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Critical Access Hospitals Strive to Improve Outcomes in MT

 |  By John Commins  
   April 24, 2013

Mergers and acquisitions are rampant in healthcare these days as large health systems get larger and use their size and market share to improve efficiencies, coordinate care, reduce costs, and leverage terms with vendors and insurers.

At the other end of the spectrum are critical access hospitals. These tiny, isolated providers by their mission and geography aren't able to tap into the advantages of this bigger-is-better delivery model. So they improvise.

In Montana, rural providers are in the second year of a three-year pilot project that eventually aspires to provide each of the Big Sky State's 48 critical access hospitals with a "better health improvement specialist." Funded by a $10.5 million Center for Medicare & Medicaid Innovation Grant, these specialists will coordinate and improve post-discharge care plans, identify operational inefficiencies, and use data that they collect to proactively target potential health issues to reduce readmissions and emergency department visits.

"We are a support mechanism for these critical access hospitals to identify where failure modes are happening within the healthcare delivery system in their system and their relationships with regional partners," says Denyse Traeder, director of the Frontier Medicine Better Health Partnership, which is coordinating the project.

"Our work with the critical access hospitals identifies where some costs savings can be made and identifies the training and opportunities that critical access hospitals could benefit from to reduce waste, save money, improve care and outcomes and satisfaction."

The project also tries to address the near universal complaint from critical access hospitals that they're left in the dark when patients return to their homes after discharge from larger hospitals.

"That is one of the biggest things that we hear from our partners is we lose track of them," Traeder says. "Half of the time we don't even know if they went in and we don't know when they come back until something critical happens and they are back in the ER. Had we known what had happened to them we could have either helped prevent it or found someone in the community to do some home care."

"Traditionally we've not able to get patients back in their home communities from regional partners not because the regional partners didn't want to but because there wasn't an action plan and they didn't know if the critical access hospital had the capability or if it was an appropriate transfer back," Traeder says.

"We're partnering with regional facilities and opening communications, developing care plans and transfer protocols and those types of documents and procedures that haven't been in place before that will be standardized between critical access hospitals and larger facilities to get those patients back into their home communities because that is where we know they want to be."

The hospitals will use electronic medical records to guide a care team that includes hospital staff, primary care physicians, patients and their families, and health coaches to coordinate daily post-discharge follow up to ensure that treatment regimens such as medication compliance are followed.

If successful, the pilot project hopes to reduce patient costs by 7% to 15% for the three-year period, improve outcomes by 10%, and improve patient satisfaction by 30%. Traeder says many cost drivers have already been identified.

"We are looking at avoidable readmissions. We are looking at ambulatory care sensitive areas, hot spotting them, care coordination and prevention and the number and source of those. Are we duplicating many tests from critical access hospitals to regional facilities and if we are what is the cost," she says.

"Another issue is transportation. We are calling out a fixed wing or a rotary much more often than we need to. Ground transportation would be much more appropriate when one flight is about $15,000. That is going to be a huge cost savings for us. It is going to be tricky because we are going to have to tease out what is appropriate and what is not. But if we can train our staff to appropriately use ground transportation or some of the other interventions we will reduce the costs of those areas. Those are a huge cost that we are identifying."

Another key responsibility of these better health improvement specialists will be to collect data—which has been a particularly nettlesome problem for critical access hospitals.

"It is not for lack of wanting to do it, but there are some real barriers in the way of reporting. It is not apathy but more of a logistical issue," Traeder says. "One of the biggest benefits to the critical access hospitals is that yes we are asking for data which requires some work but we are giving it back to them immediately. It is not collecting data and never seeing it again and not benefitting from it, which is frustrating for people. We are able to gather the data, give it to our analytics partner who runs the numbers and gives it back to them immediately."

"We did a rural operational assessment on 10 critical access hospitals during the last month and they received that data last week. They are able to immediately take that data and start making changes in their system."

While the pilot project focuses on the individual challenges of each critical access hospital, Traeder says the ongoing communication and care coordination is building a sense of community among these tiny and isolated hospitals charged with a vital mission.

"We know there is power in numbers," she says. "One critical access hospital trying to voice a concern over the healthcare system is like an insect screaming in an arena. When we put them together and build this critical access consortium there is power in numbers and that creates a voice for critical access hospitals in Montana."

John Commins is a content specialist and online news editor for HealthLeaders, a Simplify Compliance brand.

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