May is Mental Health Awareness Month. As advocates and providers work to address the stigma surrounding mental health topics, there are ongoing regulatory changes that are shifting the healthcare industry towards integrated approaches to patient-centered care. Over the last decade, healthcare has undergone a major transformation to incentivize collaboration across specialties and settings. This has sparked a movement towards considering clinical, physical, and social needs holistically and prioritizing the best ways to assess, diagnose, and address behavioral health needs.
New regulatory incentives at the federal and state level have freed up funds that enable further collaboration among various providers. Value-based payment contracts between health systems and Managed Care Organizations have placed a deeper emphasis on enhancing collaboration, removing silos between care settings, and integrating community-based resources with clinical services. With centralized care management teams that span multiple provider organizations, these resources can better manage care and focus on addressing social determinants of health.
Breaking down the silos in healthcare and integrating primary care with mental health and substance use disorder services are an important first step in proactively identifying patient needs and coordinating care to address and resolve any potential issues. When provider teams address care delivery with a focus on the whole person behind the patient, they will be equipped to improve outcomes and in time, lower the total cost of care.
As we look towards the future, the next step is finding ways of enhancing collaboration by providing interoperable solutions that will remove the need for duplicative data entry and optimize limited labor resources, meet patients where they are, and further advance the progress in providing care that considers the whole person. With value-based care, providers are incentivized to look at the patient more holistically and treat more than just a symptom or condition.
For more information on mental health in the United States, please access these resources:
Elizabeth Lagone, MPH, is the Vice President of Government Programs at CipherHealth. Prior to her current role at CipherHealth, Lagone served as the Primary Care Strategy and Improvement Director for DSRIP Initiatives at One City Health, a subsidiary of NYC Health + Hospitals focused on population health, care management, and implementation of the state’s DSRIP program.
While providers often search for the secret to effective care management and patient communication, Romano offers simplicity in the answer: Listen to, understand, act on, and then resolve patient concerns. Patients deserve the highest quality of care, delivered in a way that meets their personal needs and preferences.
Romano elaborates on the need to integrate patient preferences into the plan of care by stating, “No matter how busy you are — the patient doesn’t need to feel rushed — let the patient know you are their advocate, that you care, and will make sure they are taken care of. Once the patient feels that caring message, it is critical that follow-through occurs or they will lose trust.”
The Impact of Trust on Patient Loyalty
As providers across the country celebrate this year’s Patient Experience Week, keeping this in mind will ensure patients are satisfied with their care experiences. The trust that patients develop with their care providers will have a direct impact on the ability of healthcare organizations to remain competitive in the changing healthcare landscape.
“We must earn loyalty through exceptional service both clinically and emotionally. We must earn that patient’s trust and never lose it. We must keep them safe and make sure they feel respected as a person and that we care. When that happens, there will be no one more loyal than the person on the receiving end,” Romano concludes.
Every flight starts with the standard three-minute safety demonstration, complete with seatbelt and life vest props. During the demonstration, flight attendants inform passengers that in the event of a sudden decrease in air cabin pressure, oxygen masks will drop from the ceiling. Flight attendants explicitly instruct passengers to put their own oxygen masks on first, prior to assisting others. These safety instructions provide an important lesson for all individuals in helping professions: in order to help others, you need to take care of yourself first.
In my experience, most healthcare professionals pursue healthcare as a career to help others. To provide the highest quality of patient care, we must also care for ourselves and our peers. Attaining joy in our work is necessary to ensure optimal patient outcomes.
Prioritize Self-Care to Achieve the Quadruple Aim
In 2007, the Institute for Healthcare Improvement (IHI) developed the Triple Aim framework to support healthcare organizations in navigating the shift from reactive healthcare to the proactive improvement of health for individuals and populations. Since then, the Triple Aim has been expanded into the Quadruple Aim, as many healthcare organizations have identified restoring joy in the workplace as a prerequisite to enhance the experience of care for individuals, improve the health of populations, and reduce the per capita cost of healthcare. In fact, the President of the IHI recently shared, “Staff are much more likely to be enthusiastic and positive about securing the best outcomes for patients when they feel supported, empowered, and respected.”
According to a recent Discussion Paper published by the National Academy of Medicine, burnout is characterized by “…a high degree of emotional exhaustion and high depersonalization, and a low sense of personal accomplishment from work.” Due to significant changes in how care is provided, documented, and reimbursed, the evolving healthcare environment is a major contributor to burnout. Healthcare professionals experiencing burnout adopt attitudes that lead to lack of engagement and loss of connection at work. They may feel that patients are asking unreasonable requests, team members do not listen to their concerns, and their place of employment does not care about their experiences. As such, the National Academy of Medicine identifies burnout among healthcare professionals as a threat to safe, high-quality patient care.
Leverage Proven Strategies to Reduce Burnout
As healthcare professionals, what can we do to ensure that we feel supported, empowered, and respected? As current and future healthcare leaders, how can we take better care of ourselves and our colleagues as part of our organizational commitment to the Quadruple Aim?
The Green Cross Academy of Traumatology developed Standards of Self-Care Guidelines in recognition that only those that first care for themselves can provide the highest quality of care for others. As an ethical principle, the Academy maintains, “…the duty to perform as a helper cannot be fulfilled if there is not, at the same time, a duty to self care.”
The University of Buffalo School of Social Work provides a number of resources for self-care, including a Self-Care Starter Kit developed by Lisa Butler, PhD. Although there is no one-size-fits-all approach to self-care, important elements include managing and reducing stress, taking care of physical health, honoring emotional and spiritual needs, nurturing relationships, and finding balance in personal and work life. According to Butler, “…each person needs to identify what they value and need as part of day-to-day life (maintenance self-care), and also identify the strategies they can employ if and when they face a crisis along the way (emergency self-care).” For some, this may mean that we need to seek, find, and remember appreciation from our supervisors and clients. For others, it may mean physically exercising regularly, enjoying the outdoors, and engaging in self-reflection.
As healthcare leaders, take the opportunity to conduct proactive rounds on front-line staff at all levels of the organization. Both formal and informal check-ins are a great way to ensure that your team members connect to their day-to-day work and have the adequate resources to take care of themselves and their patients. Recognizing the achievements of your colleagues can go a long way towards reinforcing what is important and boosting morale.
To achieve the Quadruple Aim, staff must perform at their very best every day. By developing self-care strategies that include expressing and experiencing gratitude, healthcare professionals can become more proactive in the prevention of burnout. As we celebrate Patient Experience Week, take a moment to review your own self-care plan. For your own well-being and that of your patients, you will be grateful that you paused, took a breath, and reflected upon your role in providing the best possible experiences for all patients.
To learn more about how healthcare organizations can improve the patient experience across the continuum of care, we recommend these resources:
As the Senior Vice President of Client Success, Barb Davis, MHA, brings over 30 years of experience in healthcare quality and patient safety to her current role at CipherHealth. Barb led efforts at SCL Health to improve patient outcomes through the “Reconnect to Why” strategy, which was designed to help healthcare professionals articulate the relationship between the patient experience and their own experiences.
For OSF St. Mary’s, rounding is not just a task to check in with patients; it is a form of connection, accountability, and improvement across the organization. As we have explored, leadership rounding is an essential component in improving patient and staff satisfaction, and this is especially true for OSF St. Mary’s.
At the end of April, CMS issued its proposed rule for the implementation of MACRA. This came roughly one year after the government ended the SGR formula for determining Medicare payments by signing the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) into law. The goal of the new legislation is to reward physicians for quality, rather than volume, and streamline existing programs.
Whether you agree or disagree with its execution, CipherHealth believes its main provisions are here to stay. Here are our 5 key takeaways about MACRA and MIPS:
We project the performance period will be delayed and many of the requirements will be watered down. The bad news is that CMS proposes to use 2017 as the performance period for the 2019 payment adjustments, but the good news is that interest groups almost always succeed at delaying the implementation of onerous CMS programs. Bob Doherty of the of the American College of Physicians has told reporters that physician interest groups are moving toward asking CMS to start the reporting period on July 1, 2017, rather than January 1. Additionally, if the Meaningful Use requirements for Stages 1 and 2 are any indication, many of the requirements in the proposed rule are likely to be “relaxed” in the release of the final rule, which is targeted for early fall 2016.
Almost all physician groups are likely to be required to report through the Merit-Based Incentive Payment System (MIPS) the first year of the program. CMS will use this data to determine which providers have met the requirements for the APM track. (Each year, eligible clinicians are allowed to switch between MIPS and APM.) As a reminder, MIPS participants can receive a positive, downward, or neutral payment adjustment to Medicare Part B base rates, starting at +/- 4% in 2019 and growing to +/- 9% in 2022 and later. APM participants can receive a 5% lump sum incentive payment on Part B services.
The majority of providers will only qualify for the MIPS track. The government has proposed a few tracks for measuring performance and obtaining reimbursement: Merit-Based Incentive Payment System (MIPS) participant, Alternative Payment Model (APM) Qualifying participant, or partial Qualifying Participant. APMs include delivery models such as as MSSP Accountable Care Organizations. However, most physician groups are unlikely to meet the proposed nominal risk thresholds. (~95% of MSSP ACOs are participating in Track 1 of the program, which would not qualify them for an exemption from MIPS, as the proposed APM requirements only apply to Track 2 or 3.) That said, the nominal risk thresholds may be less stringent in the final rule.
Quality is the most important category. MIPS adjusts Medicare Part B reimbursement based on a total composite score derived from four separate categories: quality care, cost-of-care/resource use, clinical practice improvement activities and the “advancing care information” program a.k.a. a modified Meaningful Use program. The quality composite score is weighted at 50% of the MIPS composite score the first year, declining to 30% by the third year, while all the other categories as proposed will be weighted at 10-25% until year 3, when cost/resource use is also weighted at 30% of the total composite score.
Quality measures will be selected annually through a call for quality measures process, and are likely to include metrics similar to those of PQRS. MACRA identifies five quality domains (i.e., clinical care; safety; care coordination; patient and caregiver experience; population health and prevention). Eligible clinicians would choose to report 6 quality measures compared to the 9 measures currently required under PQRS. CMS indicates there will be more than 200 measures to pick from and over 80% of the quality measures proposed are tailored for specialists. In the recently-released final Quality Measure Development Plan, CMS prioritized the patient perspective with emphasis on patient-reported outcome measures (PROMs) and patient-reported tools, which could include PHQ-9 for depression. The government is also considering ways to make CAHPS surveys easier to administer for patient experience measurement.
The new requirements under MACRA are quite convoluted, and the details are unlikely to be fine-tuned until the release of the final rule later this year. The proposed rule was 962 pages and the Final Quality Measure Development Plan features 80 pages alone on the Quality Domain, for which no actual final measures are provided. However, for those who desire to read the fine print, the proposed rule is available here and the Final MDP is available here.
For more information about how you can prepare for MACRA, contact us today.
Promoting Quality and Coordination Across the Care Continuum: An Interview with Edgewood Place Skilled Nursing Facility on Technology in the Post-Acute Care Environment
In today’s increasingly connected world, it is becoming a standard industry practice for hospitals to interact with patients using technology. With CMS reimbursements now tied to patient satisfaction and quality measures, hospital leaders understand the importance of using technology to capitalize on payment reform. More recently, post-acute care (PAC) providers, including skilled nursing facilities (SNFs), home health agencies (HHAs), and inpatient rehabilitation facilities (IRFs) have turned to technology to comply with similar regulations.
To promote care coordination across the continuum, CMS will soon require PAC providers to standardize and report on quality, outcomes, and satisfaction. This increased transparency pushes PAC providers to improve the experiences of patients and residents, optimize care services, and reduce readmissions. Using hospitals as a model for success, it is clear that technology will be a key factor in this changing PAC landscape.
Recognizing this shift, Edgewood Place at the Village at Brookwood, a skilled nursing facility part of the Cone Health System in central North Carolina, has turned to innovative technology to improve residents’ experiences and outcomes. Edgewood recently partnered with CipherHealth to implement Voice, a post-discharge follow-up calling platform, and Echo, a digital tool to record personalized discharge instructions. This collaboration demonstrates Edgewood’s mission to keep residents healthy and happy long after they leave the facility.
Steve Swanson and Teresa Pennington, Administrator and Administrative Office Manager at Edgewood Place, spoke with CipherHealth about how they are strategically implementing technology to improve the care experience and prepare for payment reform.
Interview with Steve Swanson and Teresa Pennington
CH: As you were making the decision to implement Voice for your follow-up calling program, what were the primary challenges that you were trying to address? What specific goals did your organization have when partnering with CipherHealth?
Edgewood: Our goal when implementing Voice was to receive feedback from residents about our care services and quality in a direct way. We partnered with CipherHealth not only to receive this important feedback, but also to have a better, more streamlined way to address any issues that residents may have related to their care. This program quickly became an essential component in providing high-quality care services.
CH: What have been the residents’ reactions to the automated calls?
Edgewood: The residents have been extremely responsive to the follow-up program. Through the reports we receive from CipherHealth, we see that the majority of our residents complete the entire Voice call, and when callback is required, tend to be very honest with our staff. This allows us to address issues before they lead to adverse events, such as hospital readmissions. This proactive issue resolution also helps increase resident satisfaction and boost referrals.
CH: Was implementation of the calling system difficult?
Edgewood: From the beginning, the calling program was very user friendly and easy to implement. Should we experience any difficulties, the Cipher team is always available and eager to lend support to ensure that we are comfortable with the technology.
CH: What have you learned about your residents through the Voice and Echo programs?
Edgewood: We have learned that many residents do not fully understand their discharge instructions at the point of discharge, but may not speak up at that time. Despite this initial apprehension, residents tend to acknowledge that they need help on the Voice calls. Our staff is automatically notified of these issues or questions, and we can intervene prior to the residents making a medication mistake, improperly managing their care, or returning to the hospital.
CH: What are some of the successes that you’ve seen since implementing Voice and Echo?
Edgewood: By spotting trends in residents’ behavior and issues reported, we have been able to address several challenges that are typical of SNF residents post-discharge, for example, helping them obtain DME, Medications, and O2. Voice and Echo have also allowed us to promptly answer medication and therapy questions to prevent mistakes that could lead to hospitalizations.
CH: Can you speak to the value that you see in Echo, the digital discharge instruction recording tool, specifically?
Edgewood: With the Echo program, residents have the option to go back and listen to discharge instructions as many times as they would like at their convenience. This helps ensure that residents understand their care plans and comply properly with instructions. We’ve seen that the residents who listen to their Echoes have required fewer manual callbacks or interventions from staff.
CH: What is the role of innovative technology in SNFs, as players in the industry work to position themselves as a value-base partners to their referral sources?
Edgewood: Innovative technology is the most effective way to consistently receive meaningful feedback and drive improvements. We see the direction that medicine is moving in, and we believe that care does not end when a patient or resident walks out your door. We aim to offer high-quality care from the beginning of a resident’s experience to the end. Care must be coordinated at all levels, from hospital – to SNF- to Home Health – to outpatient – to independence, and on. We must work to prevent readmissions and additional expenditures to the referral sources, insurances, and the patients.
As highlighted by leaders at Edgewood Place, care extends far beyond the point of SNF discharge. Arguably, the window immediately after a patient or resident returns home or transitions to a lower acuity care setting is the most important time for providers to reach out. Having a robust discharge process including patient or resident follow up helps to prevent avoidable complications and hospitalizations, and creates a positive, lasting impression of the care experience. For Edgewood, incorporating Voice and Echo has allowed the organization to better understand its residents and make informed changes to improve quality of care and outcomes.
To learn how your organization can use Voice and Echo to improve quality of care and outcomes, and prepare for payment reform, contact us today.
The Comprehensive Care for Joint Replacement Model (CJR), CMS’ first mandatory bundled payment initiative, started on April 1st. The five-year program is mandatory for about 800 hospitals in 67 geographic regions. Becker’s Hospital Review has outlined 13 things that healthcare leaders must know to comply with and capitalize on this payment model, and avoid financial penalties.
CipherHealth’s digital solutions help hospitals succeed under CJR by coordinating care across different providers, and by enhancing the discharge and care transition processes. To learn more about how our products drive compliance with CJR, download our overview or view our slideshow.
Rounding is a crucial hospital function aimed at improving quality of care and patient outcomes. In addition to keeping patients safe and healthy, rounding enables hospital staff to gather feedback and data to help identify areas for improvement and drive positive change.
Although the value of rounding is well understood, only 50% of nurses indicate that they are satisfied with their team’s current rounding processes. The traditional method of pen-and-paper rounding often results in excessive documentation, fragmented communication, and limited time spent on direct patient care. With the recent growth of technology in the healthcare industry, organizations must turn to evidence-based digital rounding solutions to optimize care.
We have outlined five steps to help you get started with digital rounding:
Determine Needs and Goals
To prepare for digital rounding, you must first determine and prioritize the needs of your organization. Needs arise and evolve based on a number of factors, such as policy reform, cultural shifts, and the behavior of competitors. Your needs will dictate the types of rounding you want to prioritize (patient-centered, organization-centered, staff-centered), and your objectives for rounding.
Choosing a Digital Rounding Solution
When choosing a digital tool, you should consider how successfully it will help you to achieve your organizational goals. Important questions to ask include:
How easily will the technology integrate into your workflow and be adopted by staff?
What are the costs, and what is the expected ROI?
Is the solution adaptable to our organization’s changing needs?
What results have similar hospitals seen after implementing this solution?
Customize Rounding Scripts and Alerts
Rounding scripts should not be seen as “one size fits all.” The questions asked will differ depending on the purpose of the round and the population being rounded on. Patient-centered rounds, the most common form of rounding, will likely include a number of multiple choice questions regarding pain management, medications, food, and professionalism of staff. Employee engagement rounds, however, might include lengthier, open-ended questions.
Along with tailored rounding scripts, it is equally important to have a process in place to resolve any issues that are identified. A robust digital solution might offer customized alerts to be automatically sent to ancillary departments for quick issue resolution.
Improving patient care is only possible when staff is comfortable and confident using the digital rounding tool. When shifting away from paper-based rounds, training is key to ensure that technology doesn’t become a barrier between staff and the patient, and instead, enhances these interactions.
Use Data to Drive Improvements
A digital tool is not the silver bullet to optimal patient care. Staff must actively analyze data to make strategic and lasting changes. The information gathered from rounds enables leadership to validate current initiatives, make informed decisions, and drive continual improvements to care services.
When a digital rounding solution is chosen carefully and implemented thoughtfully, it leads to culture, satisfaction, and quality improvements across an entire organization. To learn more about digital rounding, download our overview or request a demo of our digital rounding solution, Orchid.
Over the last thirty years, patient-centered care has gone from being merely an idealistic concept to a fundamental and expected approach to care delivery. Today, Planetree, a non profit organization, leads the charge in the advancement of such care practices. In this series, we discuss and disprove the myths that Planetree has identified as challenges to achieving patient-centered care.
Before debunking these myths, it is important to explain what we mean by “patient-centered care.” As defined by the Institute of Medicine (IOM), it is “providing care that is respectful and responsive to individual patient preferences, needs, and values, and ensuring that patient values guide all clinical decisions.” In short? It means taking the patient into consideration when making clinical decisions.
Today, we address the following myth: Providing patient-centered care is too costly
Don’t I need to spend money to make improvements?
It is a common misconception that in order to become engrained in everyday practice, patient-centered care requires costly initiatives. While some hospitals have made large investments to enhance the patient experience, providing care that incorporates patient and caregiver preferences stems more from an organization’s attitude and culture than its resources or equipment.
Culture Change is Free.
Empowering staff members to make the most of each patient interaction is much more valuable than simply hiring more staff members or purchasing commodities to “wow” patients. Additionally, many hospitals have successfully implemented volunteer programs to enhance their offerings and provide additional support for patients at little to no cost.
Initiatives such as employee engagement rounding and volunteer training drive positive culture change and ultimately improve patient satisfaction, quality of care, staff satisfaction, and staff retention. Such programs do not require heavy financial investments, and any costs are quickly offset by the benefits provided. In the end, by enhancing the quality of patient care, these efforts can lead to revenue growth through higher HCAHPS scores and VBP bonuses.
For more information on debunking the misconceptions of patient-centered care, visit planetree.org.
For the ﬁrst time, CMS is making bundled payments mandatory for hospitals with the Comprehensive Care for Joint Replacement (CJR) model, set to begin April 1st. The program holds hospitals and their collaborators accountable for costs, complication rates, and quality of care for patients undergoing hip and knee replacements.
What is the purpose of CJR?
Hip and knee replacement surgeries are the most common procedures among Medicare patients, with hospitalizations alone costing more than $7 billion annually. With these patients receiving care from several providers, it is essential to coordinate care across the hospital and post-discharge environments.
CJR aims to enhance care coordination by holding approximately 800 hospitals in 67 geographic regions ﬁnancially accountable for a 90-day risk-window, including all post-acute costs. CMS will set a pre-determined target price for an episode of care. If the hospital’s spending exceeds this target, the facility pays the excess cost to CMS. In contrast, if the total episode cost is below the target, CMS reimburses the hospital the difference as a bonus.
What does CJR mean for PAC providers?
While CJR seems to impact only hospitals, the primary opportunity for hospitals to increase gain or decrease loss will occur in the post-acute care (PAC) setting. On average, 45% of all episode payments occur post-discharge. For this reason, hospitals are going to form networks and enter risk-share agreements with PAC providers that have proven to provideefficient, high-quality care. Specifically, hospitals will consider:
Home Health Compare and Nursing Home Compare (Star ratings and quality metrics)
Historical Medicare Payments
How Can PAC Providers Prepare?
To succeed under CJR and share in the rewards of the program, PAC providers must work towards better care coordination and transitions across settings. CipherHealth’s integrated engagement solutions help connect providers across the continuum, and in turn, reduce costs associated with complications and readmissions, improve quality of care, and enhance the care experience.
For more information on how we can help you to be a successful post-acute care collaborator under the CJR model, contact us today or download our overview.