http://www.mayoclinic.

org/about-mayo-clinic/quality/quality-measures/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 hospital’s
excess readmission ratio is a measure of a hospital’s readmission performance compared to the
national average for the hospital’s 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 hospital’s 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 hospital’s 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 hospital’s 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) + (non-
labor 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 patient’s age, past medical history, and other diseases or conditions
(comorbidities) the patient had when they were admitted that are known to increase the patient’s
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 hospital’s 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 hospital’s 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 hospital’s 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 kembali direncanakan untuk diease paru obstruktif kronik (PPOK) pasien
    30-hari pendaftaran kembali direncanakan untuk serangan jantung (AMI) pasien
    30-hari pendaftaran kembali direncanakan untuk gagal jantung (HF) pasien
    30-hari pendaftaran kembali direncanakan untuk pasien pneumonia
    30-hari pendaftaran kembali direncanakan untuk 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) langkah-langkah 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
hospital’s 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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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 involve—to 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 transition—a 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 Newton-Wellesley 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 fee-for-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-readmissions-reduction

Hospital Readmissions Reduction Program:

Keys to Success
, Vice President of Financial Engagement

Avoidable readmissions are a major financial problem for the nation’s 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 years—two 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 payment—or as a Medicare
Payment Advisory Commission (MedPAC) report estimates, about $125,000 per hospital.

As much as I’d like to have an extra 125K in my wallet, it’s 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 CMS’s 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 metrics—and
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 won’t 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 don’t 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: non-
technical 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 custom-
built 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
patient’s 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 meeting—and even exceeding—their 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 CMS’s 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 isn’t 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.

CMS’s 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. CMS’s
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 isn’t adding any risk adjustments because it already
monitors the impact of SES on hospital results. What’s more, CMS’s 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 hospital’s 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 patient’s 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
patient’s 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 they’re 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 wouldn’t 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 late-
binding 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 didn’t 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 didn’t 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. It’s 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 haven’t 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 isn’t 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 they’ve 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
you’re 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 can’t 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 aren’t 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 government’s effort to improve the quality of healthcare while slowing the
long-term cost growth.

Each new version of the CMS reporting measures clearly demonstrates CMS’s long-term
strategy to cut reimbursements for facilities that don’t meet quality benchmarks. It’s 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 government’s attempt to reduce hospital
readmissions for patients who’ve 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. It’s 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 Catalyst’s 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 don’t submit these reports, they’ll risk an increased payment reduction of 2 percent (up
from 0.4 percent). The proposed changes represent CMS’s 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 they’re 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
o PSI 6 Latrogenic pneumothorax rate
o PSI 7 Central venous catheter-related blood stream infection rate
o PSI 8 Postoperative hip fracture rate
o PSI 12 Postoperative pulmonary embolism (PE) or deep vein thrombosis rate (DVT)
o PSI 13 Postoperative sepsis rate
o PSI 14 Wound dehiscence rate
o PSI 15 Accidental puncture and laceration rate
 Domain 2 consists of the Center for Disease Control and Prevention’s 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 isn’t a huge hit on a hospital’s margin, when you look at the individual
programs and add up the reductions, you can see there’s 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 won’t 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 hospital’s 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 don’t successfully and systematically change won’t
survive.

Have you prepared for CMS’s 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 CMS’s 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 can’t 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 aren’t 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 government’s effort to improve the quality of healthcare while slowing the
long-term cost growth.

Each new version of the CMS reporting measures clearly demonstrates CMS’s long-term
strategy to cut reimbursements for facilities that don’t meet quality benchmarks. It’s 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 government’s attempt to reduce hospital
readmissions for patients who’ve 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. It’s 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 Catalyst’s 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 don’t submit these reports, they’ll risk an increased payment reduction of 2 percent (up
from 0.4 percent). The proposed changes represent CMS’s 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 they’re 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
o PSI 6 Latrogenic pneumothorax rate
o PSI 7 Central venous catheter-related blood stream infection rate
o PSI 8 Postoperative hip fracture rate
o PSI 12 Postoperative pulmonary embolism (PE) or deep vein thrombosis rate (DVT)
o PSI 13 Postoperative sepsis rate
o PSI 14 Wound dehiscence rate
o PSI 15 Accidental puncture and laceration rate
 Domain 2 consists of the Center for Disease Control and Prevention’s 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 isn’t a huge hit on a hospital’s margin, when you look at the individual
programs and add up the reductions, you can see there’s 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 won’t 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 hospital’s 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 don’t successfully and systematically change won’t
survive.

Have you prepared for CMS’s 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 CMS’s 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 Hospital’s Story

Health Catalyst
Posted in Customer Success Stories.

Download

“We have deployed evidence-based practices —

medication reconciliation, follow-up phone calls and
appointments, and teach back— to help reduce heart
failure readmission rates. Analytics are enabling us to
correlate our interventions with readmissions and
trend readmissions over time for comparative
purposes.”

– Associate Chief Medical Officer

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 Catalyst’s 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 grant’s 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 patient’s 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 patient’s 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, we’ll
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 you’ve learned to create a culture of safety. Review cases of HAC to discover the
source of the problem. Then apply what you’ve 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 x’s
more) and detect them earlier, allowing potential for prevention or harm mitigation. Active
surveillance systems increase an organization’s 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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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 ™ dapat membantu Anda menghindari hukuman
masa?
Powerpoint Slides

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menyoroti poin utama kunci.

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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 line-terkait (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.