How Orange Regional Medical Center Reduced Readmissions by 30 Percent

“How Orange Regional Medical Center Reduced Readmissions by 30 Percent”

Jan. 27, 2015 | 1pm ET, 10 am PT

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• Q&A Session

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Reduce readmissions. Improve patient experience.

“How Orange Regional Medical Center Reduced Readmissions by 30 Percent”

Rosemary BaczewskiChief Quality Officer, VP Quality, Patient Safety and Health Information Management

Greater Hudson Valley Health System

Patricia MetzgerDirector of Case Management | Orange Regional Medical Center

Virginia Feldman, MDPresident & CEO | Nexus Health Resources

Matt JerniganDirector, Product Management | The White Stone Group

Today’s Presenters

Matt JerniganDirector of

Product ManagementThe White Stone Group

Virginia Feldman, MDPresident & CEO

Nexus Health Resources

Patricia MetzgerDirector of

Case ManagementOrange Regional Medical Center

Rosemary BaczewskiChief Quality Officer, VP

Quality, Patient Safety and Health Information

ManagementGreater Hudson Valley

Health System

Today’s Agenda

• Integrating total hospital staff, processes and mission in qualitative outcomes

• Providing tools and processes for success in avoiding hospital readmissions

Coordinating Hospital Discharges for Quality Success

Rose Baczewski and

Patty Metzger

About ORMC

• 1 of 2 hospitals that make up Greater Hudson Valley Health System

• 353-bed non-profit medical center located in Middletown, NY

• Employs over 2,400 healthcare professionals

• More than 600 physicians on medical staff

The Readmissions Dilemma

• Solving the puzzle is extremely difficult

• Hospitals have been working on it for years

• Involves factors both within and without of the health system’s control

• Involves risk adjustment methodology, documentation, coding and much more

Summary of Action Items

• Coordination and communication across all components of the hospital spectrum

– ORMC Readmission Prevention Collaborative, community-wide effort involving key stakeholders (hospital, physicians, SNFs, etc.)

– Refinement, expansion of internal readmission meetings

Summary of Action Items

• Development of internal methods and tools

– ED and SNF communication

– Floor Nurse huddles

– Care Coordinators working personally with staff

– Shared access to Epic

– Education to SNFs

– Recording of discharge information

Key Elements Recorded at ORMC

• Teach Back instructions with care coordinator

• Follow-up appointment reminders

• Medication delivery and instructions

• Information about durable medical equipment, visiting nurses

• Instructions for communicating concerns, red flags

Benefits & Lessons Learned

• No additional hardware or devices required– No barriers to usage– 2-hour implementation time

• Lessons learned– Scripting: encourage patients to listen – Work into process: eg., “Listen when you take meds”– 24-48 hr. follow-up: reminder about listening

• Next steps– Engage staff to use tool effectively– Customize to meet patient needs

ORMC Outcomes

• 30 percent reduction in readmissions

• 1 in 3 patients access recordings post-discharge

• Recordings played back for quality scoring of discharge instructions

• Recordings used as reference in training care coordinators

ORMC Outcomes

Jan – Jun 2014

Ensuring Safe Transitions from Hospital to Home

Virginia Feldman, M.D.

About Nexus Health Resources

• Assists hospitals with transitions and coordinated care

• Services proven to reduce readmissions by 30% for partner medical facility ORMC

Healthcare Transitions Impact

• Financial

• Procedural

• Patient Experience

Financial Impact: Readmission Costs

Condition Cost Per Readmission Readmission Rate

Congestive Heart Failure (CHF) $13,000 25.1%

All-Cause Readmission $11,200 21.2%

Heart Attack $13,200 17.1%

Pneumonia $13,000 15.3%

COPD $8,400 7.1%

Joint Replacement: Total Hip $12,300 8.2%

Joint Replacement: Total Knee $10,200 5.1%

Source: Healthcare Cost Utilization Project

Readmission Costs

New in FY 2015

• Max penalty for excess readmissions increases to 3%.

• CMS began to track readmission rates for hip/knee joint replacements as well as chronic obstructive pulmonary disease (COPD).

Patient Care Impact

• Ensuring the best care in the best setting

– Safety across the continuum

– Increase knowledge across the continuum

– Minimize complications

Common Points of Breakdown

• Medication

• Transition to primary care physician

• Patient self advocating

– Recognizing signs and symptoms that are red flags

– Willingness and ability to call for help

• Psychosocial issues

– Transportation

– Support system

Nexus Health Transition Process

• Begins at Admission

– Outpatient appointments scheduled prior to discharge

– Medication delivery at bedside prior to discharge

– Communicating all aspects of the transition prior to discharge

– Teach Back with ClaraLink recording

Patient Follow-up Process

• Follow-up begins within the first 24 hours post-discharge and continues through 30-day window

• Patient phone calls

– Day before and after first PCP/specialist visit/DME

– Every 5-7 days depending on patient status

– Eg, Red Flag: Patient declines visiting nurse service

Phases of Discharge Follow-Up

• Initial focus (24-48 hrs post-discharge)

– Medication delivery

• Ensure delivery and DME

• Eliminate gaps, barriers to receiving meds

– Transportation

• Ensure facilitation and follow through

– Primary care follow-up visit

• List of questions for PCP

• Medication list

Phases of Discharge Follow-Up

• Ongoing focus (after initial PCP visit)

– Ensure patient understanding of signs & symptoms that should trigger a doctor visit

– Provide ongoing assistance with appointments, transportation, and information

Keys for Discharge Instructions

• Appointments

• Medications

• Signs & symptoms to watch

• Durable medical equipment

• Contact for questions, more info

• Other:– Diet

– Activity level

– Wound care

Methods for Providing Instructions

• Given verbally at bedside

• Missing piece: point of reference for patients when they return home

• Common tendency to “create another form”

• Does this engage the patient?

– Need to provide education in an effective way

– Give information that is unique to each patient

• Generic form doesn’t communicate

Recording Discharge Instructions

• New method: Recording instructions at the bedside via phone

– Give patients access to recording of verbal instructions

– Playback available 24/7 for patients and their caregivers

• Hospitals listen to recordings for quality assurance

– Ensure effectiveness of instructions

– Change process to meet patient needs

Recording Verbal Discharge Instructions at the Bedside

Matt Jernigan

Why record verbal instructions

• Patients forget 80% of what their providers tell them.

• Nearly 50% of the remembered data is recalled incorrectly.

Source: Kessels, Roy P C. “Patient’s memory for medical information,” J R Soc Med. 2003 May; 96 (5): 219-222.

Patients need a resource to help recall important information regarding their care.

Why record verbal instructions

• Lack of compliance is a leading cause of hospital readmissions.

Giving patients the ability to listen to instructions again can improve compliance with treatments and

medications.

Why record verbal instructions

• Families are integral part of patient’s care team and can't always be present when discharge instructions are given.

Providers need an effective way to involve families and keep them informed of a patient’s care plan.

Why record verbal instructions

• Patient understanding and compliance is dependent on the quality of the information given at discharge.

Hospitals need a reliable approach to measure the quality and consistency of instructions.

Why record verbal instructions

• New York’s provision for the blind and visually impaired requires that discharge plans be provided as an audio recording if requested by the patient or patient’s representative..

ClaraLink meets the needs of this provision.

Why ClaraLink

ClaraLink gives patients, providers and caregivers 24/7 access to their recorded discharge instructions.

• Enhance patient and family experience

• Improve compliance with instructions

• Reduce avoidable readmissions

ClaraLink Advantages

• Simple to Use

• Simple to Implement

• Additional Hardware Not Required

How ClaraLink Works

Instructions recorded.

Patient given card for retrieving instructions.

Patient retrieves instructions.1 2 3

Recording Instructions

Nurse dials number and enters PIN.1

Nurse enters patient date of birth.2

ClaraLink plays patient ID.3

Nurse places phone on speaker and sets aside.4

Recording Instructions

Playback via a Phone

Dial number. Enter patient ID and patient date-of-birth.1 2 Recording

played back.3

Playback via Quality Manager

Thank you!

Virginia Feldman, MDNexus Health [email protected]

Matt JerniganThe White Stone Group

[email protected]

Rose BaczewskiGreater Hudson Valley Health [email protected]

Patricia MetzgerOrange Regional Medical Center

[email protected]