Reform Sharpens Focus on Quality Outcomes

“We began benchmarking ourselves against the best of the industry,” he adds, noting that the hospital has focused specifically on reducing patient readmissions. “Coming to this new vision, it was very important that we engaged our medical staff in the process; our medical staff became partners in care. We agreed that our primary customers were patients and families, and that was also an essential element of focusing our quality improvement efforts,” he says.

Readmissions reduction effort

As healthcare leaders try to improve the quality status of their facilities, the federal government is also prodding them along.

One of the major areas of government concern involves hospital readmissions that occur within 30 days. The healthcare reform bill signed by President Obama a year ago this month includes a provision that reduces reimbursement for certain types of unnecessary readmissions. In addition, there are federal penalties for excessively high readmission rates for Medicare patients, with millions of dollars in funding at stake.

Bronson Methodist Hospital is one of the organizations that has made progress in reducing its readmissions, particularly for patients with heart failure, a major challenge because of the chronic nature of the condition.

The national average 30-day readmission rate for heart failure is 24.5%. At Bronson, this rate dropped from 22.3% in 2006 to 18.9% in 2009, and preliminary figures showed 17% in 2010, says Mayer.

 Readmission is particularly sensitive because it is one of those issues that, on its face, defies the bottom line, says Jan Berger, MD, chief medical officer of Silverlink Communications of Burlington, MA, which specializes in healthcare consumer communications. “One of the interesting things about readmission is getting hospitals aligned in this process. Today, hospitals are still paid if the patient is readmitted,” Berger says.

As Bronson Methodist Hospital’s executive team began considering its readmission issues, it made clear: This wasn’t about the money. “Reducing readmission was the right thing to do for our patients and consistent with our philosophy,” Mayer says.

“There was no debate or dissent whatsoever; it was obvious to everyone involved, from the board level to the C-suite to the bedside. We needed to do this to advance our strategy and vision; it speaks to the cultural transformation we have undergone,” Mayer says.

The initiatives that improved Bronson’s status were wrapped around evaluations of medication and a movement toward institutional care in the home, according
to Mayer.