LOUISIANA ASSOCIATION FOR HEALTHCARE QUALITY NOVEMBER 9, 2008

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1 Louisiana Health Care Review (LHCR) is one of 14 Medicare Quality Improvement Organizations (QIOs) awarded the Care Transitions special project by the Centers for Medicare & Medicaid Services (CMS). The Care Transitions Project is a three-year effort to be conducted by Louisiana Health Care Review, Inc., the QIO for Louisiana, in partnership with hospitals, other care providers and stakeholders in the Baton Rouge area. The project will focus on identifying and implementing a variety of interventions in the hospitals and the community that will improve the discharge process and avoid unnecessary readmission of patients with Acute Myocardial Infarction (heart attack), Congestive Heart Failure, and Community- Acquired Pneumonia. Louisiana ranks at or near the top in cost of care per Medicare beneficiary and hospital readmission rates. Evidence shows health care costs can be reduced and patient satisfaction and quality of life can be improved if patients get the followup support and after-care they need to avoid another hospital stay. LHCR will work with these providers to achieve improvement in patient and staff satisfaction and cost savings as unnecessary readmissions are reduced. This material was produced by Louisiana Health Care Review, Inc. (LHCR), the Medicare Quality Improvement Organization for Louisiana, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. LA9SoW5E108-O1843 The Louisiana Association for Healthcare Quality (LAHQ) is our state's leading organization for healthcare quality professionals. Founded in 1976 Incorporated in 1982 as the "Louisiana Association of Quality Assurance Professionals" Name changed in 1995 to Louisiana Association of Healthcare Quality (LAHQ) Our mission: to promote quality healthcare in Louisiana to maintain the integrity of the practice of quality improvement Our purpose: to support the development and professional growth of healthcare quality management professionals through education, networking and unity. REGION II NEWSLETTER, NOVEMBER 2008 Back in the Saddle Again! Great news from Region II. A Kick-Off Meeting was held on July 30 th at Ground Patti Restaurant in Lafayette and the turnout was excellent. While Region II membership is still small, the folks who attend brought a wealth of knowledge, information, enthusiasm, and connections. Established members and prospective members attended and plans were made to address membership issues and educational needs. The Region will meet monthly at first with internal education by way of round table discussions and plans to expand educational opportunities as the membership and resources allow. PAGE 1

2 REGION II NEWSLETTER, NOVEMBER 2008 (CONTINUED) THE MEMBERSHIP EXPRESS ROLLS ON Region II is full steam ahead!! Since July, we have had improvement in membership and have had several prospective members check us out! Members from all levels of expertise in quality have afforded Region II a diverse membership base, with representation from acute care, home care, infection control, education, as well as quality backgrounds. Membership initiatives have included outreach to quality professionals in the homecare, long-term care, and hospice industries, in addition to the continued networking with local quality professionals from the acute care setting. Through continued membership efforts by all current members, networking opportunities and potential memberships are promising for the near future! REGION II EXECUTIVE BOARD ELECTED The Region II membership recently elected its Executive Board to serve for term. The Executive Board Officers are Melynda Boothe President of Region II and Region II Representative for LAHQ, Catherine Belden - President-Elect, Andrea Fontenot Secretary and LAHQ Secretary, and Debbie Gooch Treasurer. The Officers and membership look forward to a fulfilling and Region IV Update October 2008 Region IV continues to make progress toward our two primary goals: (1) to increase membership and (2) to increase health care setting diversity in membership, programs, participation, and offerings. Our mid-summer luncheon on July 18 th at Ralphs on the Park was a success. Everyone enjoyed a delicious lunch and the speaker, Jennie Campbell, shared many tips on how to apply project management techniques to gain efficiencies in managing our personal lives, families, and our jobs; and, most importantly, preserving our values and sense of self at the same time. Region IV is tying up the loose ends for our Annual Education Conference on November 14, The conference will be held at the J. Bennet Johnson building on Tulane Ave. The conference titled Boot Camp: Performance Improvement 101 and Beyond covers the quality continuum from understanding productive year for Region II! The Executive Board has also recently completed bylaw revisions and are presenting to the general membership for approval soon. EDUCATION LIKE QUALITY IS JOB I! Region II recognizes the important role that continuing education opportunities play in achieving quality in healthcare. To meet the need for membership networking and education, Region II members will begin presenting various topics at meetings for education and discussion by its membership, ranging from healthcare legalities, infection prevention, safety, and other relevant issues. Topics recently presented roundtable included secrets to successful DHH surveys, outpatient core measures, and medical care evaluation studies. For more information, please contact: Melynda Boothe, MA CCC/SLP, CPHQ (337) Melynda.boothe@lhcgroupcom or Catherine Belden, RN, MSN, CLNC, CIC (337) Catherine.belden@lhcgroup.com the rationale and key elements that should be covered in an organization s quality plan to incorporating the utilization of data at an executive level into the participant s daily practice. Topics include: Annual Quality Plan presented by Donna Saxton, FACHE, MHA, MPH PAGE 2

3 Region IV Update October 2008 (continued) Data Collection presented by Valerie Luker, RN, CPHQ Statistical Analysis and Display presented by Linda McNeill, RN, MS Benchmarking presented by Sharon Cusanza, RN, CPHQ Reporting Quality Outcomes at the Executive Level presented by Troy Trosclair, RN, DNS Bringing it All Together a panel discussion with John Reilly, MD, FACC; Lisa Colletti, RN, MN; and Cindy Dauner, RN, MPH, CPHQ We will round out the year with our annual Holiday Luncheon where we simply gather to share a little taste of the holiday spirit, enjoy each other s company, and look forward to 2009 when we kick off our year with Dr. Kenneth Rhea s presentation on The Impact of Physician Communication on Patient Safety and Malpractice Risk. Reported by Linda Paradise-McNeill Region V Update, October 2008 Region V has not had much activity this year, but we are looking forward to increasing our activities and our membership in the coming months and the new year. We are planning an end of the year Get Acquainted for all current members to meet and get to know one another. Plans are to develop a schedule for reoccurring meetings and to plan programs and educational offerings for the coming year. We look forward to a fresh new year of real growth and abundance in quality programs and offerings for Region V members observed National Healthcare Quality Week October 20 24, 2008 at the Alexandria VA Medical Center. Members provided educational information to staff on an array of quality and patient safety initiatives each day of the week. The topics covered included: Performance Improvement MRSA Utilization Review Credentialing and Privileging Risk Management Our plans for the upcoming year are to become more diverse in our membership, programs and activities to reflect the many different areas that work together to increase the quality of healthcare. Respectfully Submitted: Anita Jordan, RN, MSN Region V Representative Long Term Acute Care: Another Piece in the Quality Continuum Long Term Acute Care..At first glance this may appear to be an oxymoron. Long Term Care in this country has historically been viewed as being reserved for those with chronic conditions in which return to home is not possible. Insert the word Acute and an entirely different entity appears. Long Term Acute Care Hospitals (LTACHs) are not new to the healthcare continuum. However, only approximately 300 such hospitals in the nation exist and there is often an unfortunate lack of understanding of the LTACH s role in the continuum of care. LTAC hospitals by definition are acute care facilities whose mission is to provide extended acute hospitalization services for patients with complex medical conditions. In order for a hospital to PAGE 3

4 LTAC: Another... (continued) be considered an LTACH, it must maintain an average length of stay of at least 25 days. This history of LTAC hospitals is quite interesting. The History of the LTACH LTAC hospitals often evolved from former TB and chronic disease hospitals with most patients being uninsured or underinsured. As time progressed, these hospitals transitioned to providers who specialized in treating many different complex conditions with a much greater emphasis on acute conditions. Older LTAC hospitals were usually free standing and had greater than 100 beds. These older LTACs were established and operating prior to the implementation of the inpatient prospective payment system (IPPS) in With the implementation of IPPS, a new type of LTACH evolved. These new LTACHs increased the complexity of medical conditions treated and often included complex respiratory conditions and complex wound care. Patient populations also included CVAs that could not tolerate three hours of therapy and cancer patients. Most LTAC hospitals today provided a complete compliment of therapy services including Physical Therapy, Occupational Therapy, and Speech Pathology. In comparison, newer LTAC hospitals, i.e., those established post IPPS, are more often than not colocated within short stay acute care hospitals. These types of providers are known as Hospitals-within-hospitals (HwHs). With regards to reimbursement, older LTACHs are typically less than 50% Medicare and the new HwHs are predominantly reimbursed by Medicare. Role in Quality Continuum The role of LTACs in the continuum of care was solidified with the establishment of IPPS in It was no longer cost effective to care for the significantly medically complex patient in the traditional short stay acute setting. The need for a venue which could provide this intensive medical care coupled with specialized services such as therapy and wound care became critical. It was also crucial as well that the quality of this care be equal to or greater than that provided in any other setting. After all, these were the sickest of the sick. It was in this vein that these newer LTAC hospitals, predominately HwHs began to flourish. Following suit with traditional short stay acute care hospitals, LTACHs recognized the need for comprehensive quality programs. Licensed as acute care hospitals and with the majority of LTACHs participating in the Medicare program, these facilities are obliged to maintain compliance with all state regulatory requirements, as well as, with Medicare s Conditions of Participation. While many are Joint Commission accredited, as with short stay acute care hospitals, accreditation is not mandatory. Payments to LTAC facilities are based on the LTCH PPS system. To date, LTACHs are not subject to participate in the Core Measures or pay-forperformance programs. However, their quality measures are no less stringent. LTAC hospitals must have formal performance improvement programs that address all areas of the hospital including all contracted services. Utilization management, infection control, patient safety, and formal oversight of medical staff performance are required components of the PAGE 4

5 LTAC: Another... (continued) LTACH s quality program. They are required to have an independent governing body that is responsible for all aspects of hospital operations including quality of care and safety. Medical care in this country continues to evolve and the complex array of services available to extend and improve quality of life is ever expanding. This expansion of knowledge is creating a need for a place to continue to provide for the sickest of the sick and to ensure that stateof-the art services are accessible. It is here that the LTAC hospital is not only appropriate but is also crucial to the Healthcare Quality Continuum. Reference: RTI International Health, Social, and Economics Research Project Number ; February 2005 Calendar January 10, 2009 Winter NEWSLETTER ARTICLES DUE April 10, 2009 Spring NEWSLETTER ARTICLES DUE April 29, 30 & May 1, 2009 LAHQ Board Meeting & Symposium Lafayette Hilton & Towers, Pinhook Road Lafayette, LA Constructive Relationships. An exceptional leader develops constructive relationships with others and recognizes the interdependence between the board, teams, and individual members. Effective leaders exhibit trust in others and communicate with candor, respect, and honesty. Steven Savant 100 Jonah Circle Lafayette, LA Addressee Name 4321 First Street Anytown, State 54321