Download New-IPF-Quality-Reporting-Measures-and-Bridge

New IPFQR Measures
and Bridge Appointments
Kirk Yauchler, MBA, LCSW, SAC,
ICS, ProHealth Care
Kim Johnson, MetaStar, Inc.
Ross Gatzke, MetaStar, Inc.
June 16, 2016
Objectives
Following this webinar, participants will be better able
to:
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Discuss the current transitions of care measures for
Inpatient Psychiatric Quality Reporting (IPFQR) and
the new measures which will be replacing them
Create awareness of the new IPFQR transitions of
care measures which will be collected beginning in
January 2017
Describe one best practice for outpatient follow-up
visits post-Inpatient Psychiatric Facility (IPF)
discharge with a mental health provider
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Speakers
Kirk Yauchler
MBA, LCSW, SAC, ICS
ProHealth Care
Ross Gatzke
IPF Quality Reporting
Project Lead
MetaStar, Inc.
Kim Johnson
Behavioral Health
Project Lead
MetaStar, Inc.
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Continuing Education
Disclosures
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Commercial Support or Sponsorship: None
Speaker or planner conflicts of interest: None
For CNE credit hours or attendance certificate:
• Full session attendance and completion of one
on-line evaluation
• Evaluation link:
https://www.surveygizmo.com/s3/2808462/June16-2016-LSQIN-New-IPF-Quality-ReportingMeasures-Bridge-Appointments
Thank you!
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Rationale for the Change
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IPFQR Program
Inpatient Psychiatric Quality Reporting (IPFQR)
Program
• Pay-for-reporting program introduced in 2012 by
the Patient Protection and Affordable Care Act
• Eligible hospitals that do not participate are
subject to a reduction in their APU
• Originally a set of six measures
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Rationale for Discharge
Measures
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Patients may not be able to fully report to next
level of care
Aftercare instructions may not be available at the
next level
Next level of care providers need to know or learn
about the important aspects of patient information
to provide the best care
The value of integrated care!
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IPFQR Discharge Measure:
HBIPS-6
Post-discharge continuing care plan created
• Discharge medications
• Next level of care recommendations
• Documentation of the principal discharge
diagnosis
• Reason for hospitalization
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IPFQR Discharge Measure:
HBIPS-7
Post-discharge continuing care plan transmitted to
next level of care upon discharge
• All elements required of HBIPS-6 measure
• Post-discharge continuing care plan transmitted to
the next level of care (by the fifth post-discharge
day)
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Discharge Measure
Performance
90
80
70
60
50
40
30
20
10
0
84.74
78.12
68.15
77.5
70.66
70.35
62.64
63.87
MI
MN
WI
US
HBIPS-6
HBIPS-7
CY 2014
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Rationale for Change: Removal
of Discharge Measures
HBIPS-6 and HBIPS-7 measure content not as
robust
• Missing important elements within the transition
of care process
• Additional content needed to address gaps
• Readmissions a growing concern among IPFs
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Rationale for Change: Filling
in the Gaps
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Sharing of diagnostic test results
Comprehensive medication lists
Personalized patient instructions/plan for care
Timely transmission of patient transition record
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New IPFQR Transition Measures
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New IPFQR Transition
Measures
HBIPS-6 and HBIPS-7 removed January 1, 2016
• Being replaced by National Quality Forum
transition measures
• NQF #647:Transition Record with Specified
Elements Received by the Discharged Patient
• NQF #648: Timely Transmission of Transition
Records
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NQF #647:Transition Record
with Specified Elements
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11 elements
Far more robust content requirements
Some additions include:
• Documentation of tests and procedures at
inpatient stay
• Studies pending at discharge
• Advance care plan
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NQF #648:Timely Transmission
of Transition Record
Patients for whom a transition record was transmitted
to the facility or primary physician or other health
care professional designated for follow-up care within
24 hours of discharge
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HBIPS-6 vs. NQF #647:
What’s New?
HBIPS-6
NQF #647
Principal diagnosis at discharge
Principal diagnosis at discharge
Reason for hospitalization
Reason for inpatient admission
Next level of care recommendations
Major procedures/tests performed during
inpatient stay
Discharge medications
Current medication list
Studies pending at discharge
Patient instructions
Advance directives or documented reason for
not providing advance care plan
Plan for follow-up care
24/7 contact information
Contact information for obtaining study results
Primary physician, or other healthcare
professional, or site for follow-up care
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Inpatient Care
HBIPS-6
NQF #647
Principal diagnosis at discharge
Principal diagnosis at discharge
Reason for hospitalization
Reason for inpatient admission
Major procedures/tests performed
during inpatient stay
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Post-Discharge/Patient SelfManagement
HBIPS-6
NQF #647
Current medication list
Studies pending at discharge
Patient instructions
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Advance Care Plan
HBIPS-6
NQF#647
Advance directives or documented
reason for not providing advance
care plan
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Contact Info/Plan for Follow-Up
Care
HBIPS-6
NQF#647
Next level of care recommendations
Plan for follow-up care
Discharge medications
24/7 contact information
Contact information for obtaining
study results
Primary physician, or other
healthcare professional, or site for
follow-up care
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HBIPS-7 vs. NQF #648: What’s
New?
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Both require all elements of the
discharge/transition record
Time window for successful transmission of
record reduced from 5 days post-discharge
(HBIPS-7) to 24 hours
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Conclusion
Care transitions are an important component of
providing optimal services within behavioral health
• Improved communication
• Reduction in errors
• More engaged patients
• Better outcomes!
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References
Centers for Medicare and Medicaid Services
www.cms.gov
QualityNet
www.qualitynet.org
National Quality Forum
www.qualityforum.org/
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ProHealth Care: Transitional /
Integrated Behavioral Health Services
Kirk Yauchler, MBA, LCSW, SAC, ICS
ProHealth Care
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ProHealth Care/ProHealth
Solutions
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Based in Waukesha County, WI (Milwaukee area)
2 hospitals, 13 clinics
ProHealth Solutions- ACO
698 ACO Providers
361 employed by PHC
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ProHealth Care’s Behavioral
Health Service Line
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Inpatient hospital-based psychiatric unit
Partial hospitalization program
Intensive outpatient, opioid dependence programs
Outpatient clinic-based services
Integrated behavioral health services team
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History of Integrated BH
Services Team
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Hospital-based
Similar to social work/hospital ancillary services
Had direct care roles on inpatient unit
Mix of licensed and in-training clinicians
Billing limitations due to being part of hospital
department
Limited support to clinics
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Current State
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Moved to clinic division & hospital professional office
building
11 licensed therapists with variety of clinical
functions including:
• Behavioral health/crisis assessments in ER
• Consultations on medical floors in hospital
• Crisis assessment in clinics
Function as behavioral health clinical triage for
urgent referrals
Able to bill for outpatient, hospital, and ER services
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Bridge Appointments
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Clinic visits with behavioral health provider within
7 days post-discharge from partial hospitalization
and inpatient psychiatric unit
Providers see patients 1-3 times to bridge gap
between discharge and connections with
psychotherapist within PHC or the community
Clinic psychiatrists have opened appointments for
post-discharge follow-up as well
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IBHS Dept- FY15 Results
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2,400 billed visits
$200,000 in net revenue
Covered 30% of department cost
Allowed for expansion of FTE in department for
FY16
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Challenges and Successes
Challenges
• Access to Care
• Medicare billing for LPCs
• Medicare coverage for IP
consults from IBHS
• Care for non-ACO
patients discharging from
IPF & PHP
Successes
• Increase in completed postdischarge appointments
within 7 days of discharge
• Expanded billable services
• Strengthened continuum of
behavioral health services
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Future State
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Expand IBHS team and billable services
Integrated behavioral health providers in primary
care
Have satellite presence – want a “hub and spoke”
in all clinics
Behavioral health screening services in
hospital/clinic settings
Telehealth for psychiatry, potentially other
disciplines
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Lessons Learned
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Use available resources to support ACO and
protect access
Partner with community-no need to go it alone
Engage billing/corporate compliance in process
Leverage cost of untreated behavioral health
conditions to make the case for resources needed
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Questions?
• Kirk Yauchler, ProHealth Care
• [email protected]
• Kim Johnson, MetaStar
• [email protected]
• Ross Gatzke, MetaStar
• [email protected]
www.lsqin.org
www.metastar.com
MetaStar represents Wisconsin in
Lake Superior Quality Innovation Network.
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This material was prepared by the Lake Superior Quality
Innovation Network, under contract with the Centers for
Medicare & Medicaid Services (CMS), an agency of the
U.S. Department of Health and Human Services. The
materials do not necessarily reflect CMS policy.
11SOW-MI/MN/WI-G1-16-34 061416