Title of Outcome Measure (Improvement Target):IT-3.1: All-Cause 30-Day Readmission Rate

Unique RHP outcome identification number(s): 094109802.3.5, 094109802.3.6

Outcome Measure Description:

To achieve improvement under this metric, LPDS will engage in project planning during DY 2. In DY 3, LPDS will apply the planning developed in DY 2 in order to determine baseline rates for future DYs. In DY 4, LPDS intends to improve its all-cause 30-day readmission rate by at least 2.5% over the baseline recorded in DY 3. In DY 5, LPDS intends to improve its all-cause 30-day readmission rate by at least 2.5% over the DY 4 measurement.

Process Milestones:

  • DY2:
  • P-1 – Project planning – engage stakeholders, identify current capacity and needed resources, determine timelines and document implementation plans
  • DY3:
  • P-2 – Establish baseline rates

Outcome Improvement Targets for each year:

  • DY4:
  • IT-3.1: All-cause 30-day readmission rate—2.5% improvement over DY3
  • DY5:
  • IT-3.1: All-cause 30-day readmission rate—2.5% improvement over DY4

Rationale:

According to the Medicare Payment Advisory Committee, 76 percent of re-hospitalizations occurring within 30 days in the Medicare population are potentially avoidable. Other populations affected include patients with chronic diseases, complex medical and social needs and patients with little or no funding resources for post-acute care needs. Evidence suggests that the rate of avoidable re-hospitalization can be reduced by improving core discharge planning and transition processes out of the hospital, and by improving care coordination through the use of electronic medical records and computerized provider order entry systems. A measurable reduction in LPDS’s all-cause 30-day readmission rate will indicate that LPDS has made progress towards these goals. In order to record this reduction, LPDS must first engage in planning and baseline measurement in DYs 2 and 3, respectively.

Outcome Measure Valuation:

$3,760,461. In determining the value of this outcome measure, LPDS considered the extent to which a reduction in the all cause 30 day readmission rate will address the community’s needs, the population which this improvement will serve, the resources and cost necessary to realize the improvement, and the improvement’s conformity to the goals of the Waiver (including supporting the development of a coordinated care delivery system, improving outcomes while containing costs, and improving the healthcare infrastructure). Specifically, the valuation of this outcome measure takes into account the potential of better discharge management and better records management to improve quality of care and thereby improve patient outcomes. The valuation of this outcome measure also takes into account the challenges that LPDS will face in realizing this improvement in the hospital setting.

094109802.3.5, 094109802.3.6 / IT-3.1 / All-Cause 30-Day Readmission Rate
HCA Las Palmas Del Sol / 094109802
Related Category 1 or 2 Projects:: / 094109802.2.1, 094109802.2.2
Starting Point/Baseline: / TBD
Year 2
(10/1/2012 – 9/30/2013) / Year 3
(10/1/2013 – 9/30/2014) / Year 4
(10/1/2014 – 9/30/2015) / Year 5
(10/1/2015 – 9/30/2016)
Process Milestone 1 [P-1]: Project planning—engage stakeholders, identify current capacity and needed resources, determine timelines, and document implementation plans.
Data Source: Documentation of project planning
Process Milestone 1 Estimated Incentive Payment: $438,228 / Process Milestone 2 [P-2]: Establish baseline rates.
Data Source: EHR; claims.
Process Milestone 3 Estimated Incentive Payment: $507,964 / Outcome Improvement Target 1 [IT-3.1]: All cause 30 day readmission rate.
Improvement Target: 2.5% improvement over DY3.
Data Source: EHR; claims.
Outcome Improvement Target 1 Estimated Incentive Payment: $815,105 / Outcome Improvement Target 2 [IT-3.1]: All cause 30 day readmission rate.
Improvement Target: 2.5% improvement over DY4.
Data Source: EHR; claims.
Outcome Improvement Target 2 Estimated Incentive Payment: $1,949,164
Year 2 Estimated Outcome Amount: $438,228 / Year 3 Estimated Outcome Amount: $507,964 / Year 4 Estimated Outcome Amount: $815,105 / Year 5 Estimated Outcome Amount: $1,949,164
TOTAL ESTIMATED INCENTIVE PAYMENTS FOR 4-YEAR PERIOD: $3,710,461

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