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The Meaningful Care Organization – Developing Patient Engagement Strategies to Weather the Perfect Storm of 2013
Timothy Kelly, MS, MBA Dialog Medical A Standard Register Healthcare Company
2013 TxHIMA Annual Meeting & Convention Omni Fort Worth Hotel June 28-30, 2013
2013 – A “Perfect Storm” Four Converging Legislative Initiatives
Cash for Clunkers and Meaningful Use
Cash for Clunkers <$3 billion
Grassley seeks accounting of 'Cash for Clunkers' costs. The Washington Post. January 7, 2010.
Rock and a hard place: An analysis of the $36 billion impact from health IT stimulus funding. Price Waterhouse Coopers. April 2009.
“Meaningful Use” (Healthcare Information Technology)
~$36 billion
American Recovery and Reinvestment Act of 2009
HITECH Act
Meaningful Use
Meaningful Use (MU)
HITECH Act
HITECH Act
“The changes we’re announcing today will lead to more coordination of patient care…and greater patient engagement in their own care” Health and Human Services Secretary Kathleen Sebelius announcing the Stage 2 Final Rule. August 23, 2012.
$12.6 billion in incentives paid to date (program inception through February 2013)
85% of eligible hospitals are participating in the EHR Incentive Program
75% of eligible hospitals have received an incentive payment to date
HITECH Act
Source: CMS Fact Sheet: A Record of Progress on Health Information Technology. CMS Media Relations. April 23, 2013.
Accountable Care Organizations
Patient Protection and Affordable Care Act of 2010
Medicare Shared Savings Program
Accountable Care Organizations
Accountable Care Organizations (ACOs)
Accountable Care Organizations
Voluntary groups of physicians, hospitals and other healthcare providers:
Responsible for care of a clearly defined Medicare population
Designed to foster patient-centered, coordinated care
If it succeeds in providing high-quality care while reducing cost, it shares in savings achieved for Medicare
Accountable Care Organizations (ACOs)
Source: Berwick DM. N Engl J Med 2011;365:1753-1756.
Three Goals of ACOs Better care for individuals Better health for
populations Slower growth in costs
through improvements in care
Berwick DM. N Engl J Med 2011;364(16):e32.
Accountable Care Organizations
Accountable Care Organizations
Accountable Care Organizations (ACOs)
Source: January 2012 survey of hospitals, physician organizations and health systems reported in: Tocknell MD. The Unsettled State of the ACO. HealthLeaders Media Intelligence Report. April 2012.
Currently part of an ACO?
11%
No - 89%
Plan to implement or join and ACO?
Yes - 61%
No - 39%
Yes -
Over 250 ACOs 106 on January 1, 20131
1 in 10 Americans is covered under an ACO2
Federal savings from this initiative could be up to $940 million over four years.1
Top Driver for creating an ACO – To engage physicians 56 percent of the respondents that
are or plan to be part of an ACO3 2HHS News Release. January 10, 2013. 1Gandhi N, Weil R. The ACO Surprise. New York: Oliver Wyman, November 2012. 3Tocknell MD. The Unsettled State of the ACO. HealthLeaders Media Intelligence Report. April 2012.
Accountable Care Organizations
National average readmission rate (Medicare patients): 19% Cost to Medicare is
$17.5 billion annually
2,217 hospitals will face penalties of over $280 million in 2013
Hospital Readmissions Reduction Program
Source: Rau J, Kaiser Health News, October 12, 2012 www.kaiserhealthnews.org/Stories/2012/August/13/medicare-hospitals-readmissions-penalties.aspx
Goals of Hospital VBP Program: Improve patient experience Better clinical outcomes
1 percent Medicare Holdback $ 850 million in 2013
Hospital Value-Based Purchasing (VBP) Program
Hospital Value-Based Purchasing Program Fact Sheet. Department of Health and Human Services. ICN 907664 November 2011.
Patient Satisfaction (30%)
Core Measures (70%)
VBP Performance Score
+
Patient-Centered Communications
HITECH
ACOs
Hospital VBP Program
Readmissions Reduction Program
Meaningful Use Objectives
Stages of Meaningful Use
Stages of Meaningful Use
Meaningful Use Objectives
Stage 1 Objectives for Hospitals 14 Core Objectives, 10 Menu Objectives (attain 5) First eligible payment year: 2011
Stage 2 Objectives for Hospitals 16 Core Objectives, 6 Menu Objectives (attain 3) First eligible payment year: 2014 Effectively incorporate all of the Stage 1 objectives,
along with additional objectives and higher measurement thresholds
Meaningful Use Objectives
Meaningful Use Objectives
Stage 2 Meaningful Use Objectives
19
Core Objectives Demographics Vital Signs Clinical Decision Support CPOE Transitions of Care View, Download and
Transmit to Third Party Privacy and Security Smoking Status Lab Results into EHR Patient-Specific Education Medication Reconciliation
Patient Input
Output
Input
Output Input
Core Objectives Generate Patient Lists Immunization Registries Lab Results to Public
Health Agencies Syndromic Surveillance
Menu Objectives Imaging Results Advance Directives ePrescribing Electronic Notes Electronic Lab Results Family Health History
Patient
Input
Input
Why Focus on Patient-Centered Strategies that are “Output” or
Communication-Oriented”?
“The single biggest problem in communication is the illusion
that it has taken place.” George Bernard Shaw
Output/Communication-Oriented Strategies
For the first time in 2012 Consumer Reports rated hospitals.
Output/Communication-Oriented Strategies
Communication was consistently the most poorly rated category.
Output/Communication-Oriented Strategies
Output/Communication-Oriented Strategies
These metrics are moving beyond the government sites to mainstream, consumer sites
Patient Satisfaction
Source: Kelly T. HIStalk, August 8, 2012 http://histalk2.com/2012/08/08/readers-write-8812/ (Accessed 5/10/13)
“Output-Oriented” Meaningful Use Objectives
“Output-Oriented” MU Objectives
Patient-Specific Education Patients who are provided patient-
specific education resources
Number of unique patients admitted to the hospital’s inpatient or emergency
departments during the reporting period
> 10%
“Output-Oriented” MU Objectives
2 Measures for this Meaningful Use objective
Both must be satisfied in order to meet the objective
View, Download and Transmit to Third Party
“Output-Oriented” MU Objectives
28
Patients whose information is available online within 36 hours of discharge
Number of unique patients discharged from the hospital’s inpatient or emergency
department during the reporting period
Patients who view, download or transmit to a third party the information provided online
Number of unique patients discharged from the hospital’s inpatient or emergency
department during the reporting period
> 50%
> 5%*
View, Download and Transmit to Third Party
*This measure was 10% in the Proposed Stage 2 Rule
Best Practices for Patient-Specific Education Materials
Best Practices
The informed consent discussion conducted by the surgeon should include:
1. The nature of the illness and the natural consequences of no treatment.
2. The nature of the proposed operation, including the estimated risks of mortality and morbidity.
3. The more common known complications, which should be described and discussed. The patient should understand the risks as well as the benefits of the proposed operation. The discussion should include a description of what to expect during the hospitalization and post hospital convalescence.
4. Alternative forms of treatment, including nonoperative techniques.
American College of Surgeons
American College of Surgeons Statements on Principles. Revised September 18, 2008. http://www.facs.org/fellows_info/statements/stonprin.html#anchor171960 (Accessed 5/10/13.)
Best Practices
Only 39% of 3,269 closed claims against anesthesiologists were judged to have adequate informed consent1
Inadequate informed consent was pursued as a secondary cause in more than 90% of ophthalmologic malpractice cases2
Lack of informed consent is one of the top 10 reasons for hospital malpractice claims3
Argument for Informed Consent
1Caplan RA, Posner KL. ASA Newsletter 1995;59(6):9-12. 2Kiss CG, Richter-Mueksch S, Stifter E, et at. Arch Ophthalmol 2004;122:94-98. 3Glabman M. Trustee 2004;57(2):12-16.
Best Practices
Needs to be electronic
Can’t be a “Medical Miranda Warning”
Argument for Informed Consent
Best Practices
WHO Surgical Safety Checklist
Best Practices
Need the consent for the Pre-Procedure Verification and/or the Time-Out
Verification of the consent is one of the most effective practices for avoiding wrong-patient/wrong-procedure/ wrong-site surgery1
Argument for Informed Consent
1Clarke JR, Johnston J, Finley ED. Ann Surg 2007;246:395-405.
Best Practices
Argument for Informed Consent
Best Practices
Reduce the risk of potentially life-threatening perioperative complications.
Pre-Procedure Instructions
Courtesy of the Baltimore VA Medical Center
Tea C. Perioperative concepts and nursing management. In: Smeltzer SC, et al, eds. Brunner and Suddarth’s Textbook of Medical-Surgical Nursing. Philadelphia, PA: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2010:422-483.
Best Practices
Lower the incidence of preventable surgery cancellations.
Pre-Procedure Instructions
Henderson BA et al. Incidence and causes of ocular surgery cancellations in an ambulatory surgical center. J Catarct Refract Surg. 2006;32(1):95-102
Pletta C et al. Efficiency improvement plan through patient education on thyroid imaging procedures. J Nucl Med. 2008;49(Supp 1):426P Courtesy of the Baltimore VAMC
Best Practices for Viewing, Downloading and Transmitting Patient Information
Best Practices
Providing patients with incomplete information at discharge can result in patient harm.
Discharge Instructions
Courtesy of the Portland VA Medical Center
Pennsylvania Patient Safety Advisory. 2008. Jun;5[2]:39-43.
Best Practices
Reduced the 14-day readmission rate three-fold by employing procedure-specific discharge instructions (4.1 per 1,000 outpatient procedures to 1.5 per 1,000).
Discharge Instructions
Boast P, Potts C. PS&QH. 2010;7(1):14-16.
Courtesy of the Portland VA Medical Center
Best Practices
Most valuable if they are sent well prior to the 36-hour threshold
Provided prior to admission
Paper as well as electronic
Discharge Instructions
Developing Initiatives in Your Own “Meaningful Care Organization”
The Meaningful Care Organization
Making Good on ACOs’ Promise — The Final Rule for the Medicare Shared Savings Program. N Engl J Med 2011;365(19):1753-1756. November 10, 2011.
http://www.nejm.org/doi/pdf/10.1056/NEJMp1111671
Meaningful Use – The Whiteboard Story – Stage 1 Final Rule Meaningful Use Objectives and Measures Compared to Stage 2 Final Objectives and Measures... Created as a reference tool for public use and convenience by The Advisory Board Company.
http://www.advisory.com/~/media/Advisory-com/CampaignItems/MU-Stage-2-White-Board-Story-Poster-2.pdf
Resources
43
Stage 1 Stage 2
The Meaningful Care Organization
“Meaningful Care” Checklist
45
Is the initiative patient-centered? Does it reduce risk? Does it enhance safety? Does it leverage the patient? Can you utilize HIT (EHR or
other systems)?
Does it support Stage 1 or Stage 2 Meaningful Objectives?
Yes No
Will a Focus on Patient-Centered Communications Impact the Selection
of Treatments/Procedures and Potentially the Efficiency of an ACO?
Potential Impact on Efficiency?
A series of nine reports of elective surgical procedures, released in late 2012, found wide variations in the treatments provided.
Dartmouth Atlas Project
Improving Patient Decision-Making: Regional Series. The Dartmouth Atlas of Health Care. http://www.dartmouthatlas.org/pages/decision_making_series (Accessed 5/10/13.)
Potential Impact on Efficiency?
Mastectomy rates range from 0.3 per 1,000 female Medicare patients in the San Francisco area, to 2.3 in Grand Forks, ND
Dartmouth Atlas Project
Potential Impact on Efficiency?
The report authors surmise that patients may not understand their full range of options and choices may be unduly influenced by providers and not patient preferences.
Dartmouth Atlas Project
Improving Patient Decision-Making: Regional Series. The Dartmouth Atlas of Health Care. http://www.dartmouthatlas.org/pages/decision_making_series (Accessed 5/10/13.)
Will a Focus on Patient-Centered Communications Impact Readmissions
or Patient Satisfaction?
Potential Impact on Readmissions/Satisfaction?
Press Ganey analysis of hospital readmission penalty scores vs. patient satisfaction scores.
Positive patient experience correlates well with low readmission rates and high readmission rates correlate well with poor patient experience.
Press Ganey HCAHPS Analysis
The Relationship Between HCAHPS Performance and Readmission Penalties. Press Ganey. http://healthcare.pressganey.com/content/201211-PIReadmissions (Accessed 5/10/13.)
Potential Impact on Readmissions/Satisfaction?
The relationship between patient satisfaction and readmissions is not causal. Rather it is most likely predictive of an environment stratified by patient-centered communications.
Press Ganey HCAHPS Analysis
Health Information Technology
Patient-Centered Communications
Greater Patient Satisfaction
Lower Readmission Rates
More Efficient ACOs
Patient Education Informed Consent Pre-Procedure Instructions Discharge Instructions
Stage 1 Stage 2 MU Objectives Stage 3
The Meaningful Care Organization
Questions?
www.standardregister.com/healthcare www.dialogmedical.com www.EngagingPatient.org (slides posted here)
Robbie Beck robbie.beck@standardregister.com
Tim Kelly tkelly@dialogmedical.com
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