aegis therapies response to evolving care delivery environment 4.29.15 emerging world of post-acute...
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AEGIS THERAPIES RESPONSE TO EVOLVING CARE DELIVERY ENVIRONMENT
4.29.15
EMERGING WORLD OF POST-ACUTE EMERGING WORLD OF POST-ACUTE CARE (PAC) THERAPY PROVISIONCARE (PAC) THERAPY PROVISION
REIMBURSEMENT SHIFTREIMBURSEMENT SHIFT
Traditional pay for services shrinking annually as
more potential patients need services
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CMSCMS
# 1 Priority is Post Acute Care (PAC)# 1 Priority is Post Acute Care (PAC)
• 40,000 beneficiaries exit hospitals daily• 40% over-utilization of SNF days• 80% of Medicare Reimbursement in PAC• $62B Annually• $31B SNF - $18B HH - $13B - LTAC
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REIMBURSEMENT SHIFTREIMBURSEMENT SHIFT
Experiment TrendsExperiment Trends
• Patient-centricPatient-centric
• Value-basedValue-based
• CollaborationCollaboration
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LENGTH OF STAYLENGTH OF STAY
CATEGORY DIAGNOSISSub Acute GOAL - LOS Sub Acute MEDIAN - LOS
Cardiology Heart Failure 9 to 16 days 20 days
Infective Endocarditis 11 to 20 days 22 days
Myocardial Infarction 10 to 17 days 20 days
Syncope 10 to 17 days 20 days
Orthopedics Ankle Dislocation 11 to 20 days 27 days
Ankle Fracture 12 to 20 days 26 days
Back Pain 10 to 17 days 20 days
Cervical Spine Surgery 9 to 15 days 20 days
Femur Fracture 13 to 24 days 30 days
Foot: Transmetatarsal Amputation 10 to 18 days 21 days
Hip Arthroplasty 7 to 12 days 14 days
Hip Fracture, Open Repair 14 to 23 days 28 days
Knee: Amputation Above or Below Knee 13 to 23 days 29 days
Knee Arthroplasty 7 to 10 days 12 days
Knee: Fracture of Tibial Plateau 12 to 20 days 25 days
Lumbar Spine Surgery 7 to 12 days 14 days
Pressure Ulcer Closure 25 to 39 days 39 days
Tibia/Fibula Fracture 11 to 21 days 27 days
PATIENT EXPERIENCEPATIENT EXPERIENCE
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Patient: VioletDRG: Hip & Femur procedures w/o complicationsTarget Cost: $30,237.77
Patient: HenryDRG: Hip & femur procedures w/ complicationsTarget Cost: $33,726.18
PATIENT EXPERIENCE - GOALSPATIENT EXPERIENCE - GOALS
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Patient: VioletDRG: Hip & femur procedures w/o complicationsTarget Cost: $30,237.77
Independent ADL & driving prior to surgery. Goal = Transition home w/ son, continue w/ HH
Patient: HenryDRG: Hip & femur procedure with complicationsTarget Cost: $33,726.18
Independent ADL & driving prior to surgery.
Goal = Transition home w/ wife, continue w/ HH.
PATIENT EXPERIENCE – THE RESULTPATIENT EXPERIENCE – THE RESULT
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Patient: VioletDRG: Hip & femur procedures w/o complicationsTarget Cost: $30,237.77
1/17/14 – 2/8/14: SNF (22 days) $11,584.762/10/14 – 4/10/14: HH (16 visits) $3,277.44
Patient: HenryDRG: Hip & femur procedures with complicationsTarget Cost: $33,726.18
1/20/14 – 1/25/14: SNF (5 days) $2,400.511/26/14 – 1/29/14: Hospital (3 days) $5,921.081/29/14 – 3/14/14: SNF (44 days) $24,712.703/15/14 – 4/19/14: HH (15 visits) $3,222.06
THE RESULT – FINANCIAL IMPACTTHE RESULT – FINANCIAL IMPACT
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Patient: VioletDRG: Hip & femur procedures w/o complicationsTarget Cost: $30,237.77Actual Cost: $15,812.52Cost Variance: $14,425.25
1/17/14 – 2/8/14: SNF (22 days) $11,584.762/10/14 – 4/10/14: HH (16 visits) $3,277.44
Patient: HenryDRG: Hip & femur procedures with complicationsTarget Cost: $33,726.18Actual Cost: $36,709.57Cost Variance: $4,983.39
1/20/14 – 1/25/14: SNF (5 days) $2,400.511/26/14 – 1/29/14: Hospital (3 days) $5,921.081/29/14 – 3/14/14: SNF (44 days) $24,712.703/15/14 – 4/19/14: HH (15 visits) $3,222.06
ACCOUNTABILITYACCOUNTABILITY
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CONTROLCONTROL
INFLUENCEINFLUENCE
CONCERNCONCERN
ACCOUNTABILITYACCOUNTABILITY
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SNFSNF
HHHH
OPOP
VISION – HAPPENING NOWVISION – HAPPENING NOW
• Patient-centricPatient-centric• Value-basedValue-based• CollaborationCollaboration
Aegis believes the future makes sense.Aegis believes the future makes sense.
How do we prepare to be the best at it, How do we prepare to be the best at it, as soon as possible?as soon as possible?
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PROCESSPROCESS
High-touch patient and provider engagement High-touch patient and provider engagement to drive improved outcomes at lower cost.to drive improved outcomes at lower cost.
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Embrace realityEmbrace reality
RESPONSERESPONSE
What will change?
Still provide highly skilled rehab services Determine transition plan by Day 3 Communicate with previous care setting in order to
begin where they left off Collaborate with next care setting to know what
patient will need Assess health literacy of pt./family & provide training Follow up w/ pt. after transitioning from PAC setting
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SCOPE OF PRACTICE / GOAL SETTINGSCOPE OF PRACTICE / GOAL SETTING
Therapy Scope of Practice• Current: Treat most underlying impairments and
functional deficits identified during evaluation.• New World: Treat underlying impairments or
functional deficits necessary to move patient to next transition.
Goal Setting• Current: Goals set at highest level patient seemingly
can achieve.• New World: Goals set at level patient needs to attain
in order to achieve next transition safely.15
PREDICTING CHANGEPREDICTING CHANGE
• From Day 1, therapy education is two-fold: on patient and family.
• By Day 2 of admission, IDT team must have same understanding of LOS and transition environment (home)
• Home visit completed by Day 3, on-site with patient or potential for “virtual home visit”.
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REHAB ENHANCEMENTREHAB ENHANCEMENT
Frequency and Intensity
• With multiple co-morbidities, frequency of therapy needs to be 7 days per week
• Intensity is based on clinical need to prioritize goals for the transition point
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TRANSITION ENVIROMNMENT DETERMINATIONTRANSITION ENVIROMNMENT DETERMINATION
NEW WORLDNEW WORLD• Obtain information about next care setting:
• Physical home visit with patient • Virtual home visit - aide visit home to take pictures or
short videos • Virtual home visit – family/friends take pictures or short
videos of home, take measurements, fill out checklist, etc.• Communicating with providers in transition environment.
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AVOID DECLINE POST-TRANSITIONAVOID DECLINE POST-TRANSITION
NEW WORLDNEW WORLD
• Decline in function post-transition – heavily scrutinized.
• High-touch interaction. Train family on strategies to maintain functional level.
• Enhance collaboration with resources outside usual group.
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THERAPY SCHEDULETHERAPY SCHEDULE
NEW WORLDNEW WORLD
• Trends toward shorter LOS continues.• Creates need to increase rehab hours during day AND
across more days during week.• Greater need for immediate evaluations.• “Traditional” SNF rehab hours (Mon-Sat) must expand to
7 days.
• Must address late day admits
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PAYOR-SPECIFIC GUIDELINESPAYOR-SPECIFIC GUIDELINES
• Third party payers have specific coverage guidelines• Understand the various benefits, so that
• Right Patient• Right Time• Right Discipline• Right Setting
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ACO’s ARE WATCHING & MEASURINGACO’s ARE WATCHING & MEASURING
• ACO’s measuring SNF performance.
• Measuring timeliness of nursing & therapy evals
• Measuring intensity of services
• Measuring transition time from SNF to next level.
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AEGIS TRANSITIONAEGIS TRANSITION
• Work with partners and customers to grow ACO relationships and “collaborative” possibilities
• Maintain a constant “pulse” on the changing regulatory environment
• Ongoing training - therapy staff
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NEXT STEPSNEXT STEPS
• Partner with NHA on how to introduce concepts to facility.• Is SNF experiencing new expectations? (i.e. payers driving shorter LOS and transition to next
level, pt’s demanding earlier transition?)• Timelines?• Level of detail?• Target audiences?
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SUMMARYSUMMARY
• Reduction of SNF costs CMS priority.
• PAC to reshape delivery of care with quicker transitions.
• ACO measure SNF key performance indicators
• PAC sites will be rewarded on alignment and efficiency.
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QuestionsQuestions