gagal jantung, dan radang paru-paru.
dikurangi pembayaran CMS mulai pada bulan Oktober 2014 untuk Tahun
Anggaran (TA) 2015. Untuk sistem kesehatan yang sudah berjuang dengan
inisiatif perbaikan lainnya, seperti Gunakan Bermakna dan pembelian
berdasarkan nilai-, beban keuangan tambahan ini menyajikan panggilan
untuk bertindak bagi sistem kesehatan untuk bekerja erat dengan dokter
untuk meningkatkan langkah-langkah mereka.
Mengapa Perlu Rumah Sakit Levy readmissions Hukuman?
pembuat kebijakan CMS memulai Program Pengurangan pendaftaran kembali
Hospital kembali pada tahun 2012 dengan tujuan untuk meningkatkan
kesehatan. Mereka percaya bahwa sistem kesehatan dengan kelebihan
readmissions untuk pasien dengan kondisi berisiko tinggi, seperti gagal
jantung atau pneumonia, yang menyediakan perawatan pasien kualitas
rendah dan jika mereka sistem kesehatan mengurangi angka readmissions
mereka, penurunan akan menandakan perawatan pasien membaik.
Selama tahun pertama program (TA 2013), kondisi CMS difokuskan pada
membaik yang pneumonia, gagal jantung, dan infark miokard akut. Hukuman
untuk kelebihan readmissions tahun itu satu persen. Pada tahun kedua
program (TA 2014), kondisi tetap sama, tetapi CMS meningkat penggantian
dipotong menjadi 2 persen pembayaran reguler.
tahun fiskal 2015 adalah sekarang dalam ayunan penuh, dan hukuman
maksimum tiga persen. Ini peningkatan dampak 75,8 persen dari rumah sakit
di seluruh Amerika Serikat dengan pembayaran menurun. perhitungan CMS
untuk peningkatan hukuman tiga persen didasarkan pada periode tiga tahun
discharge dari 1 Juli 2010 sampai 30 Juni 2013. Karena salah perhitungan
sebelumnya faktor penyesuaian pembayaran, pemerintah AS ulang putusan
diperbaharui pada 3 Oktober 2014.
Hasil dari program ini adalah positif sampai saat ini. Bahkan, CMS telah
memperkirakan bahwa readmissions rumah sakit menolak dengan total
150.000 dari Januari 2012 sampai Desember 2013, peningkatan yang
signifikan.
Rumah Sakit Count dan Penalty Rentang 2015

Zero-to-3% penalti breakout relatif terhadap jumlah rumah sakit dipengaruhi

oleh 2.015 readmissions peningkatan penalti.
Kekhawatiran masyarakat tentang Penyesuaian Risiko untuk Status Sosial
Ekonomi
Ada banyak komentar publik mengenai penyesuaian risiko SES (status sosial
ekonomi). Namun meskipun kekhawatiran, CMS tidak menambahkan
penyesuaian risiko karena sudah memonitor dampak dari SES pada hasil
rumah sakit. Terlebih lagi, penelitian CMS menunjukkan bahwa rumah sakit
merawat proporsi besar pasien dengan SES rendah sebenarnya mampu
melakukan dengan baik pada kebijakan.
Tindakan Penalti CMS pendaftaran kembali masa depan dan Apa yang Mereka
Mean
CMS tidak memiliki rencana untuk memperluas kondisi di 2016. Namun, itu
memang memiliki data yang menunjukkan penurunan tingkat menerima
kembali setelah operasi cangkok bypass arteri koroner (CABG) merupakan
target penting bagi inisiatif peningkatan kualitas masa depan. Akibatnya,
CMS akan menambah CABG kondisi dipantau pada tahun 2017. Langkah ini
sejalan dengan strategi untuk mempromosikan transisi sukses dari
perawatan dari rumah sakit ke pengaturan rawat jalan. ukuran tersebut juga
memenuhi kriteria biaya tinggi, volume tinggi. Data untuk 2017 akan
didasarkan pada periode 1 Juli 2012 sampai dengan 30 Juni 2015.
Ini berarti kegiatan rumah sakit saat ini dan intervensi untuk CABG dan lima
kondisi lain akan tercermin dalam file 2017 penalti. 2009 Tingkat rata-rata
untuk Medicare CABG 30-hari, risiko standar diterima kembali adalah 17,2
persen, dan kisaran pergi dari 13,9 persen menjadi 22,1 persen.
Strategi untuk Mengurangi diterima kembali Tarif
Jika Anda mencari web, ada banyak artikel tentang strategi untuk
mengurangi tarif pendaftaran kembali, terutama untuk populasi gagal
jantung. Tapi dalam pengalaman saya, ada umumnya tidak satu strategi
tunggal yang menghasilkan hasil. Sebaliknya, rumah sakit perlu menerapkan
beberapa strategi dan memantau untuk sukses.
Seperti dilaporkan oleh penulis dari sebuah artikel dari Juli 2013 isu
Circulation: Cardiovascular Quality and Outcomes, "Rumah Sakit Strategi
Associated dengan 30-Day pendaftaran kembali Tarif untuk Penderita Gagal
Jantung," ada enam strategi yang berkaitan dengan signifikan mengurangi
tingkat readmissions . Para penulis yang disurvei data dari 599 rumah sakit
untuk menentukan metode rumah sakit 'untuk mengurangi tingkat
pendaftaran kembali. Enam strategi rumah sakit yang digunakan termasuk:

Bermitra dengan dokter komunitas dan kelompok dokter

Bermitra dengan rumah sakit setempat
Memiliki perawat bertanggung jawab untuk rekonsiliasi obat
Mengatur kunjungan tindak lanjut sebelum dibuang
Memiliki proses di tempat untuk mengirim semua ringkasan debit ke
dokter perawatan primer
Menugaskan staf untuk menindaklanjuti hasil tes setelah debit
Bagaimana Satu besar Sistem Kesehatan Dicapai readmissions Mengurangi
Mencapai berkurang readmissions mungkin bila sistem yang tepat untuk
menangkap data di tempat. Misalnya, satu sistem kesehatan yang besar
menggunakan empat intervensi kunci untuk menurunkan tarif pendaftaran
kembali gagal jantung 30-hari mereka dengan 29 persen. Mereka mampu
mencapai hasil ini dengan menggunakan intervensi berbasis bukti berikut:
Obat rekonsiliasi: Ulasan Dokter obat pasien dan memberi mereka
petunjuk eksplisit tentang bagaimana benar mengambil obat.
Pasca-discharge janji: Pasien dijadwalkan untuk perawatan tindak lanjut
sebelum dibuang. Pasien dengan risiko tinggi untuk diterima kembali
menerima janji untuk kembali dalam waktu tujuh hari dari debit; lain
dijadwalkan untuk kembali dalam waktu 14 hari.
panggilan telepon pasca-discharge: Dalam jangka waktu tertentu berikut
debit - berdasarkan risiko pasien untuk diterima kembali - anggota dari tim
perawatan terkoordinasi disebut setiap pasien untuk menilai kondisi mereka
dan untuk melihat apakah mereka memiliki pertanyaan atau mengalami
masalah dengan obat mereka.
Ajarkan kembali intervensi: Pasien yang diperlukan untuk menunjukkan
pemahaman mereka dari informasi mereka sedang diberikan oleh diminta
untuk menjelaskannya.
Delapan bulan setelah menerapkan empat intervensi berbasis bukti, sistem
kesehatan mengalami:
pengurangan 29 persen dalam 30 hari readmissions HF
pengurangan 14 persen dalam 90 hari readmissions HF
120 persen peningkatan tindak lanjut janji
peningkatan 78 persen dalam rekonsiliasi obat apoteker
peningkatan 87 persen pada panggilan telepon tindak lanjut
peningkatan 84 persen dalam mengajar kembali intervensi
3 Cara untuk Mencapai signifikan Hati Tarif pendaftaran kembali Kegagalan

Agar intervensi untuk menjadi sukses, bagaimanapun, strategi dan alat harus
di tempat untuk mengumpulkan dan menganalisis data yang bersangkutan
yang akan membantu dokter menemukan jawaban yang mereka cari. Untuk
sistem kesehatan dalam contoh di atas, tiga solusi penting dilaksanakan.
Solusi adalah sebagai berikut:
Sebuah data warehouse untuk menyediakan sumber tunggal kebenaran
Sistem kesehatan tahu bahwa data yang diperlukan untuk menjadi inti dari
upaya perbaikan mereka, tetapi hanya mengumpulkan data tidak akan cukup
- penyedia juga diperlukan untuk dapat mengakses data. Jika mereka pergi
rute dari penggelaran sebuah gudang data tradisional, mereka bisa berakhir
menghabiskan tahun sebelum itu sepenuhnya dikerahkan.
Sebaliknya, sistem kesehatan memilih solusi alternatif - sebuah data
warehouse akhir-mengikat. Almarhum mengikat data warehouse mampu
mengatasi keterbatasan data warehouse tradisional karena platform lincah
nya. (Platform tangkas mendukung aturan yang cepat berubah dan kasus
penggunaan data kesehatan, dan juga memberikan nilai dalam hitungan
minggu.) Bahkan, sistem kesehatan mampu sepenuhnya menggunakan
gudang data mereka dalam beberapa bulan dibandingkan tahun karena
akhir-mengikat arsitektur.
Terlibat tim multidisiplin untuk memimpin upaya perbaikan
Untuk menjadi sukses, sistem kesehatan tahu mereka harus terlibat dokter
dan membangun budaya kepercayaan - melalui transparansi dan kolaborasi dan menyelaraskan pada visi hasil yang lebih baik. Mereka bisa memilih
untuk pergi cepat, tanpa keterlibatan dokter. Tapi mereka tahu mereka bisa
pergi lebih jauh dengan dukungan dokter. Jadi mereka mengorganisir tim
multidisiplin yang meliputi dokter, perawat, informaticists, kualitas, analisis,
IT, operasi, dan keuangan.
Analytics untuk menelusuri ke setiap episode perawatan
Setelah sistem kesehatan menerapkan platform analisis canggih, dokter
memiliki kemampuan untuk menelusuri ke setiap episode perawatan dan
menilai ketepatan waktu intervensi dan untuk menjamin intervensi yang
terjadi. Misalnya, dokter dapat menentukan apakah pasien datang kembali
untuk mereka menindaklanjuti janji dan berapa hari setelah penunjukan asli.
Melacak data seperti manual ini memakan waktu dan mahal. Tapi dengan
solusi analisis, dokter memiliki akses ke dekat-real-time data yang
diidentifikasi variasi dalam perawatan - semua jalan ke masing-masing
penyedia individu. Selain itu, dokter tidak perlu menunggu seseorang di IT

untuk menyelesaikan permintaan mereka, meningkatkan waktu untuk

menghargai. Hal ini karena platform analisis termasuk alat visualisasi yang
mudah digunakan yang tidak memerlukan permintaan rumit bagi dokter
untuk mendapatkan jawaban yang mereka butuhkan.
Hukuman diterima kembali di sini untuk tinggal
Sistem kesehatan AS adalah di tengah-tengah transformasi besar-besaran
untuk meningkatkan perawatan pasien dan mengurangi biaya. Ini adalah
tugas yang menakutkan bagi organisasi kesehatan, terutama bila tindakan
pelaporan tambahan yang diperlukan sebagai CMS gulungan keluar update
reguler untuk Program Pengurangan diterima kembali Hospital. Tantangan
menjadi lebih besar untuk sistem kesehatan yang dihadapi meningkatkan
hukuman karena mereka belum menemukan cara untuk mengurangi tingkat
readmissions mereka. Hal ini membuat mereka rentan terhadap hukuman
yang lebih tinggi dan pengawasan publik yang lebih besar.
Sementara banyak sistem kesehatan percaya EDW tradisional akan
membantu mereka mencapai perbaikan yang diperlukan untuk mematuhi
mandat CMS, teknologi ini tidak memadai. Arsitektur data terbaik harus
terlambat mengikat. Tapi di samping arsitektur yang tepat, tim harus mau
berinteraksi dengan data dan melihat nilai dalam menggunakannya untuk
inisiatif perbaikan. Sebuah sistem analisis yang menyediakan analisis
mendekati real-time memberikan dokter dan analis data mereka telah
meminta, dan memungkinkan mereka untuk - bukan hanya meminta - tetapi
juga menjawab pertanyaan tentang bagaimana untuk mendapatkan
perbaikan yang signifikan dalam tingkat readmissions.
Bagaimana tarif rumah sakit Anda ketika readmissions hukuman meningkat
menjadi tiga persen? Jika Anda menghadapi beban keuangan, apakah Anda
memiliki pertanyaan tentang bagaimana Akhir-Binding Data Warehouse
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CMS Pelaporan Persyaratan - 4 Perubahan Rumah Sakit Harus Tahu untuk
2014
Bobbi Brown
Bobbi Brown
, Wakil Presiden Keterlibatan Keuangan
Michael Barton

Michael Barton
, Engagement Eksekutif, VP
Posted in Langkah-Langkah Peraturan.
Jika rumah sakit ingin bertahan hidup lingkungan kesehatan yang baru,
mereka tidak bisa hanya mempersiapkan diri untuk Centers for Medicare &
Medicaid Services '(CMS) langkah-langkah pelaporan baru - mereka harus
proaktif meningkatkan skor kualitas mereka. Mengapa? Karena perubahan
yang signifikan terhadap aturan yang ada akan berlangsung musim panas ini
dan jika sistem kesehatan tidak siap untuk memenuhi standar kinerja baru
yang ditetapkan oleh CMS, mereka akan mengalami keuangan set-punggung
yang parah - atau bahkan keluar dari bisnis.
Misalnya, aturan yang diusulkan oleh CMS pada tanggal 30 April 2014,
berusaha untuk memperbarui kebijakan pembayaran Medicare untuk rawat
inap pada tahun fiskal 2015 (Oktober 2014 - September 2015). Tindakan ini
merupakan kelanjutan dari upaya pemerintah untuk meningkatkan kualitas
kesehatan sementara memperlambat pertumbuhan biaya jangka panjang.
Setiap versi baru dari tindakan pelaporan CMS jelas menunjukkan strategi
jangka panjang CMS untuk memotong penggantian biaya untuk fasilitas yang
tidak memenuhi tolok ukur kualitas. Ini penting bahwa sistem kesehatan tidak
hanya memahami perubahan yang akan datang ke program berkualitas
peningkatan rumah sakit CMS tetapi secara proaktif mempersiapkan mereka.
Berikut adalah empat perubahan CMS yang diusulkan untuk 2014.
Program Pembelian 1. Rumah Sakit Berbasis Nilai
Didirikan oleh Undang-Undang Perawatan Terjangkau, pembelian berbasis
nilai rumah sakit (VBP) Program menyesuaikan pembayaran (dalam bentuk
denda dan bonus) untuk rumah sakit berdasarkan kualitas perawatan yang
mereka berikan. Rumah sakit dihargai untuk praktek klinis terbaik dan
seberapa baik mereka meningkatkan pengalaman pasien perawatan.
Untuk tahun fiskal 2015, porsi pembayaran Medicare tersedia untuk
mendanai pembayaran insentif berbasis nilai-akan meningkat menjadi 1,5
persen dari pembayaran kelompok operasi dasar diagnosis terkait (DRG).
Dengan kata lain, semua rumah sakit akan memiliki pembayaran menurun
1,5 persen dengan potensi untuk mendapatkan bonus, penghargaan mereka
rumah sakit yang berkinerja baik. Menurut perkiraan CMS, jumlah total yang
tersedia untuk pembayaran insentif berbasis nilai-in TA 2015 akan menjadi
sekitar $ 1,4 miliar.
Juga akan ada dua langkah hasil baru untuk tahun 2015: Indikator

Keselamatan Pasien AHRQ (PSI) komposit dan pusat infeksi darah uap lineterkait (CLABSI). Ukuran efisiensi biaya Medicare per penerima manfaat akan
sama ditambahkan. Maka skor kinerja total untuk setiap rumah sakit akan
dihitung dengan menggunakan bobot berikut (persentase) untuk menentukan
kinerja untuk empat domain:
Proses klinis: 20 persen
pengalaman pasien: 30 persen
Hasil: 30 persen
Efisiensi: 20 persen
Program 2. Rumah Sakit readmissions Pengurangan
Program Pengurangan readmissions Rumah Sakit adalah upaya pemerintah
untuk mengurangi readmissions rumah sakit untuk pasien yang baru saja
dirawat untuk kondisi atau prosedur tertentu.
Saat ini, rumah sakit harus mengukur dan melaporkan readmissions untuk
kondisi berikut: gagal jantung (HF), infark miokard akut (AMI), dan pneumonia
(PN). Untuk TA 2015, namun, CMS mengusulkan penambahan dua kondisi
baru untuk readmissions mereka melaporkan meaures: penyakit paru
obstruktif kronik (PPOK) dan artroplasti total pinggul / lutut total artroplasti
(THA / TKA). Untuk lebih menentukan pasien THA / TKA menjalani operasi
nonpilihan, CMS mengeluarkan definisi direvisi untuk THA dan mengusulkan
untuk mengecualikan patah tulang pinggul kode baik sebagai kepala atau
diagnosis sekunder.
Untuk tahun 2015, Program Pengurangan Rumah Sakit readmissions
mengusulkan hukuman maksimal untuk readmissions dari 3 persen. Ini saat
ini ditetapkan sebesar 2 persen. CMS perkiraan dari Januari 2012 sampai
Desember 2013 sudah menunjukkan peningkatan yang signifikan sebagai
hasil dari program: rumah sakit readmissions Medicare menurun total
150.000.
Alat diterima kembali Explorer kesehatan Catalyst menampilkan mudah
memahami tren, perbandingan, dan data rinci, pasien-tingkat melalui
antarmuka pengguna rapi.
Alat diterima kembali Explorer kesehatan Catalyst menampilkan mudah
memahami tren, perbandingan, dan data rinci, pasien-tingkat melalui
antarmuka pengguna rapi.
3. Rumah Sakit Pelaporan Kualitas Rawat Inap
Rumah Sakit Rawat Inap Pelaporan Kualitas (IQR) Program, didirikan pada
tahun 2003, mengharuskan rumah sakit untuk mengirimkan pengukuran

kualitas pelaporan untuk kondisi kesehatan tertentu untuk populasi Medicare.

Dengan aturan yang diusulkan terbaru, bagaimanapun, CMS berusaha untuk
merevisi langkah-langkah untuk program ini. Secara khusus, untuk tahun
2015 dan 2016, CMS mengusulkan untuk menyelaraskan pelaporan dan
pengajuan jadwal untuk ukuran kualitas klinis untuk Program Insentif
Medicare Electronic Health Record (EHR) dengan pelaporan dan pengajuan
jadwal Program IQR Rumah Sakit. Jika rumah sakit tidak menyerahkan
laporan tersebut, mereka akan mengambil risiko pengurangan pembayaran
meningkat dari 2 persen (naik dari 0,4 persen). Perubahan yang diusulkan
merupakan upaya CMS untuk menyelaraskan mekanisme pelaporan yang
berbeda.
Kondisi (HAC) Program Pengurangan 4. Rumah Sakit-Acquired
Kondisi Program Pengurangan (HAC) Rumah Sakit-Acquired adalah program
berkualitas CMS terbaru. Program ini menghukum rumah sakit untuk tarif
HAC tinggi. CMS ingin mendorong rumah sakit untuk meningkatkan proses
kualitas mereka sebagai cara untuk mencegah pasien dari kontrak mahal,
kondisi didapat di rumah sakit ketika mereka sedang dirawat karena
perhatian utama. Hukuman Program Pengurangan HAC dimulai bulan Oktober
2014.
Di bawah Program Pengurangan HAC, rumah sakit dengan tingkat tertinggi
HACs - khususnya, orang-orang di atas 25 persen - akan menerima
pengurangan 1 persen dalam pembayaran rawat inap Medicare. CMS
memperkirakan 753 rumah sakit akan dikenakan pengurangan satu persen
dan pembayaran secara keseluruhan akan menurun $ 330.000.000 atau 0,3
persen.
Rumah sakit tidak dalam gelap ke mana mereka berdiri dalam hal tarif HAC.
CMS telah merilis sebuah file dengan skor untuk setiap fasilitas. Analisis awal
tersedia di situs web CMS.
CMS telah dikategorikan pengukuran HAC di dua domain:
Domain 1 meliputi AHRQ PSI-90 ukuran gabungan, yang terdiri dari
delapan indikator komponen:
PSI tingkat ulkus 3 Tekanan
PSI 6 tingkat pneumotoraks latrogenik
PSI 7 vena tingkat infeksi Central terkait kateter darah aliran
PSI tingkat fraktur 8 pascaoperasi pinggul
PSI 12 emboli pasca operasi paru (PE) atau tingkat deep vein thrombosis
(DVT)
PSI 13 tingkat sepsis pasca operasi
PSI tingkat dehiscence 14 Luka

PSI 15 tusukan Accidental dan tingkat laserasi

Domain 2 terdiri dari Pusat Pengendalian dan Pencegahan Penyakit ini
NHSN (Jaringan Keselamatan Kesehatan Nasional) CAUTI dan CLABSI
tindakan. CAUTI adalah infeksi saluran kemih kateter terkait dan CLABSI
pusat-line infeksi aliran darah terkait.
Untuk Domain 1 di TA 2015, rumah sakit diukur kinerja mereka dari 1 Juli
2011 sampai 30 Juni 2012. Jangka waktu untuk Domain 2 selama tahun
kalender 2012 untuk 2013. Untuk menghitung skor, bobot CMS Domain 1 di
35 persen dan Domain 2 di 65 persen.
Untuk membaca tentang empat cara untuk mengurangi risiko menerima
hukuman HAC, membaca artikel ini.
Dibutuhkan: Pendekatan sistematis untuk Meningkatkan Kualitas dan Biaya
Perubahan dari pemerintah akan berlangsung - dan CMS akan terus menerus
meningkatkan langkah-langkah biaya dan penalti mereka melalui berbagai
program peningkatan. Dan sementara itu mungkin tampak seperti
pengurangan 1 persen tidak sukses besar pada marjin rumah sakit, ketika
Anda melihat program individu dan menambahkan pengurangan, Anda dapat
melihat ada kelemahan keuangan yang luar biasa untuk tidak meningkatkan
kualitas. Bahkan, pengurangan ini bisa melebihi margin rata-rata untuk
kebanyakan sistem rumah sakit dan menyebabkan kesulitan keuangan yang
signifikan. Metode tradisional hanya memeras keluar biaya tidak akan cukup
untuk rumah sakit untuk bertahan hidup; mereka akan membutuhkan
metode yang berbeda - pendekatan yang sistematis dan berkelanjutan untuk
meningkatkan kualitas dan biaya untuk menjaga dengan ini mandat tahunan.
Kunci untuk berhasil meningkatkan kinerja kualitas dan memenuhi semua
tindakan ini adalah dengan menggunakan informasi yang tepat dan proses
yang tepat pada tingkat sistem untuk mendorong perbaikan. Sebuah sistem
analisis yang dapat melacak kinerja dan kemudian mengukur perbaikan
apapun yang dibuat berdasarkan intervensi kualitas yang ditargetkan adalah
penting. Seperti sistem pelaporan, dikombinasikan dengan mendapatkan tim
klinis di tempat untuk memecahkan masalah kualitas, dapat mengubah
budaya rumah sakit. Dalam gambaran besar dari reformasi kesehatan,
pemerintah menggunakan kekuatan beli sebagai tuas untuk mengubah
budaya kita dari pemberian perawatan. Rumah sakit yang tidak berhasil dan
sistematis mengubah tidak akan bertahan.
Apakah Anda siap untuk langkah-langkah pelaporan baru CMS? Jika demikian,
apa yang telah Anda lakukan? Apakah Anda telah sistem analisis di tempat
untuk dapat mengukur perbaikan Anda? Apa kekhawatiran terbesar Anda
tentang langkah-langkah pelaporan CMS?

Powerpoint Slides
Apakah Anda ingin menggunakan atau berbagi konsep-konsep ini? Ambil
presentasi CMS Pelaporan Perubahan ini menyoroti poin utama kunci.
Klik Disini untuk Download Slide
CMS Pelaporan Persyaratan - 4 Perubahan Rumah Sakit Harus Tahu untuk
2014
Bobbi Brown
Bobbi Brown
, Wakil Presiden Keterlibatan Keuangan
Michael Barton
Michael Barton
, Engagement Eksekutif, VP
Posted in Langkah-Langkah Peraturan.
Jika rumah sakit ingin bertahan hidup lingkungan kesehatan yang baru,
mereka tidak bisa hanya mempersiapkan diri untuk Centers for Medicare &
Medicaid Services '(CMS) langkah-langkah pelaporan baru - mereka harus
proaktif meningkatkan skor kualitas mereka. Mengapa? Karena perubahan
yang signifikan terhadap aturan yang ada akan berlangsung musim panas ini
dan jika sistem kesehatan tidak siap untuk memenuhi standar kinerja baru
yang ditetapkan oleh CMS, mereka akan mengalami keuangan set-punggung
yang parah - atau bahkan keluar dari bisnis.
Misalnya, aturan yang diusulkan oleh CMS pada tanggal 30 April 2014,
berusaha untuk memperbarui kebijakan pembayaran Medicare untuk rawat
inap pada tahun fiskal 2015 (Oktober 2014 - September 2015). Tindakan ini
merupakan kelanjutan dari upaya pemerintah untuk meningkatkan kualitas
kesehatan sementara memperlambat pertumbuhan biaya jangka panjang.
Setiap versi baru dari tindakan pelaporan CMS jelas menunjukkan strategi
jangka panjang CMS untuk memotong penggantian biaya untuk fasilitas yang
tidak memenuhi tolok ukur kualitas. Ini penting bahwa sistem kesehatan tidak
hanya memahami perubahan yang akan datang ke program berkualitas
peningkatan rumah sakit CMS tetapi secara proaktif mempersiapkan mereka.
Berikut adalah empat perubahan CMS yang diusulkan untuk 2014.
Program Pembelian 1. Rumah Sakit Berbasis Nilai
Didirikan oleh Undang-Undang Perawatan Terjangkau, pembelian berbasis
nilai rumah sakit (VBP) Program menyesuaikan pembayaran (dalam bentuk
denda dan bonus) untuk rumah sakit berdasarkan kualitas perawatan yang
mereka berikan. Rumah sakit dihargai untuk praktek klinis terbaik dan

seberapa baik mereka meningkatkan pengalaman pasien perawatan.

Untuk tahun fiskal 2015, porsi pembayaran Medicare tersedia untuk
mendanai pembayaran insentif berbasis nilai-akan meningkat menjadi 1,5
persen dari pembayaran kelompok operasi dasar diagnosis terkait (DRG).
Dengan kata lain, semua rumah sakit akan memiliki pembayaran menurun
1,5 persen dengan potensi untuk mendapatkan bonus, penghargaan mereka
rumah sakit yang berkinerja baik. Menurut perkiraan CMS, jumlah total yang
tersedia untuk pembayaran insentif berbasis nilai-in TA 2015 akan menjadi
sekitar $ 1,4 miliar.