May 2016 Update

Hospitals, ACO’s Prioritize CMS Programs for 2016

ACO’s, Bundles, Readmissions and Home Care a priority,
MSPB drops on priority or list for health systems and ACO’s

Many of you have reached out requesting a newsletter or update from the National Readmission Prevention Collaborative (NRPC). Although we do not do a monthly NRPC newsletter any longer, at the public’s request I am providing an update on recent CMS updates and how hospitals are prioritizing new Alternative Payment Models and penalty programs.

I have met with executives and case managers in Colorado, Michigan, Florida , Utah, Nevada and California in recent weeks. While all are scrambling to ensure processes are in place to ensure successful implementation of Comprehensive Care for Joint Replacement (CJR), the Better. Smarter. Healthier. initiative (that requires 30% of claims to be paid through an Alternative Payment Model this year) appears to be just as much a priority.

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Welcome to the homepage for the National Readmission Prevention Collaborative. This volunteer collaborative was created to unite industry leaders in sharing Best Practice Case Studies in care transitions and readmission prevention for hospitals, SNF's and other post acute providers. Please browse these "Best Practice" case studies to identify tools that may work at your facility in adopting to Affordable Care Act mandates. Many of the products, tools and services discussed in the case studies are available by clicking-through to the Resources section. Once you have put the Best Practices and industry-leading tools to work in your facility, we encourage you to submit your facility's success story as well! Thanks for visiting.

National Advisory Panel

White Paper

Why Hospitals and Payers are Recommending Home Care Upon Discharge Instead of SNF or Traditional Home Health Services

ABSTRACT: Seniors and other hospital patients in the United States have traditionally had the option of being discharged to a skilled nursing facility (convalescent home) for post-acute services, or home with nursing and therapy services provided in the home setting. Traditionally, these home based services have been referred to as "home health." As more Americans have retired, home health services have expanded and are readily accessible. This growth put tremendous stress on the Medicare fund which pays for senior care services. However, "Home Care," which traditionally has been viewed as non-medical home based services, has also become a booming industry for the cost conscious in recent years as more Americans reach retirement age. With the passing of the Affordable Care Act in 2010, providers and payers are now finding themselves responsible for post-acute care and continuous patient health, so cost efficient solutions for post-acute care are thriving. For the first time in history, American hospitals and Insurers are recognizing Home Care as an effective model that achieves the Triple Aim of Health Care reform. Home Care, which is no longer completely nonmedical services, has proven to be an integral part of the care continuum for seniors in recent years and is now becoming a viable solution for keeping patients well, while still honoring their desire to age and heal at home. This paper analyzes the benefits and risks of home care and provides a clear understanding as to why American hospitals are emphasizing SNF Avoidance and skipping home health, opting instead to refer patients directly to home care as the preferred discharge solution in a value based model.

Healthcare spending for seniors continues to balloon at alarming rates as ninety percent of seniors prefer to age and heal at home, as opposed to in a healthcare facility, With approximately 8,000 baby boomers a day turning 65 years old, the nation’s senior population is estimated to increase by more than thirty percent by 2025. As a result, Medicare expenditures are projected to double to greater than $800 billion by 2018. These expenditures will have a significant impact on hospitals, health systems and payers as Alternative Payment Models (APMs) become law.

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Congratulations to the NRPC for being recognized at the Los Angeles Business Journal Healthcare Leadership and Service Awards 2015!

Special thanks to the Educational Underwriters of our most recent events!

Sutter Health Los Alamitos Medical Center Signature Healthcare Dignity Health
Virginia Mason MultiCare Henry Ford

Eric Coleman, designer of Coleman Transitions Intervention; Eric Heil, CEO of Rightcare Solutions; and ​​​Josh Luke​,​​​ hospital CEO and Founder​ of the ​National Readmission Prevention Collaborative​, ​discuss MSPB (Medicare Spending Per Beneficiary), risk assessment and caretaker tools at the Northern California Readmissions Summit, September 12, 2014 in San Francisco.

Jennifer Pearce of Sutter Care at Home presented one of the hottest topics of the day,patient literacy. Sutter Health served as the educational underwriter for the event.

Glenna Yaroch of Home Instead opened up the Northern California Readmissons Summit by presenting a Best Practice case study on preventing readmissions through coordinated home care services.

Jennifer Pearce of Sutter Care at Home presented one of the hottest topics of the day,patient literacy. Sutter Health served as the educational underwriter for the event.

Dr. Josh Luke (left), and Dr. Eric Coleman, two of the most recognized voices on readmission prevention, chat during the first annual, sold out USC C-Suite Invitational, May 12, 2016 in Los Angeles.

August/September Poll

(Choose from the options below by clicking your choice)

    July Poll Results

    Does your hospital, facility or agency have a regularly scheduled care coordination/utilization review meeting with your acute/post acute partners/referral sources?

    A. Weekly - 43%

    B. Monthly - 7%

    C. Both - 0%

    D. Not At All - 50%

    We would like to thank the following organizations for their support of our collaboratives.

    Sensiotec Silverado Senior Living Cambrian Homecare PRN Ambulance
    Boehringer Ingelheim Vitaphone COMS Interactive Medline
    Home Instead Cubist Pharmaceuticals Windsor

    Donations for the Alzheimer's Association






    Follow Josh Luke

    • Only 25% of more than 3,000 U.S. hospitals avoided readmission penalties in FY. 2016.
    • Studies in 2015 found that tying physician pay to quality has not had the desired impact.
    • Hospitals have had a stronger reaction to Medicare Spending Per Beneficiary penalties than the readmission penalty.
    • CMS has announced its SNF readmission penalty program.
    Health System Priorities
    Transforming to PopMan

    1. ACO Conversion
    2. Narrow SNF Network
    3. MSPB
    4. Bundle
    5. Home health alignment

    1. Bundle preparation
    2. ACO Coordination
    3. Readmissions
    4. Home Care/Home Health
    5. Narow SNF Network

    * As determined by organizational leadership based on conversations throughout the country
    CMS ​Hospital
    Readmission Reduction Program

    1. Acute Myocardial Infarction
    2. Congestive Heart Failure
    3. Pneumonia
    4. Knee & Hip Surgeries
    5. COPD​

    Change your hospitals behavior to address All-Cause avoidable admissions!​

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