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Managing Outcomes

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Managing Outcomes Lisa Werner, MBA, MS, CCC-SLP Director of Consulting Services Data Analysis Why do we do it? Accurate outcome data is a powerful tool that can be ... – PowerPoint PPT presentation

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Title: Managing Outcomes


1
Managing Outcomes
  • Lisa Werner, MBA, MS, CCC-SLP
  • Director of Consulting Services

2
Data Analysis
  • Why do we do it?
  • Accurate outcome data is a powerful tool that can
    be used to educate key decision makers in the
    hospital, potential patients, payers, and the
    community at large.
  • Marketing efforts are enhanced when outcome
    information is used during direct marketing
    calls.
  • The team benefits from use of outcome information
    by being able to see where they are the most
    effective and also by being able to focus
    improvement efforts.
  • Breaking down your performance may reveal
    opportunities to capture the burden of care and
    yield greater reimbursement.

3
Data Analysis
  • When conducting data analysis, ask yourself
  • Does the data look real?
  • It is important to validate that the data that
    you are analyzing is reliable.
  • Can you identify any inaccuracies in your sample?
  • Do the outcomes meet your expectations?
  • Compare your outcomes to your goals and industry
    benchmarks.
  • How do you stack up?
  • What impact would change make?
  • Would there be a positive impact on your patient
    care services if you improved your performance in
    this area?

4
Data Analysis
  • Selecting Indicators
  • Review outcomes
  • Determine what is below benchmark
  • Figure out what is meaningful to your facility
  • Determine what is attainable for your facility

5
Facility Report
  • Case Mix Index
  • Are you getting paid for the work that you do?
  • Does it seem like your CMI is lower than your
    burden of care?
  • Capturing the proper CMI is essential to enable
    you to staff appropriately.
  • Since many of us predict staffing ratios based on
    patient acuity as realized through the CMI, it is
    important to capture what most closely reflects
    the care being rendered on the unit.

6
Facility Report
  • Case Mix Index
  • Benchmark against the nation and the region.
  • Investigate the components-
  • Rehabilitation Impairment Classification
  • Motor Functional Independence Measure Subscale
    Weighted Score at Admission
  • Age
  • Tier Assigning Co-morbid Conditions
  • Investigate the distribution of impairment
    groups, CMG, or RIC.
  • Investigate the components for the most common
    groups.

7
Facility Report
  • Average Medicare Expected Reimbursement
  • Based on Medicare reimbursement
  • Adjusted for your facility pricer as updated
    through eRehabData
  • Includes calculations for transfer payments and
    short stay reductions

8
Facility Report
  • Transfer Patients
  • Percentage of patients that are discharged to
    another Medicare bed
  • Acute care
  • SNF
  • LTACH
  • Another IRF
  • Discharge Destination
  • Breakdown of discharge locations for the
    patients served
  • Skilled nursing and subacute designation errors

9
Facility Report
  • Averages
  • Two benchmarks Weighted and unweighted
  • Onset days Different instructions by RIC
  • Length of stay considerations
  • Functional Independence Measure scoring data-
  • Admission Totals
  • Discharge Totals
  • Functional Independence Measure Change
  • Motor subscale at admission

10
Facility Report
  • Individual Functional Independence Measure Items
  • Admission, discharge, change, and follow-up
  • Explains difference between facility totals and
    benchmark totals
  • First glance at isolating Functional Independence
    Measure scoring errors

11
Breaking Down the CMI
  • Tips
  • Evaluate your admission Functional Independence
    Measure scores
  • How does your admission Functional Independence
    Measure score compare to those in your region and
    across the nation?

12
Breaking Down the CMI
  • Determine what percentage of the time you are
    scoring a tiering comorbidity

13
Breaking Down the CMI
  • Pay attention to the most commonly used
    comorbidity lists

14
Breaking Down the CMI
  • Pull reports to show your CMG breakdown
  • Are you missing high acuity patients, low acuity
    patients?

15
Breaking Down the CMI
  • Pay attention to the warnings to tell you when
    there is a mismatch between IGC and Etiologic
    diagnosis

16
Drill-Down
  • Reimbursement
  • Determine which populations have the greatest
    transfer payment percentages.
  • Evaluate length of stay by RIC, IGC, CMG.
  • Review discharge destinations by group.
  • Use the patient report to identify outliers.

17
Drill-Down
  • Averages
  • Onset days should be evaluated on a RIC basis to
    ensure you are hitting your targets given the
    definition stated in the IRF-PAI Training Manual.
  • RIC Report
  • Referral date to admission date
  • Length of Stay should be evaluated to ensure you
    are hitting your targets.
  • RIC, IGC, CMG, Patient Report

18
Drill-Down
  • Averages
  • Functional Independence Measure Scores
  • Total Admission Functional Independence Measure
    shows patients overall burden of care and
    potentially indicates barriers to progress or
    expected rate of progress.
  • Total Discharge Functional Independence Measure
    shows patients achieved performance. Scores are
    gathered across the last 3-days of the stay.
    Facility identifies patients best performing
    24-hour period and the lowest scores from that
    day are reported on the IRF-PAI.
  • Functional Independence Measure Change is the
    amount of gain from admission to discharge and is
    also reported on a per day gain basis.
  • Considerations
  • Totals reviewed for total population
  • Totals reviewed by RIC, IGC, CMG
  • Items reviewed in for total population
  • Items reviewed by RIC, IGC, CMG
  • Functional Independence Measure Scoring
    Comparison Graph
  • Time-Series Graph
  • Metrics

19
Strategies
  • Averages
  • Evaluate screening and admission process to
    determine if patients are being admitted at the
    right time in their recovery.
  • Evaluate initial IRF-PAI scores for proper
    scoring
  • Be sure that the lowest score is taken from the
    documentation
  • Be sure that a full set of scores is captured
    daily
  • Set the stage for accuracy through communication
    among team members
  • Evaluate the effect of the volume factor.
  • Start an ADL program, ambulation group, cognitive
    group, etc to focus on enrichment of skills
    learned in 11 sessions.

20
Functional Gain
  • Functional Gain The Functional Independence
    Measure change between admission and discharge
    measures the degree of functional improvement
    demonstrated by patients.
  • Effectiveness Ensuring patients obtain
    sufficient gain to be able to return to their
    prior level of function.
  • What are the problems?
  • Outcomes are too high
  • Outcomes are too low
  • Discrepancy between the scoring of items within
    the same category

21
Functional Gain
  • Why would outcomes that are too high be a
    problem?
  • Admission Functional Independence Measure scores
    were too low during the assessment period.
  • Failure to assess areas of the Functional
    Independence Measure (i.e., bathing, stairs) can
    lead to gains above the benchmark.

22
Functional Gain
  • Tip Focus on Gain Above Benchmark
  • Look at the number of 0s on particular
    Functional Independence Measure items
  • Remember 0 is not a score and there are only
    three
  • reasons that justify the use of 0.
  • 1. The clinician determines it is not safe.
  • 2. Medical condition or treatment
  • 3. Patient refusal
  • Look at reliability of the scoring for items that
    exceed benchmark.
  • Look at facilitators within the environment that
    enable gains to exceed benchmarks to explain the
    outcomes.

23
Functional Gain
  • Why dont we want gains that are too low?
  • Why gains are less than the benchmark
  • Patients are not admitted from acute in a timely
    manner
  • Therapy protocols or techniques need to be
    examined
  • Lengths of stay are not sufficient
  • Functional Independence Measure scoring during
    the admission process may be delayed
  •  

24
Functional Gain
  • Tip Focus on Gain Below Benchmark
  • Look at the average length of stay
  • Look at interdisciplinary treatment processes
  • Look at patient mix
  • Look at volume

25
Functional Gain
  • Look at admission scores for individual
    Functional Independence Measure items
  • Look at point at which Functional Independence
    Measure scores are collected (early within 3 day
    look back or on day 3)
  • Look at LOS on acute

26
Functional Gains
  • Look at returns to acute
  • Look at discharges to settings other than home

27
Goal Attainment
  • Goal setting is important!
  • Patient metrics page reports admit, discharge,
    goal, and gain.
  • Review again goal at team and following discharge
    for success with goal attainment.

28
Strategies
  • Goal Attainment
  • Emphasize goal revision on the plan of care.
  • Inservice on goal setting to include proper goal
    setting and progression of treatment through
    incremental goal achievement.
  • Begin reviewing long term goals in the weekly
    team conference.
  • Determine a method to communicate current status
    and goals regularly through a functional status
    board, stand-up meetings, and/or team conference.

29
Other Views
  • Time Series Graphs
  • Look at performance over time
  • Multiple indicators can be viewed simultaneously
  • Data tables are useful tools for report
    preparation

30
Other Views
  • Functional Independence Measure Scoring
    Comparison Graph
  • Graphs admission, discharge, and change scores
    for the facility and region/nation
  • Review weighted and unweighted comparisons
  • Helps identify items that may require special
    attention in order to accurately represent the
    burden of care

31
Other Views
  • Percentile Ranking Report
  • Allows comparison of your facilitys performance
    with other units
  • Ranks your performance by report item
  • States your facility ranking among all units for
    that time period
  • Offers benchmarks of what performance level you
    would need to reach your desired percentile
    ranking
  • Case Mix Index Example
  • Facility CMI 1.1180
  • National average CMI 1.2686
  • Facility Percentile Rank 16.48
  • Facility desires to be ranked at 60 of database,
    so their target CMI 1.2849

32
Other Views
  • 60 Rule Report
  • Know how you will report your compliance to the
    FI admissions or discharge
  • Know your cost report year and look back periods
  • Manage conditionally compliance closely

33
Other Views
  • 60 Rule Report
  • Confirm the final IRF-PAI with the patients
    status on the compliance report
  • Presumptive or conditional?
  • In order to appear on this report correctly, you
    will answer questions on the eRD tab to determine
    if the patient is 60 compliant or not.
  • Review the detailed assessment to determine what
    makes the patient compliant.

34
Other Views
  • 60 Rule Compliance Threshold
  • Provided that each patient is properly identified
    on your 60 report, the compliance threshold
    established for your current reporting period is
    adequate.
  • Every patient that meets the criteria for
    inpatient rehabilitation deserves to receive that
    level of care.
  • Therefore, operating at a higher compliance while
    beds are empty is essentially denying a patient
    an opportunity to regain independence.
  • The key is to be sure that you capture the 60
    status of each patient correctly.

35
Other Views
  • Dashboard
  • Great tool for daily census update
  • Offers a 14-day projection of census decline for
    current case mix
  • Provides 30-day analysis of several indicators
    CMI, 60 rule compliance, RIC distribution, and
    payor source breakdown
  • In order to provide data, your bed configuration
    and pricer need to be up to date

36
Referral Tracking
  • Referrals Outcomes
  • Designed to trend referral sources, referring
    physicians, and conversion rates.
  • Offers information on reasons for denied
    admission.
  • You can filter the information to drill down on
    physician, referral source, internal vs. external
    fill, and reason for denied admission.

37
Other Views
  • Referrals Outcomes
  • Use information to determine referral trends by-
  • Referral source
  • Referring physician
  • Internal versus external fill
  • Zip code breakdown
  • Payor source breakdown
  • Conversion rates
  • Reasons for denial
  • Drill down by RIC, CMG, and Patient
  • Patient reports list patients denied

38
Conducting a Non-Admission Review
  • Non-admission review
  • The review of all patients that have not been
    admitted to rehab unit. This is done by
    reviewing the pre-admission forms and reviewing
    the section that notes the reason for not
    admitting to the rehab unit to help identify
    trends and changes that occur over a quarter.
  • Common Reasons
  • Too impaired
  • Too functional
  • No bed available
  • Physician did not agree
  • Patient or family refused
  • Insurance did not authorize
  • Not 60 rule compliant

39
Conducting a Non-Admission Review
  • What can we do about the too impaired category?
  • Determine if the admission denial was based on
    objective criteria
  • Identify if the denial was based on staffs lack
    of competency
  • Clarify with Medical Director his/her comfort
    level with the staff managing a patient with that
    diagnosis or at that level of acuity

40
Conducting a Non-Admission Review
  • Denial because Too Functional
  • Review the referral date against the actual date
    of the screen
  • Would reducing the number of onset days have
    resulted in a decision to admit?
  • Determine what the patients deficits really were
    and if they could have benefited from a stay in
    an IRF.

41
Optional Items
  • Patient Satisfaction Instrument
  • 3-Step Satisfaction Tools specific to rehab
  • Service Recovery
  • Discharge
  • Follow-Up
  • Feedback from Stakeholders
  • Reported with demographics
  • Item by item averages of responses for each item
  • Same drill-down capabilities as facility reports

42
Optional Items
  • Patient Satisfaction Instrument
  • Graphs responses to questions from each survey
    type for selected time period
  • Graphs historical trends for each question asked
    on the surveys
  • Time Series Graphs available to drill-down by
    patient type or demographic profile
  • Stores and reports narrative comments provided by
    patients

43
Putting It All Together
  • Best Practices in Performance Improvement
  • Communicate
  • Inservice
  • Peer Auditing
  • Use Case Studies to facilitate learning
  • Select a manageable number for performance
    indicators to work on
  • Report change and what worked to facilitate
    change
  • Dont fear it!

44
Questions?
  • Lisa Werner, MBA, MS, CCC-SLP
  • Lwerner_at_erehabdata.com
  • 202-588-1766
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