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Sneak Peek: Jump into the Driver’s Seat of the New ...
Sneak Peek: Jump into the Driver’s Seat of the New ...
Sneak Peek: Jump into the Driver’s Seat of the New CPC Accreditation Model
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Hi, and welcome to your last session for the day, and the best session of the day. And if this is your first time to accreditation, welcome. If you are already accredited, we are excited to announce our new product that Tracy has built. And I'm going to introduce here my colleague and partner in crime, Tracy Blevins. She started as an accreditation review specialist, and she's been doing it for eight years. And basically, what she's done is accumulated everything that she has seen out in the field, taken voice of the customer, perspectives, experiences, and has revamped our new chest pain accreditation product, which will be released next month. So it will be a very nice, very streamlined, sexy new model to show you here. So please get excited. No pressure at all whatsoever with this intro. None. And let's give a round of applause for Tracy Blevins. Everybody. All right, so it's the last session of the day, a little ground rule. If something comes up on the slide, and you like it, I want you to pretend that you're either at church on a Sunday night, at a volleyball game, at a soccer game, wherever you get loud, we want to hear something. This room is quiet. I'm leaving. Okay. So hopefully you're going to like what you see. We've been taking our internal and external voice of the customer very seriously. We had a long list. So here we go. Are you ready to see it? All right. So how many of you, show of hands, are a current chest pain accreditation customer? Keep them up. All right. How many of you are current version 7 chest pain accreditation customers? Now out of you, how many have seen the continuous model features? Nice. All right. Here we go. I have no disclosures, by the way, other than saying I'm a little crazy. Our objectives, we are going to go over the continuous model features to reduce your reaccreditation efforts. How many of you had your hand up for continuous model? Do you like them? Okay. So this was a test. We put the slide up. We said continuous model features. Nobody hollered. Nobody hooped. Nobody clapped. Nobody did anything. But we're going to test you. There's going to be another slide. All right. We're also going to review the streamlined tool functionality that hopefully improves your customer experience. These are all voice the customer suggestions. Then we're going to try to illustrate the updates to the sampling process and the additions to the calculated measures that we got from the ACB tool for our ACB customers. So some of you that are working in the NCDR registry, these won't apply, but we saved them to last. All right. Our continuous model. There we go. All right. Now we're getting somewhere. All right. So we have some new features for our reaccrediting customers. So if you're going to be brand new to chest pain accreditation, you'll have to go through the process from beginning to end. But then as you come back through for reaccreditation, you'll have all these new features that will exist. You can bypass the baseline gap analysis, which is huge. Okay. You can auto fill the facility information, the contacts, and you can even bypass the essential components. Right? Y'all were complaining about that for years. I was listening. Okay. So if you have your facility information and your contacts and they're all the same, okay, and you want to verify it, it will pull over. Your contacts will pull over if they had a green check mark, meaning that you had everything filled in from your last tool. And all you have to do is verify the information is correct. That's it. You don't have to retype anything in. It pulls over. We like that? All right. I don't know who is flipping my slides, but I'm not flipping them. So I'm trying to keep up here. All right. The electronic health record information also will pull over, and the contacts will pull over. So down here at the bottom of the screen, you'll check the box. You'll verify that all those contacts are, in fact, correct. You don't need to retype them in. The ones that have the green check mark will only be the ones that pull over. So if you have new people, you would have to fill in those new accounts, of course, and change those. We like that? All right. This one's the big one. So for those of you that have never done accreditation with us before, you have 60 days to complete what's called a baseline gap analysis. You open the tool. You tell us a little bit about what's happening at your facility. You answer the questions in the essential components. Yes, I think we're doing this, and we're good. No, I don't even know what you're talking about here. I don't have a document. Or I'm not really sure, so I'm going to mark no and keep moving. That's what that baseline gap analysis is. You also have to enter in data in that phase. But if you're a reaccrediting customer coming back, and your data has been kept up to date, and you haven't made significant changes to your policies, your procedures, your flowcharts, I'm not doing that. Do we know why the screen is flipping? And now it's flipping forward, and I'm not touching anything. I don't know. Maybe I should put this down and not touch it. Maybe I'm juicing it, right? All right. So now, if you decide that you want to bypass the baseline gap analysis, you can answer, yes, I don't want to answer the baseline gap analysis questions. I'm pretty confident that we've stayed the same, and you go right into the application phase. Okay? How nice is that? You don't have to answer the same questions again. Now, if a lot of things have changed in your organization, you have a brand-new leadership team, you blew up some big process in the last three years, you probably shouldn't bypass the gap analysis, you probably should just go through and check what you think you're going to have to work on. But if everything kind of stayed status quo, I would encourage you to bypass and get moving in the application phase, okay? Existing customers only. Now it's going backwards. Sorry, y'all. All right. Another new feature. Remember before, for our reaccrediting customers, if you put documents in your previous tool, and now you open your new tool, you had to go up to the actions button, you had to toggle back into your old tool to find those documents to look at, then you had to go back up to actions, toggle back into your new tool, and by then you were like, I'm done for the day. Remember that process? Well, now we have a new feature that will port over all of your historical documents into the tool. Jazz hands. Okay. Now, this will save you the back and forth, so you're going to get more time back, more efficiency, but you need to understand that what will port over are the documents that have already been approved, or documents you put in that were not read, meaning that you put them in in the maintenance phase, and the ARS didn't look at them. Those will port over. See, I'm not touching anything, and it's moving. You see that? It's the weirdest thing. I don't know what's happening. I even put the thing down. I don't know. Should I do that? Are you touching it? No. Oh. Okay. It's okay. I was just trying to figure it out, because the laptop screen is already seven slides ahead of this screen. So now when I use this, it's changing the laptop and not the screen. Okay, all right. So these are our continuous model features. We like them? Yes. We good? Yes. All right. Now, we're gonna give you a little sneak peek of our future model. And again, we're jumping the gun. So our future model will be coming out mid-October, okay, about a month from now. If you are a current accreditation customer and you're in the window for renewal, you will be launched into this future model, okay? This is what you'll see. All the continuous model features would apply if you're an existing current customer. So you would get all those features we just talked about and you're gonna get this new model. I have no idea what's going on. It's like it's possessed. I am so sorry. Okay. It'll be controlled from back there, so point over there. Point at you? Yeah, this will be in the room now. Nobody will mess with it. That is yours. You heard him, right? That is over here. Okay. All right. So one of the new features in our upcoming model is we have restructured and updated the left menu. We've set this based on prioritization of your workflow. So it should correspond with the processes within chest pain accreditation. Once this goes out and the new service lines come on board like heart failure, I didn't change it, I didn't touch it, it will be the same. So you will open the left menu, prioritization, and then work down from the top based on what stage you're in in the accreditation model. Okay? Nice features. We just thought we should probably line it with the way you think during the process. Okay? Now, those of you that are existing customers, you know that when you are either in the baseline phase or you have to update something when you're in accreditation, we need an annual count from your last calendar year of certain patient populations. Okay? STEMI, non-STEMI, unstable angina, low risk based on ICD-10 primary discharge codes. In this new model, we've also added now a section where we want you at your facility to be able to pull a calendar year's worth of observation patients that were ACS. Now, I don't know how you're going to do that because there's no ICD-10 code for that, but we'll help you with that. Hopefully you have some internal tracking. You could pull all your OBS cases for a calendar year and then maybe filter them out by chief complaint or by discharge. What we're trying to get at here is an annual volume of what you're putting in observation that's ACS related. Why is that important? Because if you're new to accreditation or you haven't been in the accreditation cycle where you're working with your accreditation review specialist, we have some new tools, some new return on investment calculators. So when you plug this number in now and you give us an annual count of what's going into OBS, we're gonna take your data, we're gonna plug that into this calculator and we're gonna be able to turn around and tell you how much money we could save you by reducing your length of stay in OBS. And how do we do that? We follow evidence-based guidelines. We instruct on your protocols, your pathways. We talk to you about what are you doing with stress testing in OBS? What's your turnaround time to get those results in OBS? Why are you stressing in OBS? Because it's a bundled payment. So should you be stressing in OBS? And if you are, what does that turnaround time look like? Because at the end of the day, the longer they stay in observation, the less money you make from revenue because it's a bundled payment. All ACS observation patients are an APC 8011 cost code. It's bundled. You cannot bill and collect separately for stress tests. So taking this information and then being able to put it into a calculator, give it back to you so you could give it to your C-suite with financials attached, speaks volumes is what we're hearing from you. We need something from ACC. We need money. We need dollars. We need cents. This is how we get there. You're gonna have to do a little bit of heavy lifting for us though to find us the volume. Everybody okay with that? All right. Another new calculator that we have is our ED length of stay, return on investment calculator. So we figured out through some reference checks, through some studies, what does a normal emergency department patient look like that presents with ACS? And when they're discharged, how do we bill and collect revenue for that ED patient? So what we're gonna do here is we're gonna take that patient population field that already existed. We're gonna take your low risk volume. Now remember, these are estimates. Not all low risk patients are gonna go home from your ED. Depending on the troponin you're using, if you're using a high sensitivity troponin, there's a nice big chunk of those patients that should be going home from your ED, right? So what we're gonna do is we're gonna take your low risk volume, we're gonna take your data, we're gonna plug it into this calculator, and we're gonna give you your financial savings on working with your ED and hardwiring your processes to reduce your ED length of stay. And how do we do that? Through accreditation, working with your accreditation review specialist. We look at all your documents. We talk about your processes. We'll ask you questions. Ask some of my people in here where I was their accreditation reviewer specialist. I would say, well, why are you doing that? They would be like, well, why are you asking me that? I said, because I wanna know why you're doing that. Like, explain to me why you're doing that. So it makes sense to me. So that I can help you figure out, well, why are you doing that, okay? Now we're gonna be able to give you some financial information back as to leverage those conversations about, well, we've always done it that way. I hate that answer. Just because we've always done it that way doesn't mean that's how we're gonna keep doing it. That's not how we stay vital and important in the market share, you know? We all have to try to stay competitive. Now this was an updated thing because a lot of the voice of the customers were coming back because some of you have OCD, like me, and you're chest pain center coordinators, so you like all your I's dotted and all your T's crossed. And when you only are using either the high-sensitivity troponin assay or the contemporary assay, you weren't getting a green checkbox because one of those was left blank on purpose because you're not using both. So in this model, now you're gonna have to check the one you're not using as NA. Once you check it NA and you populate what you are using, you're gonna get the green checkbox. So you don't have to keep opening that up and saying, what did I forget? Nobody's hooting and hollering. All right. I knew some of you would like that one because you've been blowing up my email about it. All right, buckle up, here we go. So now, in this future model, coming out mid-October, we have, in our chest pain accreditation, we give you three options to do your data currently. We allow you to pick the ACD. We allow you to work in the NCDR chest pain in my registry. Or we support a hybrid model where some of you are still deciding to put some patients in the ACD and some patients in the NCDR chest pain in my registry. And although I do not understand why you're currently doing that, we left that as an option in this model until we could talk you out of that. You really should be in one or the other, right? We were hearing back and forth from our PCI resuscitation customers, why do I have to put more data in if I wanna be a resuscitation center if I'm using the CARES Registry? All right. So I pulled up the CARES Registry. I looked at what you get back for hospitals that participate with the CARES Registry. I looked at the reports. We're gonna get everything we need from the CARES Registry. So if you participate in the CARES Registry and you wanna be a PCI with resuscitation facility moving forward with this future model, all you have to do is upload your quarterly CARES Registry reports and you do not have to do additional abstraction. I'll wait. So how many of you currently wanted to be PCI with resuscitation but didn't wanna do the extra work? All right. So now you don't have an excuse. We wanna see resuscitation customers but wait till I show you the changes in the resuscitation designation and then you're gonna get really excited. And if some of you don't run up and down the aisles with excitement, I'm gonna be really disappointed. Okay? All right. Another thing on the left menu that we've updated and made new, we got a lot of feedback from you guys. Well, you have this great shared practices tab on the left menu. Why can't we have one for references? Why do I have to go through the whole tool trying to find a reference? Okay, we listened. Now you have a reference on the left menu. You click on that. It will open up an alphabetical list of all the references that are in the tool. You'll now click on view and it will open up the reference right from the left menu. Now let's talk about something else related to references. How many of you have complained that our references, the links didn't work? Or when I clicked on it, they wanted me to pay for it. Show of hands. How many of you didn't like that? All right. So for the record, we removed every single reference that you would have to pay for. They are all PDF with the exception of about six that have active links that could not be removed. They're links to like the CARES registry. They're links to eHack. That is like a full moving target, okay? If the link doesn't work, now there's only about six of them in there, you'll just have to let us know and we'll figure that out. But we removed a significant amount of the barriers to your references. All the references have been updated. All right. I'm gonna give you a chance to read the slide. Chew it up. Swallow it. Okay? All right. So when we launched version seven, we kept hearing words like, this is a beast. This is heavy. We don't like it. I can't do this. Why do you need all this stuff? We're already being asked for this by CMS. We're being asked for this from this registry. We're being asked for this. Why are you making us do all this stuff? And from an internal perspective, when our accreditation review specialists would get assigned to us, from an internal perspective, when our accreditation review specialists would get assigned a version seven system, for example, like Hackensack, when we had nine hospitals and they had to load all those documents across nine hospitals, we didn't like it very much either. Internally, right? So we decided we were gonna take a good hard look at what was in there. And we decided that if it was overarching where you're already answering for things from a higher governing body like the joint commission, things like that, we removed it. We're no longer gonna ask you about your moon process, for example. We're no longer gonna ask you about your moon process. We're no longer gonna ask you about your moon process. Nobody run in the aisles yet, but we're getting there. but we're getting there. All right. What you're going to see now in this future model, and I'm going to be honest with you, okay? For those of you that are in a holding pattern waiting to get it, now is your time to look at your current documents. And I'm gonna give you an example. We have consolidated things into existing ECs. So for example, in seven right now, you are required to do a QAPI, an ACS, Quality Process Improvement Plan, and you are required to put it in the quality tab. Yes? Then, if you are a PCI designation facility, we also wanted you to have a STEMI operators outcome metric in the designation tab. So how many of you put that into your QAPI and had to load your QAPI two places? Right? Ridiculous, right? Why are we doing all this lifting? Why are we doing all this duplicate work? So now, in this model, when you're looking at the QAPI requirement, the STEMI operator outcomes measure is already listed in there as a bullet if you're doing limited-hour primary PCI or 24-7 primary PCI. So you're gonna load the document one time. Okay? Now that being said, if you're bored and you're waiting for the future model to launch, look at your documents. Okay? If your charter wasn't inclusive and you had seven documents in order to hit the bullets in the charter section, now is the time to combine them and make it inclusive. Wouldn't you rather chase 10 documents than 100 documents when it's time to review them? So start looking at that when you're getting that future model and get more inclusivity into those protocols, those policies. Make sense? Overall, we have reduced the essential component requirements for you by 47%. All right. Let's talk about the groupings. Okay? Don't panic. We have made some changes. Okay? The Governance tab, Still Governance, it's gonna look at your program model. All of your staff education's gonna be located in staff education. And then we're gonna look at some wayfinding. Quality. We're gonna look at your QAPI. We wanna look at your process improvement. You're still gonna need to do a PI project for the site review. Community outreach. We're still looking at how involved you are with your community. Pre-hospital. We're looking at your relationship and your collaboration with your EMS agencies and your providers. How well do you work together? What do your handoffs look like? How are you building processes and policies where you're working with them, not against them? Biggest change. ACS patient care management has replaced early stabilization. Why you ask? Because in the first tab we're looking at your emergency department process. We're looking at your front-end process. How do you recognize these patients? How do you triage these patients? How do you educate who triages these patients? We're looking at what troponin you're using. What's your serial strategy? You're using a high-sensitivity troponin and you're still doing a zero, three, six-hour serial strategy. That's going to be where your accreditation review specialist says, why are you doing that? Because we've always done it that way. Well, that doesn't make that right. And then we're going to have follow-up conversations. See how that works? Then we've created a flowchart tab. You're going to put all your flowcharts in the flowchart tab. You're going to load them in one time. One time. Then we've created an order set tab where you're going to put all your order sets. You're going to load them in one time. And then we're going to look at non-ischemic evaluation and stress testing in that grouping. We've moved observation management out to its own tab. Why? Because some facilities are still really struggling with observation management. Are you putting the right patients in there? When you're putting the right patients in there, how fast are you getting them out? Are you stress testing them in ops? You're not getting paid for that. Why are you doing that? Why is your length of stay 48 hours? They only have to be in observation eight hours for you to get paid. So we ask a lot of questions. So we move that out to its own tab because now we have the ROI calculator that we can help you with that. We can leverage those conversations. We're going to try to help you get back on track depending on the assay that you're using to put the right patients into ops and move them through hardwired consistently so that your length of stay makes you money. It doesn't lose money. Transitions of care, still about how you're prepping your patients for discharge from admission to discharge. But I'm going to give you some really nice changes in that tab that hopefully you'll be excited about. Clinical quality, that's all about your data. You're not required to upload any documents in that tab. That's where your accreditation review specialist will pull your data over into that clinical quality tab regardless of where that data comes from. And then under designation we've made significant changes in our designation tabs, but the designations stay the same. You'll have chest pain base, which is you're going to refer all your STEMI's out, or you're only going to do primary PCI limited hours during the day. You're going to be able to do chest pain center with PCI, which is primary PCI coverage 24 hours a day, seven days a week, no diversion. If you're in a system and you want to do PCI, you cannot use the same STEMI operator to cover multiple campuses and get PCI accreditation. If there's any questions about that, put it in the chat so we can talk about it. And then we've made a lot of changes in our resuscitation designation. We've looked at all the latest guidelines. We're moving away from cooling. If you do cool, you have to provide us the documents. But we're looking at normal thermia, preventing fevers. We're looking at managing those patients from arrival to discharge. Still nobody running in the aisles. I don't know what I'm going to do. All right. So we're going to break this down now by essential components. The first essential component is the Governance tab. We reduced this by 38%. There are ten mandatory requirements. For those of you that have been in Version 7, remember there were four tabs in the Governance tab. Now there's three. We've gotten rid of the first tab where you were required to load your CV or your job description in there for your medical director, your chest pain coordinator, and your data abstractor. All three of those people though need to show up in your charter in the second tab, which is now going to be the first tab in Governance. So in your charter, you will also have to tell us what your sampling plan is if you're an ACD customer. So show of hands, how many of you currently in Chest Pain Version 7 use the ACD? Okay. So this might — I don't know what this is going to do. This might make the room erupt or this might make everybody be like, oh, we lost you here. So we had significant voice of the customer around the ACD and the CSV file. Most hospitals said, I don't like this CSV file. I don't like to create it. Half the time I load it, it doesn't work. And then when they sample these cases back, they're not real cases. I have to delete them. But instead of putting somebody in that I know is a low-risk case, I have to go back to the CSV file, pick another case off the CSV file and put that patient in. Am I accurate? »» Yes. »» Okay. We are removing the CSV file process from the future model for our ACD customers. Now, what does that mean for you? That means you have to define your sampling plan in your charter. So for example, we're going to walk through this. So let's say you come from a really large facility, teaching hospital. You see 100 low-risk cases a day come through your emergency department. Do you want to sample 30 low-risk cases the first day of the month in that institution? Why don't you want to do that? You want me to tell you why you don't want to do that? Because you could have a staffing problem that day. You could be working short in the ER that day. Or you could have the worst provider on working in the emergency department that day. And please don't look at me like I'm crazy because we all have one. We all have an ED provider that is slow as molasses and can't get these patients through the system. Well, if you're a large facility and you decide you're just going to put all 30 in on the first day of the month based on the discharge date, that date is probably not truly reflective of your ER process. Because again, you're working short that day and you've got slow Joe on, right. So not a good thing. So you get to define your sampling plan. And there's examples in the tool that you can use. My suggestion would be, depending on how large you are, pick like for low-risk. You're going to put three cases in, primary ICD-10 code, starting the first day of the month until you get to 30. That's over 10 days. Slow Joe ain't going to work 10 days in a row. And hopefully your staffing isn't going to be that bad for 10 days in a row. So your data is probably going to be more reflective of what's really happening with your organization. Make sense? So with the CSV file going away, we have to have you define what your random sampling strategy will be. And that has to be in your charter for our ACD customers. For our NCDR customers, you follow their inclusion criteria, which we're trying to align and update in the future. Staff education. All education is now under the staff education tab. STEMI drills is in there. Observation education is in there. Your ACS eHack education is in there. Your education policy is in there. So we know how you're holding people accountable when they don't do their education. They walk around like they know everything and they don't know anything. Right? What are you doing with them? And then wayfinding. We want to look at your policy on how you do annual inspections and how you report your findings out to your chest pain committee. That's it. One. Are you required to load photos? It says you are. But if your accreditation review specialist is coming on site to do a site review, we don't need your photos. We'll look at your signage when we get there. Okay? All right. Starting to sweat. All right. EC2 under quality, 45% reduction, five mandatory requirements. We want to see your QAPI. If you're a limited-hour primary PCI facility or a 24-7 primary PCI facility, you put your STEMI operator outcomes metric into your existing QAPI. Okay. We're going to look at your 30-day AMI readmission process. Notice the mortality is no longer there. We're going to drive the 30-day AMI readmission process with our new calculator, which I'll show you. We're going to look at your STEMI feedback process. God bless you. We're going to ask you to provide a tracking tool or metric analysis for how you go about your canceled activations or your STEMI activations. And then you have to provide, of course, your process improvement project for your site review, whether it's virtually or on site. You're still going to upload that and talk about process improvement. Community outreach. We reduced this by 72%. Two tabs to one. However, I do not want that to reflect in this room that you are not supposed to engage in your community. You've all learned that now through accreditation, that being collaborative within your communities is where it's at, identifying, screening, educating, closing the loop. That's where it is. So how did we get 72% reduction? In your Community Health Needs Assessment, which is still required, you've still got to do one every three years, we grouped that with your quarterly screenings and your quarterly education. Because you should be looking at your CHNA to determine what patients are at risk that are ACS-related. And then how are we going to go about figuring out who they are and where they are? We're going to screen and we're going to educate. We tied them together. Then you still have your two EHAC hands-only CPR events that you have to do annually. One with the school system or a youth program, and one in collaboration with EMS. But that EC is one EC now. It's not three and four ECs spread out. You following me? And then your organizational website platform. You no longer have to have your Community Health Needs Assessment posted on your website. We got significant backlash from our voice of the customer. We don't want that on our website. Okay. You still have to produce that. And now we're going to work with you to identify why you should even be looking at it for ACS accreditation. And then we're going to help you build your screening events and your community education to try to target those patients and reduce the risk in your communities. And then you still have to do an offering around AED in your community. Anybody that has not been paying attention about what's going on, we know based on the literature that bystander CPR saves lives. What else saves lives is knowing where the closest AED is to provide defibrillation timely. So the more active you are figuring out where's what in your community, how can we help? How can we train? We're not asking you to buy anybody anything. We're asking you to offer how we can get our community more knowledgeable around the AED. Pre-hospital care, we've reduced this by 50%. There's only four mandatory requirements in the pre-hospital care tab. We have added an NA option to the EMS quarterly meetings. What does that mean? EMS still needs to attend your hospital meetings in the governance tab. So if that's all you're doing, you mark NA there. EMS is coming to your meetings at the hospital, you're going to mark that yes in your governance tab. Okay. Following me so far? But when you get to the pre-hospital care, some of our hospitals are really active with their EMS agencies. They're going out to every single EMS agency that brings patients in, and they're sitting in their meetings. So they're doing hospital meetings, and then they're going out and doing EMS meetings. Well how are you getting credit for that? You weren't. So now you will. You mark that yes, and you'll tell us, we're doing these hospital meetings now, and we're doing all this in the EMS arena. And that will probably lead to noteworthies, right, because that's what happens. We're going to look at your annual EMS education. We've updated the bullets. We've given you more choices in order for topics to get EMS working with you and your chest pain accreditation. We want to see your pre-hospital activation process. And then our new one, which was a recommended item but is now a mandatory requirement, is that you must have a process that shows how your EMS patient that arrives at your hospital with a diagnostic STEMI that is stable, if your cath lab team is there and ready to stick, how does that patient go from the ER door on the EMS stretcher to the cath lab? You define that process, align with the guidelines, and we look at it. We're not telling you how to do it. I mean, if you want us to tell you how to do it, we can help you. But you define that based on your resources, your comfort level. But either way, that's what the guidelines suggest. If you have a diagnostic EKG, your team's available, and the patient has ABCs, off we go on the EMS stretcher. Okay. Nicole's happy. All right. So this is our new tab, EC5, ACS Patient Care Management. So in our initial assessment tab, we reduced that by 68%. So you'll have five mandatory requirements in there. But let's talk about the importance of those five, okay. How many of you either work in an ER or manage an ER? Woo, that number, that's low. Okay. So we're going to have to educate them. All right. If you don't work in an ER, you might not know this. But if you're in an ER and your triage nurse is not very good, you're going to have a really bad day. It does not matter how good your charge nurse is. If your triage nurse is not good at sorting quickly and accurately, you're having a terrible day. Just an old ER nurse here, used to volunteer for triage. That's how crazy I am, right. But your triage nurse is really your charge nurse. Think about it. She's running that show, or he, right. That position is so vital, we have to make sure you're educating those triage nurses. Not just when you decide you're going to put them out there, but how are you going to keep up with the rapidly changing environment? How do you know that they're going to be able to identify a patient that just doesn't present with chest pain correctly and accurately? And then what's your waiting room process look like? Because if you're putting patients out in the waiting room that might be at risk, you wouldn't want them to have a cardiac arrest out there. That's bad. Last I heard, that's still bad, right? So you would want to have a policy or a protocol for reassessment. And you want to make sure that these high-risk patients aren't sitting out in the waiting room, cooking, right? So that's where those mandatory requirements are still really, really important. That's why they're there. We're going to look at your troponin assay, regardless of which one you're using, contemporary high-sensitivity troponin. We're going to help you figure it out. And then we're also going to look at your turnaround times. Why are turnaround times for your troponins important? What does it impact? Length of stay. And we already determined with length of stay that that's money, right? So throughput, money, turnaround times are important. So if you're using a high-sensitivity troponin and you're telling me your strategy is 013, but I look at your data and you're doing 036, we have a disconnect. What's happening? And I'm going to ask you the question, why are you doing that? And you're going to be like, why are you asking me that? Because you shouldn't be doing that. What's happening? Where's the cutoff? We're trying to make it better, right? Then under non-ischemic evaluation, we reduce that by 60%, okay. We've removed the credentialing and the competency from your stress lab. You... Go ahead. Yay! We got one! Woo! All right. So we're going to look at your non-invasive testing modalities specific to your facility. So if you're only doing exercise treadmill testing at your facility, for example, you'd only have to tell us about exercise treadmill testing. But if you're doing them all, we need to see them all, okay. And then we need to look at how are you evaluating your stress testing at your facility? Are you spec-ing everybody? Why are you doing that? Stop asking me these questions. These questions are important. So it's all about your patient selection, making sure you're stressing the right patient with the right test at the right time. And then what is your throughput with that test? How many of you order a stress test, the patient goes off to the stress test at 8 o'clock in the morning, and they're still sitting in the bed at 5 p.m. waiting for somebody to read it? What is that impacting? Length of stay. What does that impact? Money. Okay. And you're backing up your emergency department, because that emergency department is still admitting people, but they don't have places to put them. All right. Now new tab location. So we have a flowchart tab. In that flowchart tab we need to see flowcharts that are ED from every portal of entry. How are these patients coming in? How are you sorting them? We need to see your non-STEMI ACS flowchart. What do you do after you determine they're a non-STEMI patient or unstable angio patient? Where do they go? Do they go to the cath lab? Is it guideline-driven? Then based on your STEMI designation, we either need to see your STEMI referral process, your limited hour primary PCI process or your 24-7 primary PCI process on a flowchart. That's it. Then your order set tab, same thing. Now this is where it's going to get a little bit muddy maybe for some of you. So we want to see your ED chest pain order set. Y'all have one. You might not call it a chest pain order set, but y'all have one. They come in, you get that EKG in ten minutes, you order a trope, you look at other stuff, some necessary, some not, right. And then you decide what you're going to do with that patient. But now we want to see your observation ACS order set. Some of you are going to be like, whoa, why is she asking me for that? Because it's an APC 8011 cost code. It's a bundled payment when you put them in OBS. You shouldn't be using your non-STEMI ACS order set. You shouldn't give them a la carte ordering, okay, because otherwise they're going to be there a long time. You're not going to be able to get rid of them. And remember, you're only getting reimbursed by the APC 8011 cost code, okay. Can't bill and collect for everything. So we're going to be asking you, what does your observation ACS order set look like in this future model? So if you don't have one, don't panic. You're using your ED one. That's fine. But your ARS is going to help you build your observation order set. Okay. Then we want to see your non-STEMI order set. And then a new order set we're going to want to see is your STEMI post-procedure order set. Okay. Because we need to make sure all those patients are going home on the right therapies, right dosing, right meds. All right. Now observation management, we pushed it out. It's its own tab. 50% reduction, five mandatory requirements. We want to see your inclusion-exclusion criteria for observation for ACS patients. I don't care what else you're putting in OBS. We only look at ACS. You should care what else you're putting in OBS and then mirror the improvements. We only look at your ACS criteria. Okay. Then we want to see your visual cues, especially if they're in a virtual unit. How does your staff know their OBS versus inpatient status? You want that patient to move faster than an inpatient. We look at a couple other things, nothing major. Your CVD risk assessment is still in there. Your pharmacy mitigation is still in there. Because remember, those things matter to observation patients. Transitions of care, reduce this by 12.5%. Seven mandatory requirements. But I'm about to drop the one on you for transitions of care. All right. So everybody familiar with the P2Y12 medication in hand requirement and how you all complain about that requirement? So bad. So bad. But you all understand why it's important for the patient to have those medications, right? Have you all looked at the latest literature though around discharge planning for your ACS patient population at discharge? The number one reason for readmission is medication compliance. We're not sending the patient home on the right meds, the right dosages. And we're not making sure that the patient can even afford the meds that we're discharging them with prescriptions for. So instead of it being a P2Y12 medication in hand requirement, it's going to be a discharge medication compliance process requirement. We want to see what you're doing with those patients to prep them for discharge. How is case management involved? How is social work involved? How is your pharmacy involved? How do you make sure that when you're about to discharge this patient, they can even afford the medication you're putting them on? What's that going to do? Well hopefully it's going to reduce your readmissions. That's the goal. That's the big one. The other big new one in transitions of care is you have to have a follow-up appointment prior to discharge or within 72 hours from discharge for your ACS population. Within 72 hours or prior to discharge. Don't panic. The literature supports it, but we'll help you with it. Yeah, so let's talk about that. So you can start with your high-risk population, right. Let's say you're not doing it at all and you open up that tool. We work with you on that. We're collaborative. We're consultative. The main goal is to be like, what resources do you have to start with, and let's identify the highest-risk patient population. So if that's STEMI, we start with STEMI. We work out then to non-STEMIs, and then eventually we get to unstable angina, and then low risks are going home from the ER. You don't really need a follow-up appointment, right. That's what we're hoping. »» Where is that literature? »» Yeah, so all the references you're going to get a hold of when you open up the tool. But if you do a Google search, you're going to find that. Follow-up appointment. Follow-up appointment. All right. Let's not get distracted. Questions in the app? All right. Cardiac Rehab ROI Calculator. This is a brand-new one, all right. But if you want us to give you feedback on how you're going to reduce your AMI readmissions, you're going to have to do a little heavy lifting here for us, okay. We're going to use most of your data. The only thing we don't know in order to populate this calculator is how many of the Cardiac Rehab patients that you're actually referring to Cardiac Rehab show up at Cardiac Rehab. And then when they show up at Cardiac Rehab, how many sessions do they attend? Because the literature now shows us that if you discharge a patient and they go to five sessions of Cardiac Rehab, it reduces the AMI readmission rate by 43%. So we're going to need you to tell us your Cardiac Rehab tracking so we can plug in your calculator with your referral, your AMI readmission rate off Hospital Compare, and then we can give you back this calculator. Okay. Clinical quality. We've improved some of our calculated measures, and we'll talk about that for our ACD at the end. Designations, we still have the three. Remember, there's three requirements for BASE now, because remember, we've moved everything. All the education went into the education tab. All the flowcharts went into the flowchart tab. All the order sets went into the order set tab. So this is your policy, your rapid response, and if you're doing limited-hour primary PCI, what does that look like? And the bullets. PCI designation, 75% reduction. Looks at your no diversion and your STEMI policy and your rapid response. Big changes here for resuscitation, 43% reduction, eight mandatory requirements. We're allowing you to use the CARES Registry so you're not doing resuscitation abstraction. We also changed the focus of resuscitation so it's not just about cooling. The other major change that we're piloting in this model for resuscitation designation hospitals is you now can allow an APP level to be your neurology provider at your meetings. But there are some instructions as to how you have to do that in order for us to sign that off when you open up your tool. All right. So for those of you that participate in the NCDR Chest Pain and My Registry and you have an award status, now when you open your tool, every essential component that gets defaulted because you won that award has this little award icon. So there will be no confusion moving forward. What's award status default and what do I have to do? Everything is going to be labeled, okay. Now for our ACD customers and calculated measures, again, we have three options for data. We'll work with you on that. Anybody that is still using the hybrid model when you get into this future model, your ARS will be talking to you. The NCDR has all those accreditation detail lines now. There really shouldn't be a reason why you're not using one or the other. And your data really should be in one place. I don't know how. My OCD, I would go crazy. But we'll work with you on that. It still exists. But we're going to try to leverage you to move in one place or the other. The voice of the customer, the CSV file goes away. Already told you that. You still pull your monthly charts by discharge code. You declare your randomization strategy in your charter. The primary ICD codes have been updated and they now align with the NCDR Chest Pain and My Registry. So we're all on the same page. Patient populations are the same. Align phase and application phase for your data. We reduced the unstable angina from 10 patients to 5. So you're going to be abstracting less, but you're still putting the same amount of STEMIs, non-STEMIs, and lowest patients in. All right, big voice of the customer here. You guys wanted the measures year-to-date report to report out by discharge date. That will now happen in the future model. So when you pull up your year-to-date, it's going to all be by discharge date of the patient, not by admission date or arrival date. Have you all fallen asleep? Yeah. Well, you're in the minority, but we can talk about why that's really good. And then you're also going to get your numerator and denominator displayed and your percentage of your metrics. So you're going to know exactly how many patients fill into that calculated measure. So mandatory element abstractions, you must abstract the date and time in the future model. Those are mandatory fields in the ACD. If you leave them blank, it doesn't help us help you with your process. We can't just guess at what you're doing. So we're going to allow you to estimate if you don't actually have a document, or we provide in the data dictionary where if somebody says, well, they had chest pain in the morning, you can enter 7 a.m. So we've really adopted and got on the same page as the NCDR registry. The data dictionary has been updated and we have 25 additional calculated measures. Now what does that mean? Some of these are because you guys were telling us, well, you're making me abstract these fields, but I'm not getting an electronic value from that. So why are you making me put this information in? Well now we're populating those for you so you don't have to go back and manually do them. Now I've added a couple of things that we think will make your life easier. We put in the EMS scene departure so you'll know when they went in and when they got out. We've added in the first shockable rhythm for our resuscitation customers. We put in the option for your non-invasive testing. So remember in the non-invasive testing section, you have to tell us how you're looking at whether or not you're stressing the right patients. Most of you are looking at your positive test case rate. Well if you're using the ACD now and you abstract that they had a stress test, it's going to ask you, was it positive? You check positive, now you're going to get a calculated measure that says, hey, 1% of all the patients we stressed this month had a positive stress test. That should be red flag, 1%. And then we added CABG in for diagnostics and then the discharge medications for AMI patients only to make sure you're sending them home on the right meds. Five minutes left. That's all I got. How did we do? I love it. So what I want to tell you is, we're having a networking session this evening. Guys I'll have that on your calendars. If some of you are interested in actually opening the tool and seeing it, you can check at our ACC booth and make an appointment. We'll do some demos tomorrow. We'll try to group some of you guys together. If you have never done chest pain accreditation and now you're interested in chest pain accreditation, stop by the ACC booth. We'll get you on the list and we'll work you through the demo so you get more information from that. Questions? Are there any questions? No questions. No. But we can work with you on that. Yeah. Okay. We'll look at that. And compliance. Yep. In the patient population where you're looking back a year for your volume? Yes. So you're looking at only patients that had an ACS cause that you put in observation status. So they had to start in OBS and either be discharged in OBS or converted to inpatient status, yeah. So some of the literature out there has basically said they don't necessarily think cooling makes a difference. So we're not moving necessarily away from cooling. We're giving you other options based on the latest guidelines. So if cooling in your hospital is what you see make improvements in those resuscitation patients, it's included in that requirement. But it's not a deal breaker now for resuscitation if you're doing preventing fevers or normal And you're following some of like the TTM-2 trial results and things like that. So big VAT there and you get to work through that with your organization. Great question. Questions on your app monitor? Okay. There were questions. There's something not working on the app. So if anybody has a question, I've got a microphone here. Thank you, Ruth. Of course. I was just there. No. So our site review policy, technically, if you are new to accreditation, it's an on-site review. We're trying to do every other where you do an on-site one time and then the next one is virtual. However, we have restrictions in the virtual arena. So like if you're really struggling, your data doesn't match, or you request an on-site visit will come out, and your ARS will have those conversations with your facility very early. But right now, it's where we could do every other, an on-site and then virtual unless you're new. We do on-site. Go ahead. I've got one over here and one over here. I'm going to go. Meet me in the middle. Meet me in the middle. Yeah. Just work with your accreditation review specialist. Yeah. Okay. Can you repeat the question? So she said that if you're coming in and you're an NCDR customer and you just want to see what the ACD looks like, the ACD is there when you pay for the accreditation. You can go in there and look. You can plug some patients in there just to see what kind of information you get and still work in the NCDR chest pain in my registry. Do you have access to that? »» I would like to say we are... »» Yeah. Just get with me after and we'll team up. Yes, ma'am. »» I feel as if I'm really loud, so I might not need the microphone. So I don't know. »» It's okay. »» I couldn't hear the person's question over there about, I just got those accreditations for two of the hospitals that we have. So we are re-accredited. So we won't be able to access those. »» Okay. »» So we are re-accredited. »» Correct. You'll work in your current model. »» Okay. »» And you'll stay in there. And you'll follow the annual checklist that you get. Basically, just putting your meeting minutes, attendance grid in there, and things like that. You'll keep up with your data regardless of where it's going. And then when you're up for your renewal window, you'll get into the future model. »» So just like keep going? »» Yes. Keep going in the existing. »» Speaking of the whole, like you want us to be one or the other, because our hospital, I feel, is just schizophrenic at this moment. »» So you're still doing the hybrid? »» Yeah. »» I'm just one person in the whole shell. So I guess, is there any literature, anything that my ARS can provide me? »» Sure. We'll work with you. Either reach out to your ARS or reach out directly to me and we'll get you some information. Reach out to me. Yeah. We'll get you that information. Absolutely. Did I get everybody's question? Was there one over here? Did somebody have a question? Are we good? All right, everybody. We'll see you in networking. Thank you.
Video Summary
The session introduces Tracy Blevins, an expert in accreditation, who unveils a new model for chest pain accreditation designed to streamline processes and enhance user experience. Tracy emphasizes the implementation of customer feedback in the product, focusing on simplifying reaccreditation tasks and updating the system for ease of use. The new features allow bypassing redundant data entry, automate information transfer, and introduce efficient ways of handling documentation. Existing customers will find the reaccreditation process more intuitive with features like auto-filling data and bypassing unchanged sections. A significant reduction in essential component requirements caters to user preferences, minimizing repetitive tasks and facilitating a more straightforward accreditation process.<br /><br />The updated system features enhanced tools for improving patient flow, particularly in observation management, aligning with hospital objectives to reduce length of stay and improve financial efficiencies using return on investment (ROI) calculators. Additionally, an emphasis is placed on the importance of engaging with community and pre-hospital care, fostering collaboration with EMS providers. <br /><br />Changes in the future model include a revamped menu layout, dedicated sections for flowcharts and order sets, and updated guidelines reflecting current practices in patient care management. Key updates also involve the removal of redundant processes and inclusion of simplified data tracking tools for existing users, aimed at reducing the workload and focusing on vital elements like turnaround times and discharge planning. <br /><br />New users and institutions in the accreditation process can expect a more integrated and user-friendly experience with adequate guidance and support from accreditation review specialists. The session concludes with an invitation to explore more about the system through demos and consultations at the conference booth.
Keywords
Tracy Blevins
accreditation
chest pain
user experience
reaccreditation
patient flow
ROI calculators
EMS collaboration
data tracking
system demo
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