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The Meaningful Care Organization: Developing Patient Engagement Strategies

  1. 1. The Meaningful Care Organization – Developing Patient Engagement Strategies to Weather the Perfect Storm of 2013 Timothy Kelly, MS, MBA Dialog Medical A Standard Register Healthcare Company 2013 TxHIMA Annual Meeting & Convention Omni Fort Worth Hotel June 28-30, 2013
  2. 2. 2013 – A “Perfect Storm” Four Converging Legislative Initiatives
  3. 3. Cash for Clunkers and Meaningful Use Cash for Clunkers <$3 billion Grassley seeks accounting of 'Cash for Clunkers' costs. The Washington Post. January 7, 2010. Rock and a hard place: An analysis of the $36 billion impact from health IT stimulus funding. Price Waterhouse Coopers. April 2009. “Meaningful Use” (Healthcare Information Technology) ~$36 billion
  4. 4. American Recovery and Reinvestment Act of 2009 HITECH Act Meaningful Use Meaningful Use (MU) HITECH Act
  5. 5. HITECH Act “The changes we’re announcing today will lead to more coordination of patient care…and greater patient engagement in their own care” Health and Human Services Secretary Kathleen Sebelius announcing the Stage 2 Final Rule. August 23, 2012.
  6. 6.  $12.6 billion in incentives paid to date (program inception through February 2013)  85% of eligible hospitals are participating in the EHR Incentive Program  75% of eligible hospitals have received an incentive payment to date HITECH Act Source: CMS Fact Sheet: A Record of Progress on Health Information Technology. CMS Media Relations. April 23, 2013.
  7. 7. Accountable Care Organizations Patient Protection and Affordable Care Act of 2010 Medicare Shared Savings Program Accountable Care Organizations Accountable Care Organizations (ACOs)
  8. 8. Accountable Care Organizations Voluntary groups of physicians, hospitals and other healthcare providers:  Responsible for care of a clearly defined Medicare population  Designed to foster patient-centered, coordinated care  If it succeeds in providing high-quality care while reducing cost, it shares in savings achieved for Medicare Accountable Care Organizations (ACOs) Source: Berwick DM. N Engl J Med 2011;365:1753-1756.
  9. 9. Three Goals of ACOs  Better care for individuals  Better health for populations  Slower growth in costs through improvements in care Berwick DM. N Engl J Med 2011;364(16):e32. Accountable Care Organizations
  10. 10. Accountable Care Organizations Accountable Care Organizations (ACOs) Source: January 2012 survey of hospitals, physician organizations and health systems reported in: Tocknell MD. The Unsettled State of the ACO. HealthLeaders Media Intelligence Report. April 2012. Currently part of an ACO? 11% No - 89% Plan to implement or join and ACO? Yes - 61% No - 39% Yes -
  11. 11.  Over 250 ACOs  106 on January 1, 20131  1 in 10 Americans is covered under an ACO2  Federal savings from this initiative could be up to $940 million over four years.1  Top Driver for creating an ACO – To engage physicians  56 percent of the respondents that are or plan to be part of an ACO3 2 HHS News Release. January 10, 2013. 1 Gandhi N, Weil R. The ACO Surprise. New York: Oliver Wyman, November 2012. 3Tocknell MD. The Unsettled State of the ACO. HealthLeaders Media Intelligence Report. April 2012. Accountable Care Organizations
  12. 12.  National average readmission rate (Medicare patients): 19%  Cost to Medicare is $17.5 billion annually  2,217 hospitals will face penalties of over $280 million in 2013 Hospital Readmissions Reduction Program Source: Rau J, Kaiser Health News, October 12, 2012
  13. 13. Goals of Hospital VBP Program:  Improve patient experience  Better clinical outcomes 1 percent Medicare Holdback  $ 850 million in 2013 Hospital Value-Based Purchasing (VBP) Program Hospital Value-Based Purchasing Program Fact Sheet. Department of Health and Human Services. ICN 907664 November 2011. Patient Satisfaction (30%) Core Measures (70%) VBP Performance Score +
  14. 14. Patient-Centered Communications H I T E C H A C O s Hospital VBP Program Readmissions Reduction Program
  15. 15. Meaningful Use Objectives
  16. 16. Stages of Meaningful Use
  17. 17. Stages of Meaningful Use
  18. 18. Meaningful Use Objectives Stage 1 Objectives for Hospitals  14 Core Objectives, 10 Menu Objectives (attain 5)  First eligible payment year: 2011 Stage 2 Objectives for Hospitals  16 Core Objectives, 6 Menu Objectives (attain 3)  First eligible payment year: 2014  Effectively incorporate all of the Stage 1 objectives, along with additional objectives and higher measurement thresholds Meaningful Use Objectives
  19. 19. Meaningful Use Objectives Stage 2 Meaningful Use Objectives 19 Core Objectives Demographics Vital Signs Clinical Decision Support CPOE Transitions of Care View, Download and Transmit to Third Party Privacy and Security Smoking Status Lab Results into EHR Patient-Specific Education Medication Reconciliation Patient Input Output Input Output Input Core Objectives Generate Patient Lists Immunization Registries Lab Results to Public Health Agencies Syndromic Surveillance Menu Objectives Imaging Results Advance Directives ePrescribing Electronic Notes Electronic Lab Results Family Health History Patient Input Input
  20. 20. Why Focus on Patient-Centered Strategies that are “Output” or Communication-Oriented”?
  21. 21. “The single biggest problem in communication is the illusion that it has taken place.” George Bernard Shaw Output/Communication- Oriented Strategies
  22. 22. For the first time in 2012 Consumer Reports rated hospitals. Output/Communication- Oriented Strategies
  23. 23. Communication was consistently the most poorly rated category. Output/Communication- Oriented Strategies
  24. 24. Output/Communication- Oriented Strategies  These metrics are moving beyond the government sites to mainstream, consumer sites Patient Satisfaction Source: Kelly T. HIStalk, August 8, 2012 aders-write-8812/ (Accessed 5/10/13)
  25. 25. “Output-Oriented” Meaningful Use Objectives
  26. 26. “Output-Oriented” MU Objectives Patient-Specific Education Patients who are provided patient- specific education resources Number of unique patients admitted to the hospital’s inpatient or emergency departments during the reporting period > 10%
  27. 27. “Output-Oriented” MU Objectives  2 Measures for this Meaningful Use objective  Both must be satisfied in order to meet the objective View, Download and Transmit to Third Party
  28. 28. “Output-Oriented” MU Objectives Patients whose information is available online within 36 hours of discharge Number of unique patients discharged from the hospital’s inpatient or emergency department during the reporting period Patients who view, download or transmit to a third party the information provided online Number of unique patients discharged from the hospital’s inpatient or emergency department during the reporting period > 50% > 5%* View, Download and Transmit to Third Party *This measure was 10% in the Proposed Stage 2 Rule
  29. 29. Best Practices for Patient-Specific Education Materials
  30. 30. Best Practices The informed consent discussion conducted by the surgeon should include: 1. The nature of the illness and the natural consequences of no treatment. 2. The nature of the proposed operation, including the estimated risks of mortality and morbidity. 3. The more common known complications, which should be described and discussed. The patient should understand the risks as well as the benefits of the proposed operation. The discussion should include a description of what to expect during the hospitalization and post hospital convalescence. 4. Alternative forms of treatment, including nonoperative techniques. American College of Surgeons American College of Surgeons Statements on Principles. Revised September 18, 2008. (Accessed 5/10/13.)
  31. 31. Best Practices  Only 39% of 3,269 closed claims against anesthesiologists were judged to have adequate informed consent1  Inadequate informed consent was pursued as a secondary cause in more than 90% of ophthalmologic malpractice cases2  Lack of informed consent is one of the top 10 reasons for hospital malpractice claims3 Argument for Informed Consent 1Caplan RA, Posner KL. ASA Newsletter 1995;59(6):9-12. 2Kiss CG, Richter-Mueksch S, Stifter E, et at. Arch Ophthalmol 2004;122:94-98. 3Glabman M. Trustee 2004;57(2):12-16.
  32. 32. Best Practices  Needs to be electronic  Can’t be a “Medical Miranda Warning” Argument for Informed Consent
  33. 33. Best Practices WHO Surgical Safety Checklist
  34. 34. Best Practices  Need the consent for the Pre-Procedure Verification and/or the Time-Out  Verification of the consent is one of the most effective practices for avoiding wrong- patient/wrong-procedure/ wrong-site surgery1 Argument for Informed Consent 1Clarke JR, Johnston J, Finley ED. Ann Surg 2007;246:395-405.
  35. 35. Best Practices Argument for Informed Consent
  36. 36. Best Practices  Reduce the risk of potentially life-threatening perioperative complications. Pre-Procedure Instructions Courtesy of the Baltimore VA Medical Center Tea C. Perioperative concepts and nursing management. In: Smeltzer SC, et al, eds. Brunner and Suddarth’s Textbook of Medical-Surgical Nursing. Philadelphia, PA: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2010:422-483.
  37. 37. Best Practices  Lower the incidence of preventable surgery cancellations. Pre-Procedure Instructions Henderson BA et al. Incidence and causes of ocular surgery cancellations in an ambulatory surgical center. J Catarct Refract Surg. 2006;32(1):95-102 Pletta C et al. Efficiency improvement plan through patient education on thyroid imaging procedures. J Nucl Med. 2008;49(Supp 1):426P Courtesy of the Baltimore VAMC
  38. 38. Best Practices for Viewing, Downloading and Transmitting Patient Information
  39. 39. Best Practices  Providing patients with incomplete information at discharge can result in patient harm. Discharge Instructions Courtesy of the Portland VA Medical Center Pennsylvania Patient Safety Advisory. 2008. Jun;5[2]:39-43.
  40. 40. Best Practices  Reduced the 14-day readmission rate three-fold by employing procedure- specific discharge instructions (4.1 per 1,000 outpatient procedures to 1.5 per 1,000). Discharge Instructions Boast P, Potts C. PS&QH. 2010;7(1):14-16. Courtesy of the Portland VA Medical Center
  41. 41. Best Practices  Most valuable if they are sent well prior to the 36- hour threshold  Provided prior to admission  Paper as well as electronic Discharge Instructions
  42. 42. Developing Initiatives in Your Own “Meaningful Care Organization”
  43. 43. The Meaningful Care Organization  Making Good on ACOs’ Promise — The Final Rule for the Medicare Shared Savings Program. N Engl J Med 2011;365(19):1753-1756. November 10, 2011.   Meaningful Use – The Whiteboard Story – Stage 1 Final Rule Meaningful Use Objectives and Measures Compared to Stage 2 Final Objectives and Measures... Created as a reference tool for public use and convenience by The Advisory Board Company.  Stage-2-White-Board-Story-Poster-2.pdf Resources 43
  44. 44. Stage 1 Stage 2
  45. 45. The Meaningful Care Organization “Meaningful Care” Checklist 45  Is the initiative patient-centered?  Does it reduce risk?  Does it enhance safety?  Does it leverage the patient?  Can you utilize HIT (EHR or other systems)?  Does it support Stage 1 or Stage 2 Meaningful Objectives? Yes No      
  46. 46. Will a Focus on Patient-Centered Communications Impact the Selection of Treatments/Procedures and Potentially the Efficiency of an ACO?
  47. 47. Potential Impact on Efficiency?  A series of nine reports of elective surgical procedures, released in late 2012, found wide variations in the treatments provided. Dartmouth Atlas Project Improving Patient Decision-Making: Regional Series. The Dartmouth Atlas of Health Care. (Accessed 5/10/13.)
  48. 48. Potential Impact on Efficiency?  Mastectomy rates range from 0.3 per 1,000 female Medicare patients in the San Francisco area, to 2.3 in Grand Forks, ND Dartmouth Atlas Project
  49. 49. Potential Impact on Efficiency?  The report authors surmise that patients may not understand their full range of options and choices may be unduly influenced by providers and not patient preferences. Dartmouth Atlas Project Improving Patient Decision-Making: Regional Series. The Dartmouth Atlas of Health Care. (Accessed 5/10/13.)
  50. 50. Will a Focus on Patient-Centered Communications Impact Readmissions or Patient Satisfaction?
  51. 51. Potential Impact on Readmissions/Satisfaction?  Press Ganey analysis of hospital readmission penalty scores vs. patient satisfaction scores.  Positive patient experience correlates well with low readmission rates and high readmission rates correlate well with poor patient experience. Press Ganey HCAHPS Analysis The Relationship Between HCAHPS Performance and Readmission Penalties. Press Ganey. (Accessed 5/10/13.)
  52. 52. Potential Impact on Readmissions/Satisfaction?  The relationship between patient satisfaction and readmissions is not causal. Rather it is most likely predictive of an environment stratified by patient-centered communications. Press Ganey HCAHPS Analysis
  53. 53. Health Information Technology Patient-Centered Communications Greater Patient Satisfaction Lower Readmission Rates More Efficient ACOs Patient Education Informed Consent Pre-Procedure Instructions Discharge Instructions Stage 1 Stage 2 MU Objectives Stage 3 The Meaningful Care Organization
  54. 54. Questions? (slides posted here) Robbie Beck Tim Kelly