AEGIS THERAPIES RESPONSE TO EVOLVING
CARE DELIVERY ENVIRONMENT
EMERGING WORLD OF POST-ACUTE
CARE (PAC) THERAPY PROVISION
4.29.15
REIMBURSEMENT SHIFT
Traditional pay for services shrinking annually as
more potential patients need services
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CMS
# 1 Priority is Post Acute Care (PAC)
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40,000 beneficiaries exit hospitals daily
40% over-utilization of SNF days
80% of Medicare Reimbursement in PAC
$62B Annually
$31B SNF - $18B HH - $13B - LTAC
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REIMBURSEMENT SHIFT
Experiment Trends
• Patient-centric
• Value-based
• Collaboration
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LENGTH OF STAY
CATEGORY
DIAGNOSIS
Sub Acute
GOAL - LOS
Cardiology
Heart Failure
9 to 16 days
20 days
Infective Endocarditis
11 to 20 days
22 days
Myocardial Infarction
10 to 17 days
20 days
Syncope
10 to 17 days
20 days
Ankle Dislocation
11 to 20 days
27 days
Ankle Fracture
12 to 20 days
26 days
Back Pain
10 to 17 days
20 days
Cervical Spine Surgery
9 to 15 days
20 days
Femur Fracture
13 to 24 days
30 days
Foot: Transmetatarsal
Amputation
10 to 18 days
21 days
Hip Arthroplasty
7 to 12 days
14 days
Orthopedics
Hip Fracture, Open Repair 14 to 23 days
Knee: Amputation Above
Sub Acute MEDIAN - LOS
28 days
PATIENT EXPERIENCE
Patient: Violet
DRG: Hip & Femur procedures w/o complications
Target Cost:
$30,237.77
Patient: Henry
DRG: Hip & femur procedures w/ complications
Target Cost: $33,726.18
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PATIENT EXPERIENCE - GOALS
Patient: Violet
DRG: Hip & femur procedures w/o complications
Target Cost:
$30,237.77
Independent ADL & driving prior to surgery.
Goal = Transition home w/ son, continue w/ HH
Patient: Henry
DRG: Hip & femur procedure with complications
Target Cost: $33,726.18
Independent ADL & driving prior to surgery.
Goal = Transition home w/ wife, continue w/ HH.
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PATIENT EXPERIENCE – THE RESULT
Patient: Violet
DRG: Hip & femur procedures w/o complications
Target Cost:
$30,237.77
1/17/14 – 2/8/14: SNF (22 days) $11,584.76
2/10/14 – 4/10/14: HH (16 visits) $3,277.44
Patient: Henry
DRG: Hip & femur procedures with complications
Target Cost: $33,726.18
1/20/14 – 1/25/14:
1/26/14 – 1/29/14:
1/29/14 – 3/14/14:
3/15/14 – 4/19/14:
SNF (5 days)
$2,400.51
Hospital (3 days) $5,921.08
SNF (44 days) $24,712.70
HH (15 visits)
$3,222.06
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THE RESULT – FINANCIAL IMPACT
Patient: Violet
DRG: Hip & femur procedures w/o complications
Target Cost:
$30,237.77
Actual Cost:
$15,812.52
Cost Variance: $14,425.25
1/17/14 – 2/8/14: SNF (22 days) $11,584.76
2/10/14 – 4/10/14: HH (16 visits) $3,277.44
Patient: Henry
DRG: Hip & femur procedures with complications
Target Cost: $33,726.18
Actual Cost: $36,709.57
Cost Variance: $4,983.39
1/20/14 – 1/25/14:
1/26/14 – 1/29/14:
1/29/14 – 3/14/14:
3/15/14 – 4/19/14:
SNF (5 days)
$2,400.51
Hospital (3 days) $5,921.08
SNF (44 days) $24,712.70
HH (15 visits)
$3,222.06
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ACCOUNTABILITY
CONCERN
INFLUENCE
CONTROL
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ACCOUNTABILITY
OP
HH
SNF
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VISION – HAPPENING NOW
• Patient-centric
• Value-based
• Collaboration
Aegis believes the future makes sense.
How do we prepare to be the best at it,
as soon as possible?
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PROCESS
Embrace reality
High-touch patient and provider engagement
to drive improved outcomes at lower cost.
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RESPONSE
What will change?
 Still provide highly skilled rehab services
 Determine transition plan by Day 3
 Communicate with previous care setting in order to
begin where they left off
 Collaborate with next care setting to know what
patient will need
 Assess health literacy of pt./family & provide training
 Follow up w/ pt. after transitioning from PAC setting
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SCOPE OF PRACTICE / GOAL SETTING
Therapy Scope of Practice
• Current: Treat most underlying impairments and
functional deficits identified during evaluation.
• New World: Treat underlying impairments or
functional deficits necessary to move patient to next
transition.
Goal Setting
• Current: Goals set at highest level patient seemingly
can achieve.
• New World: Goals set at level patient needs to
attain in order to achieve next transition safely.
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PREDICTING CHANGE
• From Day 1, therapy education is two-fold:
on patient and family.
• By Day 2 of admission, IDT team must have same
understanding of LOS and transition environment
(home)
• Home visit completed by Day 3, on-site with
patient or potential for “virtual home visit”.
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REHAB ENHANCEMENT
Frequency and Intensity
• With multiple co-morbidities, frequency of
therapy needs to be 7 days per week
• Intensity is based on clinical need to prioritize
goals for the transition point
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TRANSITION ENVIROMNMENT DETERMINATION
NEW WORLD
• Obtain information about next care setting:
• Physical home visit with patient
• Virtual home visit - aide visit home to take
pictures or short videos
• Virtual home visit – family/friends take pictures
or short videos of home, take measurements, fill
out checklist, etc.
• Communicating with providers in transition
environment.
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AVOID DECLINE POST-TRANSITION
NEW WORLD
• Decline in function post-transition – heavily
scrutinized.
• High-touch interaction. Train family on
strategies to maintain functional level.
• Enhance collaboration with resources outside
usual group.
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THERAPY SCHEDULE
NEW WORLD
• Trends toward shorter LOS continues.
• Creates need to increase rehab hours during
day AND across more days during week.
• Greater need for immediate evaluations.
• “Traditional” SNF rehab hours (Mon-Sat)
must expand to 7 days.
• Must address late day admits
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PAYOR-SPECIFIC GUIDELINES
• Third party payers have specific coverage
guidelines
• Understand the various benefits, so that
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Right Patient
Right Time
Right Discipline
Right Setting
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ACO’s ARE WATCHING & MEASURING
• ACO’s measuring SNF performance.
• Measuring timeliness of nursing & therapy evals
• Measuring intensity of services
• Measuring transition time from SNF to next
level.
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AEGIS TRANSITION
• Work with partners and customers to grow ACO
relationships and “collaborative” possibilities
• Maintain a constant “pulse” on the changing
regulatory environment
• Ongoing training - therapy staff
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NEXT STEPS
• Partner with NHA on how to introduce
concepts to facility.
• Is SNF experiencing new expectations?
(i.e. payers driving shorter LOS and transition
to next level, pt’s demanding earlier
transition?)
• Timelines?
• Level of detail?
• Target audiences?
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SUMMARY
• Reduction of SNF costs CMS priority.
• PAC to reshape delivery of care with quicker
transitions.
• ACO measure SNF key performance indicators
• PAC sites will be rewarded on alignment and
efficiency.
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Questions