LTAC s Role in the Continuum: Opportunities for Enhanced Financial Performance and Patient Satisfaction

Transcription

1 LTAC s Rle in the Cntinuum: Opprtunities fr Enhanced Financial Perfrmance and Patient Satisfactin O H I O H O S P I T A L A S S O C I A T I O N A N N U A L M E E T I N G J U N E 9,

2 Presenters Thmas Knske, CEO, Regency Hspital Cleveland East Lynn Schen, CEO, Kindred Hspital f Daytn Kristen J. Weinhart, MSN, RN, Directr Patient Care Services, Critical Care, Dialysis, Munt Carmel West

3 Learning Objectives 1. Define lng-term acute care (transitinal care) hspitals including service mix, cmmn patient diagnses, patient acuity and quality metrics 2. Demnstrate hw acute care and lng-term acute care hspitals can partner t enhance the acute care hspital s case management ptins, manage hspital readmissin rates and imprve financial perfrmance 3. Demnstrate hw acute care and lng-term acute care hspitals can partner t enhance patient satisfactin

4 Learning Objectives 1. Define lng-term acute care (transitinal care) hspitals including service mix, cmmn patient diagnses, patient acuity and quality metrics 2. Demnstrate hw acute care and lng-term acute care hspitals can partner t enhance the acute care hspital s case management ptins, manage hspital readmissin rates and imprve financial perfrmance 3. Demnstrate hw acute care and lng-term acute care hspitals can partner t enhance patient satisfactin

5 What is Pst-Acute Care? In 2012, Medicare spent apprximately $62 billin n pst-acute care Pst-acute care prviders include: Lng-term acute care hspitals Inpatient rehabilitatin facilities Skilled nursing facilities Hme health Assisted living Hspice

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7 Fcus Cmparisn f Pst-Acute Prviders LTAC High acuity, medically cmplex patients Rehab Hspital (IRF) Restratin f functinal independence Skilled Nursing Facility Step-dwn medical/rehab care Nursing Hme Lng-term supprtive care Length f Stay 25+ days days days Indefinite Medically Cmplex Patients? Ventilatr- Dependent Patients? 24 Hur Respiratry Therapy? Brad Range f Physicians? Nursing Hurs Per Patient Day Yes N Sme N Yes N N N Yes N N N Yes Yes, if in an acute-care hspital N N

8 What is an LTAC? Certified as an acute care hspital and meets criteria t participate in Medicare Certified by Medicare as a lng-term care hspital based n an average length f stay > 25 days May be accredited by JCAHO Specializes in the treatment and rehabilitatin f medically cmplex patients wh require an extended stay in a hspital setting

9 What is an LTAC? Uses the same DRG s as an acute care hspital, hwever, the same diagnsis will have a different weight in an LTAC May be free-standing r c-lcated within an acute care hspital There are 449 LTAC s in the United States There are 25 LTAC s in Ohi

10 LTAC s are nt nursing hmes

11 Ohi Hspitals

12 LTAC Services Include Daily physician visits Access t multiple physician specialties Nursing Respiratry therapy Physical, ccupatinal and speech therapy Nutritinal therapy Telemetry Dialysis Wund care Prcedures (e.g. brnchscpy, PEG tube placement, debridements) Labratry, radilgy and pharmacy Case management

13 LTAC Patients Referred frm a variety f health care settings 95% cme frm acute care hspitals 35% f Medicare beneficiaries are discharged frm acute care hspitals t a pst-acute prvider 2% are discharged t an LTAC Surce: Research Triangle Institute, 2009: Examining Pst-Acute Care Relatinships in an Integrated Hspital System

14 LTAC Patients Have a large variety f cmplicated clinical cncerns including: ventilatr dependence pulmnary disease cardiac disease kidney disease cmplex wunds infectins requiring lng-term IV antibitics Vary widely in age

15 Patients wh need the mst intensive pstacute care are ften discharged t LTAC s

16 Tp 10 DRG s fr Patients Referred t an LTAC Acute Care DRG 871 Septicemia w/ MV 96+ hurs 004 Trach w/mv 96+ hurs 003 ECMO r trach w/ MV 96+ hurs 853 Infectins & parasitic diseases 870 Septicemia w/ MV 96+ hurs Acute Care Weight Acute Care Gemetric Mean LOS Number f Discharges t LTAC , , , , ,768

17 Tp 10 DRG s fr Patients Referred t an LTAC Acute Care DRG 207 Respiratry w/ ventilatr (96+ hurs) 291 Heart failure and shck with MCC 193 Pneumnia and pleurisy 177 Respiratry infectins 329 Bwel prcedures w/ MCC Acute Care Weight Acute Care Gemetric Mean LOS Number f Discharges t LTAC , , , , ,563 Surce: 2013 MedPAR, Medicare FFS nly

18 LTAC Quality Metrics Percentage f patients that return t an acute care setting Percentage f patients that discharge t a lwer level f care Ventilatr wean rates Hspital-acquired infectin rates (BSI and UTI) Restraint rates Patient satisfactin scres

19 Learning Objectives 1. Define lng-term acute care (transitinal care) hspitals including service mix, cmmn patient diagnses, patient acuity and quality metrics 2. Demnstrate hw acute care and lng-term acute care hspitals can partner t enhance the acute care hspital s case management ptins, manage hspital readmissin rates and imprve financial perfrmance 3. Demnstrate hw acute care and lng-term acute care hspitals can partner t enhance patient satisfactin

20 LTAC s Can Assist Acute Care Hspitals Manage length f stay Manage cst fr medically cmplex patients (especially imprtant in ACO s) Reduce readmissin rates Imprve pst-discharge utcmes

21 Manage Length f Stay Reduce ICU bttlenecks by referring patients frm the ICU t the LTAC setting LTAC s effectively manage high-acuity patients LTAC s can manage and initiate weaning f newly intubated patients

22 Days LTAC s Lwer the Cst f Care fr the Medically Cmplex Average Length f Stay fr Medicare Patients DRG 003 and 004 ECMO r Trach w/ Mechanical Ventilatin 96+ Hurs Nn-LTAC Discharges LTAC Discharges 2013 MedPar, Medicare FFS Data

23 LTAC s Prvide Cst-Effective Care $3,000 $2,500 $2,000 $1,500 $1,000 $500 $0 Cst per Day Acute Care Hspital Reimbursement per Day LTAC 2013 MedPar, Medicare FFS Data

24 LTAC s Prevent Readmissins Hspitals are nt ging t achieve meaningful reductins in readmissins unless they are partnered with pst-acute care. Terry O Malley, MD, Medical Directr, Nn-Acute Care Services, Partners HealthCare

25 LTAC s Prevent Readmissins Apprximately 20% f all Medicare patients are readmitted t acute care hspitals within 30 days f discharge and represent 17% f ttal Medicare spending A study based n 2010 Medicare data shwed nly 8% f patients with heart failure r pneumnia diagnses were readmitted frm a study grup f 75 LTAC s t their hst r primary referral acute care hspital

26 LTAC s Prevent Readmissins Patients can be admitted directly frm an Emergency Department t an LTAC

27 Learning Objectives 1. Define lng-term acute care (transitinal care) hspitals including service mix, cmmn patient diagnses, patient acuity and quality metrics 2. Demnstrate hw acute care and lng-term acute care hspitals can partner t enhance the acute care hspital s case management ptins, manage hspital readmissin rates and imprve financial perfrmance 3. Demnstrate hw acute care and lng-term acute care hspitals can partner t enhance patient satisfactin

28 Discharge t an LTAC Can Enhance Patient Satisfactin Allws fr lnger, medically-supervised recvery time Enables Medicare patients t cntinue t use their hspital benefit and preserve their skilled nursing benefit if needed fr further recvery Majrity f LTAC s utilize a third-party t measure patient satisfactin

29 Develping a Framewrk fr Partnership Educate attending physicians, cnsulting physicians, nurses and case managers abut LTAC s Establish nging lines f cmmunicatin Cllabrative review f ptential referrals Peer-t-peer handffs fr referred patients Onging review f quality metrics Discuss care cllabratin and perfrmance imprvement pprtunities

30 Questins