Proving Respiratory Therapy value in the Affordable Care Pay Structure

Transcription

1 Proving Respiratory Therapy value in the Affordable Care Pay Structure

2 The Curve 2 2

3 No Margin No Mission (FFS) Outcomes 3 * 2001 study in five states found that medical debt contributed to 46.2% of all personal bankruptcies and in 2007, 62.1% of filers for bankruptcies claimed high medical expenses. [4] USA pays twice as much yet lags behind other wealthy nations in such measures as infant mortality and life expectancy. USA has a higher infant mortality rate than most of the world's industrialized nations. [nb 1][6] United States life expectancy is 42nd in the world 7]

4 No Margin No Mission (FFS) Outcomes * U.S. Census Bureau 49.9 million residents, 16.3% of the population, were uninsured in 2010 *According to the World Health Organization, the United States spent more on health care per capital ($7,146), and more on health care as percentage of its GDP (15.2%), than any other nation [5] *United States had the fourth highest level of government health care spending per capita ($3,426) [3] * Deaths in Hospitals two 3 year studies 100,000 year-747 Jet carries 500 people s 4

5 Accountable Care Organization? The New Reality No Outcome No Income What is an accountable care organization (ACO)? Why did Congress include ACOs in the law? How would ACOs be paid? Are there any possible legal concerns?

6 AARC Competencies needed by 2015 Diagnostics-PFT, Sleep, Invasive Dx Procedures Disease Management-Acute & Chronic Evidence-Based Medicine and Respiratory Care Protocols Patient Assessment -Patient Assessment, Diagnostic data, Physical exam Leadership-Team member, Health regulatory systems, written and verbal communication, Healthcare Finance, Team Leader

7 EVENT RATE (# of SSE/APD) x 10,000 Rolling 12 month Rate (Red Line) EVENTS Raw # of events each month (blue bars) RT s Contribution to ACO payment model SAFETY-$??? Began HPI Engagement Serious Safety Event Rate SM (SSER SM ) Rockingham Memorial Hospital Leadership Engagement *Safety First GOAL: Decrease SSE Rate to.44 by 12/31/11 Staff Training - Feb & March 2010 Validate & Verify and Speak Up For Safety Baseline Rate Rate of.83 2/11 Goal Rate of.44 = 2011 Goal 2 - J 2009 M M J S N J 2010 M M J S N 0 Serious Safety Event (SSE) = a deviation in generally accepted performance standards reaches the patient and results in moderate to severe harm or death.

8 RT s Contribution to ACO payment model -SAFETY

9 RT s Contribution to ACO payment model-why are RTs ready? Diseases we treat:-4 of top 15 RTs treat Patient points of entry -work in many of the patient s points of entry into healthcare system Patient Engagement; RTs spend more time with Patients in acute admission New payment model; -RTs understand ROI concept

10 RT s Contribution to ACO payment model -Inpatient DRG fixed payment Evidence based Clinical Practice Guidelines SBT, Assess & Treat, Multidisciplinary Rounds Emergency 911 Rapid Assessment C Section Asthma Education MDI reinstruction DME Handoff

11 RT s Contribution to ACO payment model - Inpatient DRG fixed payment BAN Improved Drug Delivery $135,000 Conventional Lung: 32% Throat: 68% Breath Actuated Lung: 72% Throat: 28% J Aerosol Med 2001;14(3):421

12 RT s Contribution to ACO payment model -Inpatient DRG fixed payment Anthem Q HIP $570,000

13 RT Contribution to ACO Payment Model- Pulmonary DX Out PFT In PFT MD Office PFT Airway IV sedation Traditional Bronchoscope EBOUS Bronchoscope Research Bronchoscope ABG CAP Surveyor

14 RT Contribution to ACO Payment Model- Public schools 5 th Year Towards No Tobacco Program-Evidence based OUTCOMES! Virginia Tobacco Settlement Foundation Grant 6 th graders in Rockingham County and City school

15 RT Contribution to ACO Payment Model- Pulmonary Rehab Improve patient functional capacity Monitored Exercise therapy Strength training with Disease education Pulmonary Associates Home Oxygen Sleep screen with Stop Bang Depression, Diabetes, Dietary

16 RT Contribution to ACO Payment Model-, Cardiac Cath/EP Labs, MD Office EKG Rhythms Emergency airway skills Cardio pulmonary training Hemodynamic Monitoring Artery access PFT Asthma Educator COPD

17 RT Contribution to ACO Payment Model- Sleep Lab OSA & Central Apnea CPAP titration CPAP interface Scoring Home studies CPAP Compliance Public Safety

18 RT Contribution to ACO Payment Model- Home Care Safety Oxygen administration conservation Ventilator CPAP Link to MD Third Party payors

19 RT s Contribution to ACO payment model - New Budget Metrics New Budget Metrics Transition from dollars charged to Overall metrics RC Budget Expense per RVU for non-labor, labor and Total expense Total Cost per unit of RT Service. Measure the total cost of providing RT service. Break this down into non salary and salary then total cost of care.

20 RT s Contribution to ACO payment model-aarc Benchmark 0.64 Adjusted 0.79 Variable 0.4% Missed 4.23 Days

21 RT s Contribution to ACO payment model-leadership Patient Bedside, Emergencies ICU MDR Acute Care Team Leadership Team Emergency Room Director Hospital committees-vap, ICU Transformation, Code Blue, Lab State Board of Medicine System Multiple Hospitals

22 RT s Contribution to ACO payment model- HCAHPS Customer Satisfaction from Medicare

23 RT s Contribution to ACO payment model- HCAHPS Customer Satisfaction from Medicare

24 RT s Contribution to ACO payment model-hcahps Customer Satisfaction from Medicare-$285,000

25 RT s Contribution to ACO payment model- COPD and Pneumonia Readmissions $ 25

26 Pepper Audit Pneumonia

27 RT s Contribution to ACO payment model-rac and PEPPER Audits $ RAC Proper CPT codes OBV status Pepper Audits Sputum cultures Simple Pneumonia vs Respiratory Infection Review of 28 cases 23/28 Sputum helped $15,500 and 5 cases moved from Simple to Resp Infection

28 Quality RC Recognition Program Quality Respiratory Care Recognition Means First Rate Respiratory Care As a respiratory patient you know you deserve the very best in respiratory care services. But how can you tell if that s what you re getting?the American Association for Respiratory Care (AARC) is here to help. The hospitals and home care companies receiving the Association s Quality Respiratory Care Recognition (QRCR) designation meet strict safety and quality standards related to the provision of respiratory care services by qualified respiratory therapists. Requirements for hospitals: All respiratory therapists employed by the hospital to deliver bedside respiratory care services are either legally recognized by the state as competent to provide respiratory care services or hold the CRT or RRT credential. Respiratory therapists are available 24 hours. Other personnel qualified to perform specific respiratory procedures and the amount of supervision required for personnel to carry out specific procedures is designated in writing. A doctor of medicine or osteopathy is designated as medical director of respiratory care services.

29 Quality RC Recognition Program Legally recognized by the state as competent to provide respiratory care services or hold the CRT or RRT credential. Respiratory therapists are available 24 hours. Doctor of medicine or osteopathy is designated as medical director of respiratory care services. Benchmarking efficiency and quality metrics with similar departments for the purpose of identifying and achieving best practice Other personnel qualified to perform specific respiratory procedures and the amount of supervision required for personnel to carry out specific procedures must be designated in writing. Hospital policy prohibits the routine delivery of medicated aerosol treatments utilizing small volume nebulizers, metered dose inhalers, or intermittent positive pressure treatments to multiple patients simultaneously. Hospital has a policy that prohibits Concurrent care

30 Going where no RT has ever been before.best Job!!!