Reducing 30-day Readmissions, Simply

Beginning in October, hospitals and health systems will feel the sting of Medicare penalties for high 30-day readmission rates in three disease categories: heart attacks, heart failure, and pneumonia.  If you're waiting for the Supreme Court to change all that with the stroke of a pen, you're likely to be out of luck. The court's impact on those penalties may be limited. 

Whatever the court decides about the Patient Protection and Affordable Care Act, you'll get further in your fiscal planning and save more dollars by implementing a simple, yet effective care coordination program like the one used by McKay-Dee Hospital in Ogden, Utah.

In April, I took a look at how readmission rates could be reduced using predictive modeling tools, an approach that's garnering great success at several hospitals. Although not every hospital has the wherewithal to invest in more technology needed to achieve results, care coordination is proving to be an effective tool for readmission rate reductions. (To learn more about tools for achieving 30-day readmission rate reduction in cardiac conditions and pneumonia, tune in to this webcast.)

McKay-Dee Hospital is a 352-bed, private, nonprofit hospital and part of Intermountain Healthcare's system of hospitals. It has built centers of excellence in the areas of heart and vascular, newborn ICU, cancer, spine, emergency and trauma services, and rehabilitation. And it also happens to have one of the lowest readmission rates in the nation—7.8% for pneumonia, nearly half of what it was two years ago.

Patients admitted to this hospital are some of the least likely to be readmitted within 30-days, thanks to a care coordination program launched in 2009. It not only improved the overall wellness of high-risk patients, but it also reduced readmission rates, particularly for pneumonia patients.

"Intermountain uses evidence-based care, and we use clinical best practices across the continuum of care to promote standardization" explains Timothy Trask, MD, medical director of the hospitalist program at McKay-Dee Hospital. Trask says the care coordination program extends to all areas of care, not just pneumonia.

Care teams consisting of the hospitalists, nurses, case managers and social workers were created to work with patients to both educate them and to coordinate their care. Guided by the goal of creating better patient-focused care, teams use standardized care protocols in conjunction with electronic health records to treat the patients at highest risk for readmissions. Data is gathered at each encounter with the patient and made available in real-time to all members of the care coordination team.

This allows them to address and fix areas of concerns throughout the process. Trask says the EHR helps support and improve not only the physician's approach to care, but also serves to guide each member of the team to act in unison throughout the care continuum.

For instance, the nursing staff uses a pneumonia core measure checklist to ensure that things such as blood cultures are drawn in a timely manner.  Nurses and case managers assess the patient's literacy level and adjust educational materials and teaching methods to ensure that treatment and care instructions can be understood. Along with the data that's tracked and managed in the system, the nurses use white boards in patients' rooms to communicate essential information to both staff and patients.

Data evaluation and process improvement is carried out during meetings with hospital administrators, quality administrators, physicians, and nursing managers to assess the care coordination program and to review the core measures. Physicians are also given a scorecard so they can gauge their performance on key areas and benchmark that to the organization. They are also given information on which of their patients have been readmitted and why.

"It's becoming more evident that quality of care transitions affects readmission rates," notes Judi Sant, RN, BSN, director of medical/surgical at McKay Dee Hospital. "So when patients leave the hospital, coordination of care must extend beyond the hospital's doors and to the next site of care."

This is why prior to the patient's discharge, the team assesses each patient's needs and level of at-home support, then researches available resources, The team schedules follow-up appointments for patients prior to discharge and calls patients to touch base within 24-48 hours of care.

Patients are given a clear treatment plan, which is explained to them and all providers involved in the patient's care are made aware of the plan. All high-risk patients are discussed by the care coordination team during team meetings, so treatment plans and next steps can be put in place. 

In taking this approach, Trask notes, "The patient is more likely to get the follow up care necessary and to comply with our recommendations for treatment."

"This approach is good for the patient, but it's also creating cost savings. We have a better plan and our patients are better prepared for discharge and that ends up giving us more virtual beds," However, the most important part of our multi-faceted approach is the successful outcomes and low readmission rates for our patients," says Sant.

Though they did hire a consultant to evaluate their processes, ultimately McKay-Dee's care coordination program didn't require expensive equipment, just a restructuring of personnel into teams and the creation and use of standardized care checklists. 

"We're using care process models and clinical models that essentially synthesize and distill data into a working model based on best practices. Our care providers use these lists so things don't get missed," says Trask.

In less than two years, McKay-Dee Hospital managed to cut its readmission rates in half for patients who acquired pneumonia within 30 days of discharge. It used existing tools and personnel, and restructured how the providers approached the treatment of high-risk patients. McKay-Dee's care coordination team isn't revolutionary, but it's proving to be very effective without being pricey.