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Comprehensive Care for JointReplacement ModelBeneficiary Identification & Notification:Promising PracticesComprehensive Care for JointReplacement ModelMarch 1, 2018Audio available through device speakers ORby dialing (800) 832-0736Conference Room:*2657582#Access Code: 030118#

Webinar Agenda Welcome Announcements & Logistics Panel Discussion Questions & Answers Announcements & RemindersComprehensive Care forJoint Replacement Model2

Introduction to Adobe ConnectTo Raise Your HandTo Dial InViaTelephoneClosedCaptioningTo AskQuestionsor SendMessagesDownload Available ResourcesComprehensive Care forJoint Replacement Model3

Introduction to Adobe Connect (Cont.) Use the Chat pod to submit anyquestions or comments Please use “@” if yourquestion/comment is directedto a specific presenter Submit your question/commentby clicking the chat bubble iconComprehensive Care forJoint Replacement Model4

Comprehensive Care for JointReplacement ModelHartford HealthCareLisa TshonasBusiness Administrative OversightDianne VyeJoint Replacement CoordinatorMidState Medical CenterNadine FraserData LeadLori MatneyJoint Replacement CoordinatorThe William W. Backus Hospital5

CMS Learning SystemCJR Beneficiary NotificationHartford HealthCareConnecticut3/1/18

Hartford HealthCare (HHC) and CJR Overview Connecticut population 3.6 million Three major hospital systems in state: HHC, Yale, and Trinity Health of New England Orthopedic market share through 9/17:– HHC: 28.6%– Yale: 20.2%– Trinity: 10.9% HHC represents an integrated Health system with a focus on patient experience, quality performance andoutcomes & collaborative sharing of best practices HHC’s partners include:– Six (6) acute care hospitals located in the Hartford, Central, East and Northwest regions of the state;– Behavioral Health Centers;– HHC Medical Group;– HHC Rehabilitation network;– HHC at Home;– HHC Senior Services CJR Participation in: The William W. Backus Hospital, a 213-bed acute care hospital (Norwich, CT MSA);MidState Medical Center 156 acute care beds (New Haven, CT MSA). CJR PY 2 volume through December for MidState is 101; Backus – 144; this represents 14%, and 30% oftotal joint volume respectivelyCJR Notification Hartford HealthCare7

CJR Beneficiary Notification and Documentation ProcessMidState Hospital: Epic· CJR Patients arrive for Pre-admission testing 2- 3 weeks prior to surgery (100% compliance)a. A report has been built that indicates patient’s insurance with procedure.b. During that appointment, the RN’s verify that the patient is a CJR participant by verifyinginsurance.c. CJR Notification Letter is provided & documented in Medical Record. The manager in Pre-Admission testing then audits patient list weekly and confirms it wasdocumented in the medical record. If, for some reason, a patient was missed, the letter is mailed to the patient and is documented We are consistently at 100% complianceWilliam Backus Hospital: MediTech to EPIC in October, 2017 No Pre-Admission Testing currently; coming in Spring 2018 – process to follow MidState Notification given day of surgery to patient by registrar who looks at daily report and pullsMedicare primary CJR Registrar scans letter into patient’s medical record for documentation Email sent to Total Joint Program Coordinator informing that the patient received the letter and itwas scanned into the medical recordCJR Notification Hartford HealthCare8

Emergent Beneficiary NotificationMidState Hospital: Total Joint Replacement Coordinator refers to the Ortho PA consult list daily toidentify fractured hips Medical record is then checked for insurance & procedure Awaiting analytic report build in Epic that identifies Medicare A and B patientsadmitted with hip fracture and scheduled for Bipolar Hip ArthroplastyprocedureWilliam Backus Hospital: Total Joint Replacement Coordinator manually reviews census to identify hipfractures Medical record then reviewed to determine CJR status Awaiting EPIC analytic daily report build (see above)CJR Notification Hartford HealthCare9

Operational Infrastructure and System Support of Program CJR Legal and compliance touch point (Monthly): In-House Legal Counsel; RegionalCompliance Officer; and CJR Operational Team including CJR Program Director, TotalJoint Replacement Coordinators, Quality and Business Development Representatives Orthopedic Council (Bi- Monthly): System representation including CJR OperationalTeam, Orthopedic physician leads, Local Hospital and System Administrators CJR Operational Subcommittee (Monthly) –CJR Operational Team and Regionalrepresentation including Physician Collaborators and Practice Managers, HHC RehabOperational leads, and Directors of Ortho Service line for Backus and MidState Hospitals CJR Operations Steering Committee (Bi-Monthly): System Support office leadership andmulti-disciplinary representation; key leaders of the HHC Preferred Provider network Hospital Level Ortho Service Line Committee (Monthly): Total Joint Coordinator, ServiceLine Director, Case Mangers, Pre-Admission Staff, Clinical staff including MD, RN, APRN,PA; Physician Liaison, Peri-op Representation, HHC Rehab, HHC Homecare and QualityData Representation CJR Bundled Touch Point (Bi-Weekly): Outside Consultant and CJR Operational Team CJR Data and Policy Review (Bi-Weekly): CJR Operational TeamCJR Notification Hartford HealthCare10

Questions & Answers Use the Chat pod to submit any questions Please use “@” if question is directed to aspecific presenterComprehensive Care forJoint Replacement Model11

Comprehensive Care for JointReplacement ModelProHealth Care Quality DepartmentTina Ottson, BSN, RN, ONCOrthopedic Quality Nurse12

About ProHealth Care An innovative and agile integratedhealth care system Not-for-profit organization Over 100 years of history Closely connected to the community 4,700 employees Hybrid medical staff13

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CJR ProvidersHospitalsProHealth Waukesha Memorial Hospital Tertiary care hospital 255 bedsCJR population 144 in 2016 197 in 2017ProHealth Oconomowoc Memorial Hospital Acute care hospital 58 bedsCJR Population 173 in 2016 235 in 2017Surgeons One independent group 15 surgeons15

Identifying Beneficiaries Pre-Op Administrative assistantsin the office use thedecision tree todetermine if the patientwill be attributed to CJR For CJR patients, theadministrative assistantgives a copy of theSurgeon and Hospitalnotification to thepatient anddates/times/stickers asecond copy for the chartthat gets scanned intoEpic.16

Identifying Beneficiaries in the Hospital Elective Patients- Health Coach Note Hip Fractures A phone call from the Care Coordinator on the inpatient unit to the Health Coachor Quality Nurse for any hip fracture repaired via Hemiarthroplasty.If patient is CJR-all three beneficiary notification given to the patient by the carecoordinator ASAP prior to discharge with copy placed on chart17

EPIC Barcoding andVerifying Compliance Patient Sticker placed on form.Scanned into Media Tab of EPICby HIM (Health informationmanagement)Monthly On-base Report sentto Quality Nurse by HIMSupervisorQuality Nurse cross referencesMRN’s from On-base Report toMRN’s in CJR Share Point site toverify all patients werecapturedCare Coordinators on the floorenter a dot-phrase noteindicating they gave the CJRnotification(s) and explainedthe program to the patient. AReporting Work Bench Reportcan be run off the dot-phrase.CJR “Medicare Bundle packetprovided and all questionsanswered. A labeled copy wasplaced on the chart.”92% Success with this process18

Questions & Answers Use the Chat pod to submit any questions Please use “@” if question is directed to aspecific presenterComprehensive Care forJoint Replacement Model19

Comprehensive Care for JointReplacement ModelHenry Mayo Newhall HospitalKimberly Davidson, BSN, RN, CEN, ONCNurse Navigator for Spine and Joint Program20

Henry Mayo Newhall Hospital 21Located in Valencia, CA. 25miles north of Los Angeles238 bed not-for-profitcommunity hospitalLevel II Trauma CenterAdvance Certification forTotal Hip and Total KneeJoint Commission Center ofExcellence for ShoulderReplacement and SpineSurgeryAdvanced Primary StrokeCenter

Process for Identifying and Notifying ElectiveTotal Joint Patient Population Elective patients areidentified by an algorithmset by IT, scheduledprocedure and Medicare asprimary insurer. An email is generated theweek prior that goes toAdmitting staff, Navigator,Case Management, andHealth Information. Admitting staff gives thepatients the notificationletter when signing in themorning of surgery.22

Process for Identifying FracturePatients Multiple meetings tookplace to brainstorm athow best to capture thesepatients. Who would beresponsible to give thenotification? Consideringthey arrive at any hour ofthe day. With so many variablesthis was challenging;confused patients with noavailable family etc.23

Process for Identifying FracturePatients (Cont.) An algorithm wasdeveloped capturing bysurgical procedurescheduled, more than whatwould fall into the categoryfor CJR so that no onewould be missed. Email sent to Navigator,Admitting, CaseManagement. Weekends and holidaysnotification given byAdmitting staff. Onweekdays it is given byNavigator.24

Questions & Answers Use the Chat pod to submit any questions Please use “@” if question is directed to aspecific presenterComprehensive Care forJoint Replacement Model25

Comprehensive Care for JointReplacement ModelOregon Health and Science UniversityHospitalVijay Judge, BSc, BSN, MBAComprehensive Joint Replacement Coordinator26

Oregon Health & Science University Portland, OR Oregon’s only academic medical center– Serving the entire state and greater PacificNorthwest region– Highest level of care in Oregon 573 beds: 428 Adult and 145 Pediatrics– Ortho Unit: Beds: 26 Staffing: 80% RN, 20% CNA LEJR*: 700 Level 1 Trauma Center & Tumor sub-specialtywithin the department*LEJR: Lower Extremity Joint Replacement27

Oregon Health & Science University(Cont.) CJR Physician Leadership: Dr. Kathryn Schabel CJR Team: Inpatient Nursing, OR Nursing, Quality,Clinical Integration (MDs and Administration),Clinical Informatics, Rehabilitation Services,Program Care Coordinator, and a data analyst. Anticipated volume: 240 cases–29% of Total CJR volume–100% capturing elective–100% capturing fracture’s28

About CJR EHR ChallengesCentral Challenge of Using EHRs for APMs:1. How to track and manage patient activityacross encounters during episode time period2. How do we share information acrossproviders, both internal and external3. How to coordinate our encounter data toenable episode-based reporting29

Care Coordination in 90 day EpisodesPatient Identification Work FlowCJR PatientIdentificationusing EHRUpdate assurgeonscome andgoPredefined filter in EHR forsurgeons that do lowerextremity joint replacementFilter forprimaryindemnityMedicareA&BOf theseMedicare“A&B” filterMD notesfor primaryLEJR hip &kneeCreate an appointment tosee the patient pre-opAdd to active CJR patient listin EHRFinal list of potential CJRpatients in EHR (option:can be saved)Create an “Episode” in EHRso all can see patient isunder CJR bundleAre any ofthese Medicare“A” onlyNoAssign Patient ReportedOutcome (PRO)questionnaireYesENDDiscard30

Care Coordination in 90 day EpisodesPatient Identification (1) The encounter that is created can be seen by all services as a flag Alternative Payment Model (APM) It appears in the EPIC patient header as [APM Yes] Due to EPIC vendor restrictions we are unable to show a screen shot–All services can see this31