GBMC HealthCare. Cathy Hamel VP Post Acute Services Executive Director, Gilchrist Hospice Care

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1 GBMC HealthCare Cathy Hamel VP Post Acute Services Executive Director, Gilchrist Care It is not necessary to change. Survival is not mandatory W. Edwards Deming

2 About GBMC HealthCare Community Hospital 200+ beds 90+ Primary Care Physicians 5 Medical Homes Old, Old Geriatric Practice Advanced Disease & Symptom Management (a.k.a. Palliative Care) Comprehensive Services Adults/Children life limiting illnesses (6 month prognosis) End of Life Care

3 ADSM and Benefits to Hospital Economic Reducing Readmissions Decreasing mortality rates Managing Length of Stay New source of care funding for the patient Clinical (Quality & Satisfaction) Extending life for the patient Comfortable EOL care tailored to patient preferences Family Support Resources Organization-specific quality Satisfaction with ADSM and/or hospice services increases hospital satisfaction and word-of-mouth marketing Operational Additional staffing support through GHC relationship Timely, effective transitional care Staff development and education for referral awareness and appropriateness Source: Trends in and Palliative Care: State of the Industry and Key Strategic Considerations. Advisory Board interviews and analysis; Landis and Brown. 2012

4 Lowering Costs: End-Of Life Care Cost Days in $2,561 enrollment ( days) $2,650 enrollment (1-7 days) $5,050 enrollment (8-14 days) $6,430 enrollment (15-30 days) Enrollment saves money for Medicare and Improves Care Quality across a number of different lengths of stay. Source: Enrollment Saves Money For Medicare and Improves Care Quality across a Number of Different Lengths-of-Stay; Kelley, S; Deb, P; Du, Quigling, Carlson, M; Morrison, S. Health Affairs; March 2013.

5 Dartmouth Atlas Data Understanding the Efficiency and Effectiveness of Health Care Inpatient Days 6 months Prior to DOD ICU Days 6 months prior to DOD % of Deaths with ICU Admission % admitted to Days GBMC * Hospital A** Hospital B** Hospital C** Region High GBMC GBMC Region Low *Prior to ADSM Program/2013 Trustees of Dartmouth College Data from ** Hospitals with significant hospice affiliations/ownerships

6 GBMC Readmissions

7 Phase 1: Interventions for Change- April 2012 Hospitalist/Attendings High Risk Order Sets E-fax Discharge Summaries to PCPs Clinical Review of all bounce backs Post Acute Providers Standardize Education Home Care Partners Transition Guides Liaison Expanded Care Program Care Management Re-Admission Interviews Didn t Understand Not confident No MD appointment Secure MD Appointment before DC Nursing Education Standardized Education Packets Magnets Interdisciplinary Team Data Drive Identified Target Population (CHF/COPD) Monitor Results

8 Phase 2: Interventions for Change- December 2012 Hospitalist/Attendings Surprise Question added to order sets Target Referrals to ADSM 6% Post Acute Providers Add SNF Network with our physicians Care Management New High Risk Referrals MD Appointments Readmission Interviews Integration with office based case managers Nursing Education Risk Score Use Pharmacy Med Rec prior to D/C Interdisciplinary Team Data Drive Add Colo-Rectal SSI Monitor Results Risk Score to Everyone

9 Case Study #1 81 yo male with PMH of End Stage Renal Disease on HemoDialysis, Coronary Artery Disease Status post Coronary Artery Bypass Graph Surgery, and aortic valve stenosis status post bioprosthetic valve, strep viridans bacteremia and subdural MRSA empyema who presented to GBMC with c/o nausea and vomiting -- thought to be secondary to constipation. Overall very frail. Patient admitted Sept, Nov., Dec and then in Feb. Second admission for infected catheter, then sepsis and endocarditis. Final admission for nausea and vomiting likely due to constipation. He had frequent issues with volume status. Throughout this time, he became more and more dependent functionally, and had waxing and waning mental status. Advanced Disease & Symptom Management (ADSM) consulted on day 2 of final hospital admission; ADSM met with wife and discussed transitioning goals of care and consideration of hospice. In the end, she elected to stop HD and transitioned to home hospice on day 4.

10 Case Study #2 70 yo female with metastatic pancreatic ca (diagnosed Aug 2012) P.J. was admitted 2/21 with nausea, abdom pain. ADSM saw P.J. on 2/25 and had a long discussion re: hospice services Had 2-3 hospitalizations prior to this one. P.J. elected home hospice and hospital-based Liaison was able to quickly make arrangements. Certainly would have had multiple hospitalizations if she did not elect hospice.

11 s In Maryland Stella Maris Gilchrist Care of Frederick County Carroll Calvert Western Maryland Health System of Chesapeake Joseph Richey EverCare, A United Healthcare Company Season s and Palliative Care of Charles County Coastal of Garrett County Holy Cross Homecare and Chester River Home Care and Jewish Social Services Agency Montgomery of St. Mary s of Queen Anne s of Washington County Shore Home Care & Talbot Foundation and Palliative Care Network of Maryland

12 Every System is Perfectly Designed to Get the Results it Gets.