using data to drive improvement: addressing social … · 2 days ago · using data to drive...

Using Data to Drive Improvement: Addressing Social Determinants of Health

Comprehensive Care for Joint Replacement Model

January 17, 2019

Audio available through device speakers OR by dialing (800) 832 - 0736

Conference Room:*2657582# Access Code: 011719#


Comprehensive Care for Joint Replacement Model 2

Welcome

Alicia Goroski, MPH CJR Learning System Team

The Lewin Group

Lauren Nir, MPH CJR Learning System Team

The Lewin Group


Webinar Agenda

• Welcome & Meeting Logistics

• Beneficiary Incentive

• CHI St. Vincent Hospital Hot Springs Presentation

• Forbes Hospital Presentation

• Palisades Medical Center Reaction

• Questions, Answers, & Discussion

• Leaving in Action

• Announcements & Reminders


Meeting Logistics

• All telephone lines are muted • We encourage comments, questions, and

reactions via Chat • Participate!

– Chat – Polls – Post-Event Survey


Introduction to Adobe Connect

Closed Captioning

Download Available Resources

To Ask Questions

or Send Messages

To Dial In Via

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Resources


Let’s Chat!

• Use the Chat pod to submit any questions or comments

• Please use “@” if your question/comment is directed to a specific presenter

• Submit your question/comment by clicking the chat bubble icon

• Please share in Chat now : – Organization – Location – A CJR improvement activity currently

in progress at your organization


Using Data to Drive Improvement Series: Past Webinars

Using Data to Drive Improvement – June 14th, 2018

Using Data to Drive Improvement: Part 2 – August 9th, 2018


Poll

I took action or worked with others in my organization to take action based on my participation in the Using Data to Drive Improvement webinar series. • Strongly Agree • Agree • Neither Agree or Disagree • Disagree • Strongly Disagree • I Did Not Attend the Earlier Webinars in this Series

If applicable, please briefly explain what actions you took based on your participation. For example, did you share the information with your team, consider implementing a practice mentioned by another CJR participant hospital, etc.?


Beneficiary Incentive Summary

• Beneficiary Incentives are available to hospitals participating in the CJR model. This allows participating hospitals to provide certain items or services to CJR beneficiaries during an episode of care that is not tied to the standard provision of health care. – The item or service must be reasonably connected to a beneficiary’s

medical care and either be preventive or advance a clinical goal. – Hospitals must document items/services that exceed a value of $25. – Items/services involving technology may not exceed $1,000 in value.

• Example of Beneficiary Incentive: post-surgical monitoring equipment


FAQs about Beneficiary Incentives

• There is no limit to the amount of money a hospital can spend on beneficiary incentives that are not technology - related – Technology related items or services may not exceed $1,000 in value

• Hospital’s costs for beneficiary incentives do not count toward calculation of episode spending

• Beneficiary incentives may not be provided to a beneficiary prior to initiating a CJR episode

• The hospital does not have to choose from a list of accepted technologies or services

• Hospitals must maintain documentation of items and services furnished as incentives with a retail value of $25 or greater.

Source: https://innovation.cms.gov/Files/x/cjr-faq.pdf

https://innovation.cms.gov/Files/x/cjr-faq.pdf


Beneficiary Incentive: General

a. General. Participant hospitals may choose to provide in - kind patient engagement incentives to beneficiaries in a CJR episode, subject to the following conditions:

1. The incentive must be provided directly by the participant hospital or by an agent of the hospital under the hospital's direction and control to the beneficiary during a CJR episode of care.

2. The item or service provided must be reasonably connected to medical care provided to a beneficiary during a CJR episode of care.

3. The item or service must be a preventive care item or service or an item or service that advances a clinical goal, as listed in paragraph (c) of this section, for a beneficiary in a CJR episode by engaging the beneficiary in better managing his or her own health.

4. The item or service must not be tied to the receipt of items or services outside the CJR episode of care.

5. The item or service must not be tied to the receipt of items or services from a particular provider or supplier.

6. The availability of the items or services must not be advertised or promoted except that a beneficiary may be made aware of the availability of the items or services at the time the beneficiary could reasonably benefit from them.

7. The cost of the items or services must not be shifted to another federal health care program, as defined at section 1128B(f) of the Act.

Source: https://www.govinfo.gov/content/pkg/CFR-2016-title42 - vol5/pdf/CFR-2016-title42-vol5-sec510-515.pdf

https://www.govinfo.gov/content/pkg/CFR-2016-title42-vol5/pdf/CFR-2016-title42-vol5-sec510-515.pdf


Beneficiary Incentive: Technology

b. Technology provided to a CJR beneficiary. Beneficiary engagement incentives involving technology are subject to the following additional conditions: 1. Items or services involving technology provided to a beneficiary may not exceed $1,000 in retail value

for any one beneficiary in any one CJR episode. 2. Items or services involving technology provided to a beneficiary must be the minimum necessary to

advance a clinical goal, as listed in paragraph (c) of this section, for a beneficiary in a CJR episode. 3. Items of technology exceeding $100 in retail value must –

i. Remain the property of the CJR participant; and ii. Be retrieved from the beneficiary at the end of the CJR episode. The participant hospital must

document all retrieval attempts, including the ultimate date of retrieval. Documented, diligent, good faith attempts to retrieve items of technology will be deemed to meet the retrieval requirement.

Source: https://www.govinfo.gov/content/pkg/CFR-2016-title42-vol5/pdf/CFR-2016-title42-vol5-sec510-515.pdf



Beneficiary Incentive: Goals

c. Clinical goals of the CJR model. The following are the clinical goals of the CJR model, which may be advanced through beneficiary incentives:

1. Beneficiary adherence to drug regimens. 2. Beneficiary adherence to a care plan. 3. Reduction of readmissions and complications resulting from LEJR procedures. 4. Management of chronic diseases and conditions that may be affected by the LEJR procedure.




Beneficiary Incentive: Documentation

d. Documentation of beneficiary incentives. 1. Participant hospitals must maintain documentation of items and services furnished as beneficiary

incentives that exceed $25 in retail value. 2. The documentation must be established contemporaneously with the provision of the items and

services and must include at least the following: i. The date the incentive is provided. ii. The identity of the beneficiary to whom the item or service was provided.

3. The documentation regarding items of technology exceeding $100 in retail value must also include contemporaneous documentation of any attempt to retrieve technology at the end of a CJR episode as described in paragraph (b)(3) of this section.

4. The CJR participant hospital must retain and provide access to the required documentation in accordance with § 510.110.




Presentations

The examples that follow do not serve as advice or endorsements provided by the Centers for Medicare and Medicaid Services. The ultimate responsibility for compliance with the regulations lies with the provider of services.

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CHI St. Vincent Hospital Hot Springs Presentation

Teresa Lambert, MBA, BSN, RN, OCN Clinical Director of Nursing

Chastity King, BSN, RN, CCM Comprehensive Joint Replacement

Clinical Care Coordinator

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Total Joint Replacement Program CHI St. Vincent Hot Springs Hot Springs, Arkansas

Teresa Lambert, MBA, BSN, RN, OCN Clinical Director, Nursing

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CHI St. Vincent Hot Springs

• Located in Hot Springs, Arkansas • Licensed for 282 beds • Perform approx. 800 TJR annually • Service area is Southwest

Arkansas, East Texas and Oklahoma

• Level II Trauma Center • Received The Joint Commission’s

Gold Seal of Approval® for Advanced Certification for Total Hip and Total Knee Replacement

• All Orthopedic doctors are integrated physicians

Catholic Health Initiatives 19

Current State Patient Experience & High-Level Care Path (1)

High-Level Process Major Steps in PTKA patient flow

Best Practice Activities & Systems Services & Outcomes differentiating sub-processes and communications standards

• Consistent discharge expectations set cross the continuum of care, beginning with the surgeons.

• AR Health Network RN Population Health Coaches assist with post acute calls and serve as resources.

• Someone available for patients to contact 24/7. Open lines of communication for escalation of issues.

Catholic Health Initiatives

Current State Patient Experience & High-Level Care Path (2)

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High-Level Process Major Steps in PTKA patient flow

Best Practice Activities & Systems Services & Outcomes differentiating sub-processes and communications standards


Discharge Disposition (1)

Episodes discharged to SNF, IRG, or LTAC utilization have decreased 48% from Baseline period • On average, 78% of episodes are discharged to Home or Home Health per quarter • Episodes discharged to SNF or IRF = 27% in 2017 Q2 (up from 19% in prior 3 quarters)


Discharge Disposition (2)


90 Day Readmissions


Screening

• Begins in Physician Office with screening tool and contract for joint replacement

• Continues with Joint Academy

• No Coach - No Surgery

• Reassessed before discharge

• Follow - up calls made at 24 - 48 hours, 7 - 10 days, 30days, 60 days and 90 days. If in LTC, calls are weekly until discharged

• Barriers identified


Post-op Calls (1)

• Follow - up calls made at 24 - 48 hours, 7 - 10 days, 30days, 60 days and 90 days. If in LTC, calls are weekly until discharged


Joint Academy Attendance

Post-op Calls (2)



Barrier Solutions (1)


Barrier Solutions (2)

• Community Services ü Food Pantries ü Charitable Christian Medical Clinic ü AHN Social Worker ü Churches ü Area Agency on Aging ü Home Health Agencies


Concerns

• Transportation

• Cost of Medication


QUESTIONS

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Forbes Hospital Presentation

Elizabeth Trent, CMA (AAMA), AAS Orthopedic Navigator

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Forbes Hospital Patient Navigation of Joint

Replacement Patients

Forbes Hospital is located in Monroeville, Pennsylvania. We are part of the Allegheny Health Network system and a

Level 2 Trauma Center. Our Orthopedic “Diamond Care” program has been in place for 5 years.

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Creating A Network of Excellence

Standardizing the continuum of care from decision for surgery through discharge planning resulting in better patient outcomes, increased patient satisfaction and lowering the overall costs.

All processes and protocols are developed through clinician collaboration and are established for every department that “touches” the patient.

TJR – Process Map

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Physician and Patient agree to

Joint Replacement

Pre-Operative Testing

Patient Education

Admissions Case Management

Day of Surgery

Pre-Op Room

Operating Room

PACU

Patient Room

Physical Therapy

Post Acute

Discharge Home Health

Out-Patient PT

SNF

Pre-Op Planning Hospitalization

Diamond Care Navigator

Freedom of

Choice

IPR

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AREAS OF FOCUS

Patient Outcome

Patient Selection Ø Pre Op Testing Ø Comorbidities Ø Pre Hab Visits Ø Anesthesia Consults Complications Ø IV Antibiotics Ø Room Traffic Ø Instrument Preparation Ø Same Day Rehab Ø Dedicated Joint Floor Episode of Care Ø Discharge Destination Ø Length of Stay

Partner Facilities versus Non Partner Facilities

Patient ExperiencePre Op Ø Welcome Packet Ø Education Ø Insurance

MiJourney App Hospital StayØ Dedicated Resource Ø Dedicated Room Ø Anticipated Expectations Ø Meds to Beds Program

Physical/OccupationalTherapy

Post Op Ø Follow up Ø Understanding of Rehab Ø Patient Survey Ø Phone calls Ø Get well cards

CostFacility CostØ Adopt GPO Contracts Ø Create Hospital Margin Ø Implement Protocols Lean MethodologyØ Eliminate Waste Ø Eliminate Variability Ø Standardize Flow

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ADDRESSING SOCIAL DETERMINANTSPreoperative Education Class Components • Nutrition (15 minutes)

• Dietician speaks to preoperative and postoperative nutrition• Able to provide nutritional protein drink samples or coupons

• Home Environment• Preparing home for post - discharge• Durable Medical Needs obtained in advance

• Educational materials• MiJourney Application

Preoperative Home Visits• Implemented "Pre - H ab" h ome visit• Surgeons identify patients• PT conducts visit to patient home and makes recommendations:

• Discharge Disposition• Changes or modifications to home environment

In process of identifying other resources in the community to help address social factors

• Patienty Safety Concerns

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SUSTAINABILITY

Monthly data files measuring outcomes, experience and cost

Monthly compliance of processes and

protocols

Quarterly meetings to review process and contracts.

Continually approve

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Thank you

Elizabeth Trent, CMA (AAMA), AAS Orthopedic Navigator

Forbes Hospital [email protected]

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Reaction

Zoraida Bautista Clinical Program Manager Palisades Medical Center


Questions & Answers

• Use the Chat pod to submit any questions

• Please use “@” if question is directed to aspecific presenter


Leaving in Action

• Please type into the Chat pod:– What new information have you identified today that you

will continue to think about and work on throughout thenext month?

43


Announcements & Reminders


Continue Discussion on CJR Connect

• Join the Discussion!o Engage with your peers on CJR Connect by liking and commenting on their

posts• If you would like to ask a question of your peers or today’s speakers, you can:

o Go to the Groups tab, select “CJR All” and post your question in the group,OR

o Go to the Chatter tab, type a message into the open text box using the“Post to All” feature.


Resources Available

Event Resources • CJR Implementation Toolkit• At a Glance Resource Guide

To download a file, select the file and click the Download File(s) button which will open a pop - up window that will allow you to save the document to your computer.

Web Links • CMLN SDOH Links

To access a web link, select the link and click the Browse To button which will open the URL in your browser.


Upcoming Events

Strategies and Innovations in the CJR Model: Advanced Discharge Planning and Coordination

February 21, 2019 2-3 PM EST

If you have any questions about this event, send an email to [email protected].

mailto:[email protected]


Reminders

• Send any questions to [email protected].

• To request a CJR Connect account, go to:https://app.innovation.cms.gov/CJRConnect/CommunityLoginand click “New User? Click Here.”

• Please take a few minutes to respond to the Post - Event Survey!

mailto:[email protected]

https://app.innovation.cms.gov/CJRConnect/CommunityLogin

using data to drive improvement: addressing social … · 2 days ago · using data to drive...

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