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July 14, 2012 International Symposium on Geriatric Medicine

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Geriatric Medicine:Sensible Practice in Modern Societies (1)

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Population aging and long-term care insurance in Korea

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International Symposium on Geriatric Medicine: A Focus on Orthogeriatrics

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clinical benefits of post-acute care for older patients with hip fractures in taiwan_a prospective cohort study(1020908)_fina (1)

Geriatrics Fellowship Teaching Schedule

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Post-Acute Care Services in the US_Overview and Future Development.YWang.R2.12.02.2013 (1)

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位置: eLearning Site of APLCGG > e-Learning > 2013International Conference of Intermediate Care > Post-Acute Care Services in the US_Overview and Future Development.YWang.R2.12.02.2013

Integrated Health and Long Term Care (56:05)

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標題

1. Post-Acute Care in the USOverview and Future Development

2. Discussion

3. US versus Taiwan

4. Medicare and Medicaid Dually Eligibles

5. “Dually Eligible” Population Profile- the most vulnerable, costly and diverse population

6. The Medicare and Medicaid Dully Eligible- 9 million individuals with both health and LTC needs

7. “Medicare and Medicaid Dually Eligible Population” a Snap Shot

8. The Medicare and Medicaid Dully Eligible- 9 million individuals with both health and LTC needs

9. “Medicare and Medicaid Dually Eligible Population” a Snap Shot

10. Example - Population (Medicaid) NH Entry – Cost Shifting Once enters NH, Medicare stabilizes through transition and Medicaid grows by factor of 5 Pre/Post

11. Nursing Home Entry Analysis(Significant Medicaid Population Entered NH Without Intervention - If only focus on Medicaid, the intervention is greatly limited)

12. Hospitalization Patterns12 months before and 12 months after Medicaid NH admissions Significant Needs for Care Coordination between LTC and Medical Care

13. Example - Population (Medicaid) NH Entry – Cost Shifting Once enters NH, Medicare stabilizes through transition and Medicaid grows by factor of 5 Pre/Post

14. Hospitalization Patterns12 months before and 12 months after Medicaid NH admissions Significant Needs for Care Coordination between LTC and Medical Care

15. Nursing Home Entry Analysis(Significant Medicaid Population Entered NH Without Intervention - If only focus on Medicaid, the intervention is greatly limited)

16. From Payment Reform to System ReformTrends in the Care: Delivery Evolution

17. DEFINING THE ECOSYSTEMDriven by Payment System Reform (DRG)

18. DRG Impacts - Decrease Hospital Length of Stay

19. DEFINING THE ECOSYSTEMDriven by Payment System Reform (DRG)

20. Under DRG, PAC allowed hospitals to reduce inpatient average lengths of stay (“ALOS”)

21. DRG Impacts - Decrease Hospital Length of Stay

22. DRG Impact: Hospital Beds Decrease

23. DRG Impact: Reorganization of Hospital Care

24. DRG Impact: More Staff Ratio per Bed

25. DRG ImpactHome Health Care Payments are Increasing

26. DRG ImpactSkilled Nursing Facility Payments are Increasing

27. PAC Tools

28. Patient severity of illness varies by PAC setting

29. PAC Tools

30. Nursing Home Compare

31. Patient severity of illness varies by PAC setting

32. Leading Diagnoses Among Medicare LTACH Patients, 2008

33. Patient severity of illness varies by PAC setting

34. Number of facilities and patient volume differ by PAC setting

35. Leading Diagnoses Among Medicare LTACH Patients, 2008

36. Patients with Leading Diagnoses atOne Rehabilitation Facility, 2009-2010

37. Leading Diagnoses Among Medicare SNF Patients, 2007

38. Leading Diagnoses among Medicare Home Health Patients, 2006

39. Re-hospitalization Rates for Patients Who Received Transition Managementand Patients Who Did No

40. Supporting heart failure patients with home care and educational can reduce utilization

41. Federal RegulationsExample: Skilled Nursing Home

42. SNF 483.40 Physician Services

43. Slide 32

44. Slide 33

45. Slide 34

46. Federal Intervention 2010

47. A Typical Patient

48. Slide 37

49. ACA encourages multiple strategies to break down barriers between care settings

50. Payment Reform Strategies

51. Development at Patient and System Level

52. Payment Reform Strategies

53. What Ideal Care System Could Look Like

54. Development at Patient and System Level

55. Lessons from United States

56. Slide 43

57. Integrated Care Development Considerations

58. Lessons from United States

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