“WellPoint’s initiatives to reduce hospital readmissions by following up with Medicare Advantage members after discharge has decreased the readmission rate and reduced skilled nursing days, according to Karen Amstutz, MD, vice president and medical director of care management for seniors and state sponsored business for the Indianapolis-headquartered health benefits company.

“One of our key initiatives at WellPoint and across our health plans is to look at the cost of care and identify the areas where we can make the greatest impact,” Amstutz says. “Our readmission prevention initiatives use a range of tactics to identify members at risk for readmissions at the time of discharge and provide the appropriate level of case management that will keep them out of the hospital.”

Click here to see the complete article.

“The only factor associated with readmission within 30 days among patients with stroke or cerebrovascular disease was an index hospitalization that lasted more than 10 days, results from a large, single-center analysis found.

“…Multivariate analysis revealed that an index hospital stay of more than 10 days was the only significant factor associated with readmission within 30 days (odds ratio of 2.34 when compared with an index hospital stay of less than 5 days). Age, gender, race, primary diagnosis, the specialty of the discharging clinicians, and the year of discharge were not significant predictors.

“Length of stay is often considered a representation of disease severity and our results add support to the previously mixed data showing that a prolonged hospital length of stay is associated with higher readmission rates among patients with stroke and cerebrovascular disease,” Dr. Nahab said in an interview after the meeting.”

Click here to see the complete article.

1) When it comes to the chief causes for preventable readmissions, in your opinion the problem begins after the hospitalization.

Hospitals overwhelmingly identified the chief causes of readmissions to be related to patient’s poor self-management skills, patient non-compliance and poor post-discharge care coordination. This effectively shifts our focus on reducing preventable readmissions to beyond  the four walls of the hospital.

2) Despite this, most hospitals are trying to solve the issue during the hospitalization.

All indications were that hospital efforts to reduce preventable readmissions were aimed at shoring up in-hospital processes and procedures (such as educational efforts during the stay) as opposed to looking at ways to extend their reach. Bottom line: time for a new approach.

It is understandable that hospitals are addressing the issue through methods inside the hospital that they are more comfortable with and have more control over.  But it is apparent that limiting the action plan to changes while the patient is still in the hospital isn’t solving some of the most important variables. The patient’s compliance with discharge instructions – particularly to their medication plan, timely visits to a primary care provider who has received accurate information about the patient’s hospital stay, and the patient’s understanding of the “red flags” to watch for with their condition all play a significant role in determining whether they will need to be readmitted. And unfortunately there is a limited amount that can be done to address these factors while the patient is in the hospital. Now that hospitals are going to be penalized for readmissions, they need to reach out to patients post-discharge in ways that they haven’t done in the past.

For examples (and results) of how other hospitals are incorporating post-discharge follow-up into their readmissions reduction strategies, check out the Follow-up Calls category link in the column to the right of this blog. Some hospitals even take it a step further and use Home Visits, many using programs like Care Transitions. However, item number 5 on the CareTeamConnect (CTC) survey indicates that resources are indeed scarce and finding staffing (money) for phone calls is likely challenging enough…

Click here to see the CTC survey results.

And if you are looking for a more cost-effective way to use nurses and pharmacists for post-discharge follow-up calls, click here to learn more about Pareto Health’s MedFollow service (sorry, I couldn’t help adding the plug – it was just too obvious!)

Konrad
CEO, Pareto Health

St. John’s Hospital in Springfield, Missouri.

“… St. John’s low readmission rates for heart attack and heart failure patients may be attributed to the close attention it pays to patients after  discharge and its engagement of the community’s primary care physicians. Further, being part of a system and working in partnership with its health plan have influenced how the hospital approaches care coordination and cost-effective care. This case study focuses on St. John’s strategies and efforts to improve heart attack and heart failure care and reduce related readmissions.

 
“Patient-focused interventions after discharge

• telephone calls to all heart failure patients to answer questions and remind them about the importance of having a follow-up visit with their personal physician;
• referrals to an outpatient cardiac rehabilitation program;
• use of an interactive voice response telemonitoring program for heart failure patients;
• 24-hour nurse triage help line to provide after-hours support;
• medication assistance program for patients with limited resources; and
• 24- to 48-hour follow-up by a St. John’s Health Plans care manager (for health plan members) to review discharge instructions, ensure patients have appointments with their personal physicians, check medications, and remove any barriers to following treatment plans.

“Interventions focused on community providers

• telephone and electronic notification to patients’ personal physicians about patients’ hospitalization and need for follow-up visits within one week;
• “call in, get in” standard of care, in which personal physicians make heart failure patients a priority; and
• an electronic heart failure registry to track such patients’ care over time.”

Click here to access the complete case study.

St. John’s program is very similar to Pareto Health’s MedFollow service, which offers outsourced telephonic post-discharge follow-up by nurses and pharmacists for hospitals who don’t have the staffing to do this type of a program on their own. Pareto Health is currently seeking pilot customers interested in utilizing the MedFollow service at a discounted rate. Click here to learn more.

The Windham Hospital Foundation was awarded a grant of $4,960 from the Connecticut Office of Rural Health to improve outcomes for patients served by the hospital. The grant will assist Windham Hospital’s efforts to reduce the number of readmissions to the hospital from patients with heart failure.

… The quality initiative will provide two targeted education programs for staff, community providers, local nursing facilities and home care agencies to help increase compliance with discharge instructions. As a result, there will be standard messages across the healthcare continuum that will reduce the rate of readmissions.

Click here to read the complete article.

Employing a multidisciplinary team-based approach to care for heart failure (HF) patients that includes the development and dissemination of patient-friendly, standardized educational materials can both streamline resources and decrease readmissions, according to a poster presented by Kristin Dixon, RN, MSN, CSN, and Megan Mansfield, RN, BSN, of Scripps Health in San Diego, at this year’s annual leadership meeting of the American College of Cardiovascular Administrators (ACCA) in Chicago.

Scripps put together a team to streamline and align HF care, and also condensed six evidence-based HF resource packets into one branded HF booklet.

Lastly, the health system piloted the Advanced Practice Nurse (APN) intervention for high-risk HF patients. The APN intervention initiative included an individualized teaching approach to the patient based on assessment and followed up with these HF patients for four weeks via telephone.

Dixon and Mansfield reported that the updated HF patient resources are now distributed in outpatient, inpatient and the home health setting. Additionally, it was noted that within six months of implementation of the APN model, HF readmission rates dropped 11 percent, from 22 percent to 11 percent.

Click here to read the complete article.

April 26, 2011 – This Week in Washington

This week, the federal Centers for Medicare & Medicaid Services (CMS) released details on the implementation of the Medicare hospital readmissions reduction program as part of its proposed inpatient prospective payment system (IPPS) rule for fiscal year (FY) 2012. You’re listening to This Week in Washington, the National Association of Public Hospitals and Health Systems health policy update for the week of April 25, 2011…

Click here to listen to the podcast (mp3).

Click here to read the transcript.

By Lisa Vorderbrueggen
Contra Costa Times
April 22, 2011

MARTINEZ — Reducing hospitals’ mistakes and averting dangerous and costly readmissions are the foremost goals of a regional initiative launched Friday in the East Bay.

Partnership for Patients, a $1 billion component of the federal Affordable Care Act passed in 2010, calls for a 40 percent decline in the number of preventable hospital-acquired conditions and a 20 percent drop in hospital readmissions related to avoidable complications.

If successful, the initiative will save 60,000 lives and reduce Medicare and Medicaid costs by $50 billion in the next decade, federal officials estimate.

Contra Costa Regional Medical Center was among the first of 1,300 hospital and health care organizations to sign the pledge, and Rep. George Miller, D-Concord, and federal representatives of the U.S. Department of Health and Human Services roundly praised the public hospital during a presentation for about 100 people Friday morning.

Click her to read the full article.

The Centers for Medicare & Medicaid Services has outlined five tested strategies to help meet these goals, as reported in American Medical News:

• Increasing patient training and self-care skills before patients leave the hospital.
• Sharing plans of care across inpatient and outpatient settings.
• Standardizing communication exchanged between physicians and other health professionals caring for patients.
• Improving medication reconciliation and safe medication practices.
• Establishing that the health professional initiating a handoff maintains responsibility for the patient until he or she receives confirmation that the transfer is complete.

For examples of how hospitals and providers are using these strategies currently, check out the Programs in Use category on the right side toolbar.

To learn how Pareto Health’s MedFollow service can assist your hospital with these strategies, click here.

April 19, 2011 — The average length of a hospital stay for hip replacement surgery has decreased significantly in recent years, new research indicates. But the rate of readmissions for complications or referrals to skilled care facilities has increased.

Researchers say the two findings are not likely coincidental. They say the readmissions and increased need for specialized care may be related to the shorter stay in hospitals after hip replacement.

Scientists examined data on 1.5 million Medicare Part A beneficiaries who underwent primary total hip replacement between 1991 and 2008, and also 348,596 people who underwent revision total hip replacements (replacement of an artificial hip joint).

Also, researchers say the average length of stay in a hospital for primary hip replacement patients decreased from 9.1 days in 1991-1992 to 3.7 days in 2007-2008.

The readmission rate for all causes in 30 days decreased from 5.9% in 1991-1992 to 4.6% in 2001-2002, but then increased to 8.5% in 2007-2008.

Click here to read the full article.

For other articles addressing length of stay factors on readmissions, including one finding that decreased length of stay correlates to lower readmission rates, click here.