hospital time Why it’s readmissions to focus on Bridging the gap between hospital and home
Nov 30, 2014
hospital
time Why it’s
readmissions
to focus on
Bridging the gap between hospital and home
$2 trillion
SOURCE: Fazzi R, Agoglia R, Mazza G, Glading-DiLorenzo J. The Briggs National QualityImprovement/Hospitalization Reduction Study. Caring: National Association for Home�Care magazine. 2006; 25(2):70.
Approx.
is spent on healthcare in the U.S. each year.
1/3 SOURCE: Fazzi R, Agoglia R, Mazza G, Glading-DiLorenzo J.
The Briggs National QualityImprovement/Hospitalization Reduction Study. Caring: National Association for Home�Care magazine. 2006; 25(2):70.
hospitalizations. is spent on
Flickr: Daquella manera
SOURCE: Fazzi R, Agoglia R, Mazza G, Glading-DiLorenzo J. The Briggs National QualityImprovement/Hospitalization Reduction Study. Caring: National Association for Home�Care magazine. 2006; 25(2):70.
of those hospitalizations are
readmissions. 20%
A hospitalization that occurs within a specified time frame after discharge from the first or
index admission.
SOURCE: American Journal of Medical Quality. Redefining Hospital Readmissions to Better Reflect Clinical Course of Care for Heart Failure Patients.
Hospital Readmission (Definition)
“ I think readmissions are a bellwether of whether we are really
doing the kind of support, education, outreach, and coordination that really
can keep people as healthy as they possibly can [be].”
Dr. Donald Berwick, Administrator of the
Centers for Medicare and Medicaid Services
stressful. Leaving the hospital
can be
Patients may be tired.
Patients may be tired.
…uncertain about their discharge instructions.
…nervous about transitioning home.
Patients may be tired.
…uncertain about their discharge instructions.
…nervous about transitioning home.
Patients may be tired.
…uncertain about their discharge instructions.
…concerned their condition could worsen.
…nervous about transitioning home.
Patients may be tired.
…uncertain about their discharge instructions.
…concerned their condition could worsen.
…unhappy with their hospital experience.
…at risk of readmission.
This is especially true
with Medicare patients.
18-20% of Medicare patients
are re-hospitalized within
30 days of discharge.
SOURCE: Jencks S, et al. "Rehospitalizations among patients in the Medicare fee-for-service program."�New England Journal of Medicine 2009.
33% readmit within 90 days.
SOURCE: Jencks S, et al. "Rehospitalizations among patients in the Medicare fee-for-service program."�New England Journal of Medicine 2009.
However, many of these readmissions are potentially
avoidable.
“ Readmissions are not primarily about people being
re-hospitalized because of mistakes made in the hospital. [Readmissions]
are about making transitions effectively.”
Stephen Jencks, M.D., a former senior clinical adviser to CMS.
A potentially preventable re-hospitalization… that in many cases may be prevented with proven
standards of care.
SOURCE: MedPAC (June 2007) Report to the Congress: Promoting Greater Efficiency in Medicare
(Definition) Avoidable Readmission
too common.
readmissions are all
Avoidable
In fact, 13% of Medicare re-hospitalizations are
SOURCE: Hackbarth G, Reischauer R, Miller M. Report to Congress: Medicare Payment Policy. Washington, DC: Medicare Payment Advisory Committee; March 2007.
potentially avoidable.
$12 billion! ($7,000 per person)
SOURCE: Recreated from Table 5-2 within: MedPAC (June 2007) Report to the Congress: Promoting Greater Efficiency in Medicare. P 107, from 3M analysis of 2005 Medicare discharge claims.
That’s a cost of about
What causes these
readmissions? potentially avoidable
Patients don’t follow home care instructions.
Reason #1
complications with
their at home recovery.
Which can cause serious
medications.
when dealing with Especially
In fact, 2/3 of Medicare readmissions are due to medication non-compliance.
SOURCE: Jencks S, et al. "Rehospitalizations among patients in the Medicare fee-for-service program."�New England Journal of Medicine 2009.
adequate follow up or monitoring.
There isn’t
Reason #2
aren’t seen by physicians promptly after discharge.
Many patients
In fact, 50% of Medicare patients had
no interaction with a physician between discharge and readmission.
SOURCE: Jencks S, et al. "Rehospitalizations among patients in the Medicare fee-for-service program."�New England Journal of Medicine 2009.
appointments
With no one to help them
schedule and keep those
gap in care occurs. …a significant
gap in care occurs. …a significant
health deteriorates. And patient
Reason #3
sharing
Hospitals
aren’t good at
patient care plans.
and Physicians
physicians
Quite often,
aren’t kept in the loop about
discharge plans.
only 3%-20% of hospitals communicate with the
primary care physician.
SOURCE: Kripalani S, LeFevre F, Phillips CO, Williams MV, Basaviah P, Baker DW. Deficits in�communication and information transfer between hospital-based and primary care�physicians: implications for patient safety and continuity of care. JAMA. Feb 28�2007; 297(8):831-841.
In fact, one review found that
And only 12%-34% of primary care physicians have access to
discharge summaries during the first post discharge visit.
SOURCE: Kripalani S, LeFevre F, Phillips CO, Williams MV, Basaviah P, Baker DW. Deficits in�communication and information transfer between hospital-based and primary care�physicians: implications for patient safety and continuity of care. JAMA. Feb 28�2007; 297(8):831-841.
But change is on the horizon.
The Center for Medicare and
Medicaid Services (CMS)
hospitals accountable. is beginning to hold
Starting October 2012, CMS will begin withholding payments for
excessive readmissions.
1. Congestive Heart Failure (CHF) 2. Acute Myocardial Infarction (AMI) 3. Pneumonia
Focusing first on:
�then adding others in 2014.
4. Chronic Obstructive Lung Disease 5. Coronary Bypass Grafting 6. Percutaneous Coronary Interventions 7. Vascular Procedures
CMS penalties are based on a
maximum percentage of total inpatient operating
payments.
increase Which will
over the next
three years.
2012 = 1% 2013 = 2% 2014 = 3%
Their goal is to incentivize hospitals to improve patient health by
extending care services beyond the hospital setting – thereby
reducing costs.
“ The incentives we're putting into place have created a
whole new way to think about hospital care.”
Jonathan Blum, deputy administrator of the federal Centers for Medicare & Medicaid Services, or CMS.
not just And it’s
about the numbers.
Patient Experience will play a key role in measuring
the effectiveness of a hospital’s inpatient and discharge planning.
In fact, higher HCAHPS have been associated with a lower 30-day risk of
hospital readmission for:
SOURCE: The American Journal of Managed Care: Relationship Between Patient Satisfaction With Inpatient Care and Hospital Readmission Within 30 Days
Congestive Heart Failure (CHF) Acute Myocardial Infarction (AMI) Pneumonia
CMS penalties,
aftercare to support patients using
it will be critical for hospitals
To avoid
services.
The subsequent care or maintenance of a patient after a stay in the hospital.
SOURCE: New Oxford American Dictionary
(Definition)
Aftercare
Hospitals need to start thinking of themselves as
care managers.
leading role
And take a
in managing patient care
after discharge.
In other words…
expectations Set clear
on what will happen.
expectations Set clear
on what will happen.
Stay in contact with the patient after discharge.
expectations Set clear
on what will happen.
Stay in contact with the patient after discharge.
Keep physicians
in-the-loop.
expectations Set clear
on what will happen.
Stay in contact with the patient after discharge.
Keep physicians
24x7 access
Provide
to decision support services.
in-the-loop.
“ While timely follow-up is critical, that alone isn’t enough
to prevent readmissions. To be effective, you need a care team that
can connect, evaluate, and escalate patients
to appropriate care and/or administrative resources.”
Jeff Forbes, President, SironaHealth
Outbound calling programs that rapidly assess a patient's current health status, schedule follow-up care,
and gather feedback on their hospital experience.
SOURCE: SironaHealth
(Definition)
Post Discharge Follow-up
post discharge To be successful,
calling programs must…
24-72 hours Follow up
after discharge
instructions
Review patient discharge
coaching decision support and
Provide
health
Find a Doctor
Schedule Follow Up
Escalate to Urgent or
Emergency Care
Guide to Other
Hospital Services
Facilitate
next steps appropriate
clinician*
Make it easy to
with a reconnect
*in case they develop symptoms after initial call.
informed members
Keep all
of the care team
experience
Use to improve the discharge
feedback
“ If we are able to smooth the transitions [after
discharge], those people would stay home where they want to be and
costs would fall because [the patients] are not deteriorating. We have a tremendous
possibility there.”
Dr. Donald Berwick, Administrator of the
Centers for Medicare and Medicaid Services
We Agree.
Post Discharge Follow Up Services Keep patients healthy, reduce readmissions, improve experiences
Learn more! www.SironaHealth.com/post-discharge
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