HEART FAILURE QUALITY IMPROVEMENT. American Heart Association Shawni Smith Regional Director, Quality & Systems Improvement

Transcription

1 HEART FAILURE QUALITY IMPROVEMENT American Heart Association Shawni Smith Regional Director, Quality & Systems Improvement 1

2 DISCLOSURES NONE 2

3 3 WHY IS THIS IMPORTANT?

4 WHY? Heart Failure Currently, an estimated 5.7 million Americans are living with heart failure. An additional 670,000 new cases are diagnosed annually, up from 500,000 a few years ago. The cost of providing heart failure care ranks among the leading U.S. healthcare expenditures. 4

5 WHY? Readmission Rates Approximately one in five Medicare patients historically were readmitted to the hospital within 30 days (not limited to HF readmissions) although, this statistic is improving slightly. In 2011, hospital readmissions attributed to more than $41 billion in health care costs (Source: Agency for Healthcare Research and Quality). 5

6 WHY? Typical breakdowns associated with: o Patient assessment o Family caregiver education o Handoff communication o Following discharge from the hospital 6

7 7 WHAT IS BEING DONE?

8 READMISSION REDUCTION PROGRAM In 2012, CMS started to reduce Medicare payments for certain hospitals that have higher-than-expected (excess) readmission rates. Hospital s 30-day readmission rate for heart attack (AMI), heart failure (HF), pneumonia, chronic obstructive pulmonary disease (COPD), hip/knee replacement (THA/TKA), and coronary artery bypass graft surgery (CABG) are compared to an expected readmission rate. Expected rate is based on the average readmission rate. Hospitals that have an excess readmission rate (i.e., a ratio greater than ) are penalized financially--medicare FFS claims. 8

9 FY 2018 RESULTS For FY 2018, approximately 2,500 hospitals were penalized for excess readmissions. Hospitals payments could be penalized up to 3 percent. Information about readmission penalties is publicly available via CMS Web site. 9

10 FY 2018 RESULTS COUNTY COMPARISON Los Angeles County # of Hospitals Assessed Average # of Years Hospitals Penalized in Last 6 Years Orange County % (#) Hospitals Penalized for FY % (58) 81.0% (17) % (#) Hospitals in FY 2017 that Improved/Sustained 0 in FY 2018 (Decreased Penalty or No Penalty Both Years) 68.5% (50) 61.9% (13) Median Penalty FY Max Penalty FY % (#) Hospitals Penalized 6 Years in a Row 57.5% (42) 57.1% (12) 10 Source: Hospital Compare and Data.Medicare.Gov

11 11 HOW CAN WE HELP?

12 12 GET WITH THE GUIDELINES - HEART FAILURE Quality improvement program launched in 2005 aimed at improving care by promoting consistent adherence to the latest scientific treatment guidelines Focuses on the acutely admitted heart failure patient from ED admission through discharge Target: Heart Failure (launched in 2011) focuses on the transition time from hospital discharge to outpatient setting Over 1,200 participating U.S. hospitals Nearly 1.8 million patient records GWTG HF participation benefits Patient management tool One-on-one local quality expert and support Real-time benchmarking Performance metric evaluation and drill-down Decision support Award recognition 12

13 13 GET WITH THE GUIDELINES - HEART FAILURE ACHIEVEMENT MEASURES ACEI/ARB or ARNi at discharge: Percent of heart failure patients with left ventricular systolic dysfunction (LVSD) and without angiotensin converting enzyme inhibitor (ACEI) and angiotensin receptor blocker (ARB) contraindications or angiotensin-receptor/neprilysin inhibitor (ARNI) contraindications who are prescribed an ACEI, ARB or ARNi at hospital discharge. For purposes of this measure, LVSD is defined as chart documentation of a left ventricular ejection fraction (LVEF) less than 40% or a narrative description of left ventricular function (LVF) consistent with moderate or severe systolic dysfunction. Evidence-based specific beta blockers: Percent of heart failure patients who were prescribed with evidence- based specific beta blockers (Bisoprolol, Carvedilol, Metoprolol Succinate CR/XL) at discharge. Measure LV function: Percent of heart failure patients with documentation in the hospital record that left ventricular function (LVF) was assessed before arrival, during hospitalization, or is planned for after discharge. Post-discharge appointment for heart failure patients: Percent of eligible heart failure patients for whom a follow- up appointment was scheduled and documented including location, date, and time for follow up visits. 13

14 14 GET WITH THE GUIDELINES - HEART FAILURE ADDITIONAL METRICS Anticoagulation for atrial fibrillation or atrial flutter Influenza vaccination during flu season: 60 minutes of heart failure education Discharge instructions Lipid-lowering medications at discharge DVT prophylaxis Hydralazine/nitrate at discharge And much more 14

15 15 GET WITH THE GUIDELINES - HEART FAILURE Activity Level Instruction Heart failure patients discharged home with a copy of written instructions or educational materials given to patient or caregiver at discharge or during the hospital stay, addressing activity level CY

16 16 GET WITH THE GUIDELINES - HEART FAILURE Influenza Vaccination During Flu Season Percent of patients that received an influenza vaccination prior to discharge during flu season CY

17 17 GET WITH THE GUIDELINES - HEART FAILURE Follow up Instruction Heart failure patients discharged home with a copy of written instructions or educational materials given to patient or caregiver at discharge or during the hospital stay, addressing follow-up appointment - CY

18 18 GET WITH THE GUIDELINES - HEART FAILURE Follow-up Visit Within 7 Days or Less Percent of eligible patients with a follow-up visit scheduled within 7 days or less from time of hospital discharge CY

19 19 QUALITY IMPROVEMENT TOOLS PUBLIC DOMAIN

20 AMERICAN HEART ASSOCIATION WEB SITE 20

21 PROVIDER TOOLS 21

22 PATIENT INTERVIEW FORM 22

23 SAMPLE CHF DISCHARGE CHECKLIST AND ORDER SETS 23

24 PATIENT RESOURCES 24

25 WHAT ARE OUR GOALS FOR THE IMMEDIATE FUTURE? 25 25

26 26 GOALS FOR FUTURE Increase number of hospitals participating in Get With The Guidelines - Heart Failure in LA and Orange counties Meet with hospital staff and leadership teams to present Work with payers to implement incentives for hospitals participating in Get With The Guidelines Work collaboratively with providers across the continuum of care to reduce readmissions Identify best practices in surrounding counties that can be shared with others 26

27 FOR ADDITIONAL INFORMATION: SHAWNI SMITH, AHA