Volume 4, Number 5
May 2015
Reducing Preventable Readmissions Through Quality Cycle Management by Abbot Whitney
C
osting the healthcare industry an estimated $25 billion annually, readmissions have been seen historically as occurrences beyond the hospital’s control. Additionally, the traditional fee-for-service payment system incents providers per admission to the hospital, including readmissions that are potentially avoidable. But that reality is changing.
The Affordable Care Act (ACA) shifts provider performance to focus on outcomes rather than the volume of care provided. Not only do ACA reforms put significant reimbursement dollars at risk for quality outcomes, such as excessive rates of preventable readmissions, the stakes are getting higher every year as more conditions are measured, growing the dollars at risk. Hospitals cannot afford to delay addressing these reforms. In fact, because of the way in which the measurement and performance cycles are structured, even as hospitals improve their numbers, reimbursement will not reflect their performance for two years into the future.
(continued on page 5)
Understanding the Readmissions Nexus: A Focus on the Triad of Patient, Provider and Community Factors by Charles A. Odonkor, M.D., M.A
In This Issue 1 Reducing Preventable
Readmissions Through Quality Cycle Management
1 Understanding the
Readmissions Nexus: A Focus on the Triad of Patient, Provider and Community Factors
5 Innovation the Theme for 2015
8 Thought Leaders’ Corner:
What is the relationship between provider workload and preventable readmissions?
9 Industry News 12 Catching Up With… Kyle Everett
A
midst a rapidly changing healthcare landscape, the Hospital Readmissions Reduction Program continues to gain traction nationally as a primary impetus for accountability within the healthcare delivery system. In fiscal year 2015, the 1 fine for hospitals with excess readmission ratios above the national average increased from 1% to 3%. In addition to heart attacks, heart failure and pneumonia, two more conditions are being added: chronic obstructive pulmonary disease and 2 total hip/knee replacements. Accordingly, there are higher stakes and incentives for institutions across the country to devise bolder and innovative ways to bend the readmissions curve. As indicated by the volume of published literature on interventions to curb readmissions, the 3,4,5 A major obstacle has been the disproportionate focus on provider level risks only, which belies the task is proving elusive. complex dynamic interactions among multiple determinants of readmissions. The trend in the literature has been to use predictive models evaluating single causative factors, with the expectation of one6,7 to-one linear associations with outcomes. Readmission prevention interventions based on such models have been 8 unsuccessful, in part because the models fail to account for important cross interactions among multiple causative factors. (continued on page 2)
Published by Health Policy Publishing, LLC ● 209-577-4888 ● www.ReadmissionsNews.com
2
Readmissions News
May 2015
Readmissions News May 2015, Volume 4, Issue 5 ISSN 2166-255X (Electronic) ISSN 2166-2568 (Print) National Advisory Board Amy Boutwell, MD, MPP Founder and President, Collaborative Healthcare Strategies, Lexington, MA Molly Joel Coye, MD, MPH Chief Innovation Officer, UCLA Health System, Los Angeles, CA Thomas R. Graf, MD Chief Medical Officer, Population Health and Longitudinal Care Service Lines Geisinger Health System, Danville, PA Brian Jack, MD Professor of Family Medicine, Boston University Medical Center, Boston, MA Martin S. Kohn, MD, MS, FACEP, CPE, FACPE, Chief Medical Scientist, Care Delivery Systems, IBM Research, Hawthorne, NY Randall Krakauer, MD, FACP, FACR National Medical Director, Aetna Medicare, Princeton, New Jersey Cheri Lattimer Director, National Transitions of Care Coalition (NTOCC), Little Rock, AR Josh Luke, PhD, FACHE Founder, National Readmission Prevention Collaborative, Author, Readmission Prevention: Solutions Across the Provider Continuum Harold D. Miller Executive Director, Center for Healthcare Quality and Payment Reform; President and CEO, Network for Regional Healthcare Improvement, Pittsburgh, PA Mary D. Naylor, PhD, RN, FAAN Marian S. Ware Professor in Gerontology and Director of the NewCourtland Center for Transitions and Health, University of Pennsylvania, School of Nursing, Philadelphia, PA Jeremy Nobel, MD, MPH Medical Director, Northeast Business Group on Health Boston, MA Bruce Spurlock, MD President and Chief Executive Officer, Cynosure Health Solutions, Roseville, CA _____________________________
Editor’s Corner
G
reetings readers of Readmissions News! Thank you once again for subscribing and we feel you will be very happy with the excellent content in this month’s issue. As always, I welcome all questions, comments or concerns. Please email me personally a
[email protected]. Regards, Peter Grant Editor, Readmissions News
Understanding the Readmissions Nexus…continued from page 1 By looking beyond singular associations to explore the multifaceted indicators of 9 readmissions risk, emerging models may add newer perspectives to the literature. Analogous to the triple aim of targeting patient care, population health and costs to improve the U.S. health system, a focus on the triad of patient, provider and community-level factors is prerequisite for successful readmissions prevention and reduction. Identifying and understanding interactions among patient-specific (age, gender, ethnicity, health conditions, SES, health coping strategies and accommodations), provider (size, location, health payer) and community (neighborhood wealth, health attitudes and literacy) characteristics is critical for 10 targeted risk prevention and interventions. However, limited data exists that quantifies this important aspect of readmissions, in part due to overt reliance on 11 administrative data, which fail to capture essential predictive metrics. To fill this gap, recent studies examined the role of patient, provider and community-level measures in readmissions risk prognostication, with promising results: •
•
Publisher - Clive Riddle, President, MCOL Senior Editor – Peter Grant Readmissions News is published by Health Policy Publishing, LLC monthly with administration provided by MCOL. Readmissions News 1101 Standiford Avenue, Suite C-3 Modesto, CA 95350 Tel: 209.577.4888 -- Fax: 209.577.3557
[email protected] www.ReadmissionsNews.com
•
Compared to individuals from high SES backgrounds, patients from disadvantaged communities with lower education and neighborhood wealth 6 were three times more likely to experience recurrent hospitalizations. This underscores possible links between low SES, community educational status and a potential role for health literacy in readmission risk reduction. Broadening health literacy efforts from the individual to community level may help foster better health management behaviors. Some have suggested development of a toolkit inclusive of patient educational materials as well as a checklist for clinicians and community health workers to track patient and 10 community health risk factors and to design targeted interventions. Patients with low physical function, poor self-rated health and moderate-to10,7 severe depression were at the highest risk of 30-day readmissions. Patients with moderate-to-severe depression had a 72% predicted probability of 30-day readmissions, as neighborhood wealth declined. In communities with high “Patients with low physical neighborhood wealth, individuals with function, poor self-rated minimal depression had 16% predicted probability of readmissions compared to health and moderate-tothose with moderate-to-severe depression. severe depression were at This discrepancy could reflect differences in the highest risk of 30-day resource access, health attitudes or the tendency to seek care between individuals readmissions.” with minimal vs. severe depression from low vs. high wealth neighborhoods. Association of marital status (used as a proxy for social support) with readmissions was moderated by depression. Married vs. single/divorced couples with zero to minimal depression had a 48% decrease in the odds of 30-day readmissions compared to those with moderate-to-severe 10 depression. The results underscore a link between depressive symptoms and social support, which may be of interest to readmission outcomes. The findings also corroborate other reports highlighting the contextual role of social support in health outcomes. (continued on page 3)
Published by Health Policy Publishing, LLC ● 209-577-4888 ● www.ReadmissionsNews.com
May 2015
Readmissions News
3
Understanding the Readmissions Nexus …continued from page 2 As suggested elsewhere, “primary groups (e.g. immediate family, significant others) provide companionship and emotional stability, which may help patient’s cope with life stressors (pain, fatigue and physical limitations). Secondary groups (e.g. friends, co-workers, neighbors) are considered sources of informational support, and may help reinforce behavioral 12 adaptations to life stressors. Stable marital status, which reflects one’s social support system, perhaps serves as a buffer to help vulnerable patients maintain their health, and follow through with post discharge care.” Pilot programs to revamp social support for low income patients — through better patient education, home health aide visits, proactive nursing and medical staff follow-ups, and easily accessible post-discharge telephone hotlines — could help improve outcomes. No matter which system is used for communicating patient information between physicians, it should be routinely assessed for deficiencies, timeliness, and completeness by all parties to limit the risk of liability and improve patient safety. Figure 1
With a major shift towards outpatient care as majority of the U.S population lives longer with chronic diseases, the readmissions conundrum may yet be untangled with newer evolving care paradigms such as the patient centered medical 13,14 5 Since 70% of all patient care happens in the outpatient setting, the home, and comprehensive outpatient care centers. 6 above studies provide insight into the key metrics required to implement substantial change in readmissions. A critical review of the literature underscores the need for a multimodal approach inclusive of public health, community and provider level 8,7,6 Although associations certainly do not imply causation, the ability to reliably identify interventions to address readmissions. the most vulnerable high-risk groups is a nascent step towards addressing readmission barriers. In the era of big data, it is high time to design algorithms that collate patient, provider and community level metrics in computation of risks and in the design of prevention modalities. Via readmissions propensity scores, providers could preemptively realign resources to target patient- and community-specific needs. Reconfiguring the electronic health record (EHR) to capture important metrics not currently available from traditional administrative data sets is without question an important step. Healthcare systems and providers need to take advantage of cloud based computing and real time data analytics to incorporate patient, provider and community level risk indicators in the design of customized pre-admission and post-discharge care plans. Not surprisingly, Google and Microsoft have become heavily invested in providing e-health cloud computing services, with beta testing of Google Health® and Health-Vault®, 15,16 respectively. (continued on page 4) © 2015, Health Policy Publishing, LLC. All rights reserved. No reproduction or electronic forwarding without permission.
page 3
4
Readmissions News
May 2015
Understanding the Readmissions Nexus …continued from page 3 Combined with wearable fitness devices for remote monitoring of physical and health activities, these dynamic EHRs hold 17 promise for providing relevant metrics for more nuanced risk prediction. Newer readmissions risk models must not only be inclusive of the readmissions triad — patient, provider, community factors — but also reflect functional status, an important 7 measure recently shown to be predictive of readmissions. Reconceptualizing readmissions from a physiatrist framework, which targets barriers to participation for patients with functional limitations, a focus on physical function, social support, 10 psychological health and socio-demographics may provide deeper insight into risk for hospital recidivism.
“Reconceptualizing readmissions from a physiatrist framework, which targets barriers to participation for patients with functional limitations, a focus on physical function, social support, psychological health and sociodemographics may provide deeper insight into risk for hospital recidivism.”
Vulnerable and at risk groups may benefit from targeted physical activity interventions to improve functional status and overall health outcomes. Outside the hospital setting, longitudinal testing and tracking of cardio-respiratory fitness is now possible via wearable devices and sensors and this could allow for more accurate near real-time patient monitoring and feedback. The innovative use of telemedicine is revamping care delivery with various new mobile apps designed to provide patients direct and easy access to physicians. Health care professionals are able to respond to non-urgent issues and address patients’ concerns; in turn patients are less likely to pay non-urgent visits to the hospital. It is anticipated that development and widespread adoption of these technologies may broaden the scope of readmissions risk reduction strategies.
Understanding the readmissions nexus necessitates defining the interactive pathways that link patient, community and provider specific factors. Related to this, more research needs to be done to better understand patients’ bio-psychosocial accommodations: those compensatory strategies and behavioral responses to changes in environment, health, or functional 18 capacity. As suggested elsewhere, this is key to individuals’ ability to participate in “productive social and civic life,” with important implications for health outcomes, and potentially, readmissions risk. Incorporating patient accommodations and behavioral attitudes into risk models could potentially provide more accurate readmissions risk stratification and more reliable prevention tools. Importantly, each aspect of the readmissions triad provides potential targets for readmissions risk reduction interventions (Figure 1). In particular, realigning resources to provide public and community health workers, care navigators and coordinators could help reinforce healthy adaptive behaviors that would encourage at risk and highly vulnerable groups to practice better self-health management. In summary, adopting policies and strategies with a focus on vulnerable groups, improving community based health education and literacy, providing behavioral and psychosocial counseling as well as the innovative use of telemedicine and cloud computing to target pivotal components of the readmissions nexus, all hold much promise to helping bend the readmissions curve. As healthcare in the U.S continues to undergo rapid changes, one thing remains clear: a drive to reduce readmissions is incomplete without a call for continued patient engagement along the entire spectrum of care — we must have a commitment to provide a continuum of ongoing patient engagement (Figure 1). It is also a call for more accountability and conscientious care for our patients and communities. 1
2 3 4 5 6 7 8 9 10 11 12
“Incorporating patient accommodations and behavioral attitudes into risk models could potentially provide more accurate readmissions risk stratification and more reliable prevention tools.”
Readmissions Reduction Program [Internet].; 2015 []. Available from: http://www.cms.gov/Medicare/Medicare-Fee-for-ServicePayment/AcuteInpatientPPS/Readmissions-Reduction-Program.html. Jencks SF, Williams MV, Coleman EA. Rehospitalizations among patients in the Medicare feefor-service program. N Engl J Med. 2009;360(14):1418-28. de Bruijne MC, van Rosse F, Uiters E, Droomers M, Suurmond J, Stronks K, et al. Ethnic variations in unplanned readmissions and excess length of hospital stay: a nationwide record-linked cohort study. Eur J Public Health. 2013 Dec;23(6):964-71. Friedman B, Basu J. The rate and cost of hospital readmissions for preventable conditions. Med Care Res Rev. 2004 Jun;61(2):225-40. Kansagara D, Englander H, Salanitro A, Kagen D, Theobald C, Freeman M, et al. Risk prediction models for hospital readmission: a systematic review. JAMA. 2011;306(15):1688-98. Odonkor CA, Hurst P, Kondo N, Makary MA, Pronovost PJ. Halting the Revolving Door: How a Focus on Patient- and Community-Level Risks May Help Curb Readmissions After Surgery. Am J Med Qual. 2014 Aug 7. Hoyer EH, Needham DM, Miller J, Deutschendorf A, Friedman M, Brotman DJ. Functional status impairment is associated with unplanned readmissions. Arch Phys Med Rehabil. 2013;94(10):1951-8. Bradley EH, Curry L, Horwitz LI, Sipsma H, Thompson JW, Elma M, et al. Contemporary evidence about hospital strategies for reducing 30-day readmissions: A national study. J Am Coll Cardiol. 2012;60(7):607-14. Mudge AM, Shakhovskoy R, Karrasch A. Quality of transitions in older medical patients with frequent readmissions: Opportunities for improvement. Eur J Intern Med. 2013;24(8):779-83. Odonkor CA, Hurst PV, Kondo N, Makary MA, Pronovost PJ, Jewish NL. Beyond the Hospital Gates. American Journal of Physical. 2014;894(9115/14):0000-. Bradley EH, Yakusheva O, Horwitz LI, Sipsma H, Fletcher J. Identifying patients at increased risk for unplanned readmission. Med Care. 2013 Sep;51(9):761-6. Uchino BN, Bowen K, Carlisle M, Birmingham W. Psychological pathways linking social support to health outcomes: a visit with the “ghosts” of research past, present, and future. Soc Sci Med. 2012;74(7):949-57. (continued on page 5)
Published by Health Policy Publishing, LLC ● 209-577-4888 ● www.ReadmissionsNews.com
May 2015
Readmissions News
5
Understanding the Readmissions Nexus …continued from page 4 13
14 15 16 17 18
Moy NY, Lee SJ, Chan T, Grovey B, Boscardin WJ, Gonzales R, et al. Methods, tools, and strategies development and sustainability of an inpatient-to-outpatient discharge handoff tool: A quality improvement project. Joint Commission Journal on Quality and Patient Safety. 2014;40(5):219-27. American Academy of Family Physicians. Joint principles of the Patient-Centered Medical Home. Del Med J. 2008 Jan;80(1):21-2. Amarasingham R, Moore BJ, Tabak YP, Drazner MH, Clark CA, Zhang S, et al. An automated model to identify heart failure patients at risk for 30-day readmission or death using electronic medical record data. Med Care. 2010 Nov;48(11):981-8. Raven MC, Billings JC, Goldfrank LR, Manheimer ED, Gourevitch MN. Medicaid patients at high risk for frequent hospital admission: real-time identification and remediable risks. Journal of Urban Health. 2009;86(2):230-41. Vargheese R, Viniotis Y. Influencing data availability in IoT enabled cloud based e-health in a 30 day readmission context. Collaborative Computing: Networking, Applications and Worksharing (CollaborateCom), 2014 International Conference on; IEEE; 2014. Freedman VA. Adopting the ICF language for studying late-life disability: a field of dreams? J Gerontol A Biol Sci Med Sci. 2009 Nov;64(11):1172,4; discussion 1175-6.
Charles A. Odonkor, MD, MA, is a resident physician in physical medicine and rehabilitation at the Johns Hopkins University School of Medicine. He served as the 2013 national vice president of the American College of Medical Quality Student-Resident Section, and currently serves on the Johns Hopkins Hospital Quality Improvement Council. He is Vice-Chair of the Association of Academic Physiatrists Resident/Fellows Council and is interested in a career in healthcare leadership & health policy, quality improvement and patient safety outcomes.
Reducing Preventable Readmissions Through Quality Cycle Management …continued from page 1 “In order for hospitals to achieve success, quality cycle management requires a clearly defined cadence, welldefined metrics with targets, a firm culture of accountability, and deep executive engagement.”
As never before, hospitals are under the quality measurement microscope. Their performance is made increasingly transparent, and their financial success is tied directly to the quality outcomes they provide. This changing theory of the business is giving way to a new reality in which the processes that lead to desirable patient outcomes must be managed as rigorously and with as much attention as that given traditionally to business processes. We term this new focus and the rigor that surrounds it “quality cycle management.” In order for hospitals to achieve success, quality cycle management requires a clearly defined cadence, well-defined metrics with targets, a firm culture of accountability, and deep executive engagement – requirements not unlike what are needed to succeed in any business. What quality cycle management aims to provide are structured techniques to find, prioritize and track areas in need of improvement, and a culture of “high accountability” in which executives, managers and staff hold each other accountable to deliver on agreed upon targets.
Using a core methodology, we’ve seen quality cycle management work for a group of approximately 350 hospitals that shared their outcomes data to define standards of top performance in areas like readmissions, harm and mortality. After six years of creating a measurement framework, defining measures and benchmarks, and monitoring performance against those benchmarks, they saved $13.2 billion and 165,000 lives. They also prevented 55,845 readmissions in just two years. But how did these hospitals really do it? Let’s focus on readmissions. Poor discharge procedures and insufficient follow-up care with patients at elevated risk of readmission are cited as among the primary drivers for preventable readmissions. Embedding a consistent quality cycle management process with a focus on improved discharge planning, medication management, high-risk populations and care coordination is essential in order to impact this outcome. Among techniques known to reduce readmission rates are the following: Improved discharge plans: Improved discharge planning can reduce readmissions by about 17 percent, improving outcomes for patients as they move to the next level of care. To be most effective, discharge plans must be comprehensive, often involving a written document that is developed while the patient is still in the hospital. They are helpful to ensure patients understand where to go and what to do if their condition changes, as well as ensure they have plans to obtain post discharge services. Medication management: A significant number of readmissions are caused by medicationrelated adverse events. In fact, up to 19 percent of patients experience an adverse event after discharge, two-thirds of which are attributed to medications. Specific medication management interventions include reviewing the purpose of each medication - how to take correctly, side effects, etc. and confirming the patient is able to get their medications.
“… up to 19 percent of patients experience an adverse event after discharge, two-thirds of which are attributed to medications.”
Targeting high-risk populations: High-touch, intensive readmission prevention services are essential for those at a high risk for readmission, including patients that have already been hospitalized at least once in the prior year; those with a longer hospital stay; those who received multiple procedures; and those with severe illnesses such as cancer. Improved management of high-risk patients includes a follow up phone call and in-person appointment with a care provider within 48 hours of discharge, a review of the patients who return to the emergency department within 48 hours of discharge and evaluation of the process for those that were unexpected by leadership.
(continued on page 6)
© 2015, Health Policy Publishing, LLC. All rights reserved. No reproduction or electronic forwarding without permission.
page 5
6
Readmissions News
May 2015
Reducing Preventable Readmissions Through Quality Cycle Management …continued from page 5 Case management and care coordination: Case managers typically are responsible for arranging follow-up, post-discharge care before the patient leaves the hospital, including making medical appointments, arranging for the delivery of durable medical equipment, scheduling rehabilitation services and/or arranging for services that may be needed after a hospitalization. Specific care coordination interventions include providing contact numbers so primary care providers (PCPs) can be contacted during evenings and weekends, making appointments with input from the patient regarding best time and date, a dedicated nurse discharge advocate position, and educating patients of next steps in care throughout their stay.
As Goethe observed, “Knowing is not enough; we must apply. Willing is not enough; we must do.” Many hospitals are motivated to improve readmission rates and other quality metrics, and there are certainly many techniques that have been shown to have an impact. However many hospitals struggle with effectively implementing these practices into a culture not often embracing of change and only recently aligned with the financial incentives of the payment system. This is where the structure imposed by quality cycle management can help. Hospitals that are able to successfully implement improvements have a culture in which leadership is visible, metrics are used routinely and transparently across the institution, and follow a structured process for improvement. In these hospitals, staff is held accountable for achieving results. Leadership, too, is held accountable in removing obstacles to progress. Quality cycle management is designed to identify areas of improvement, expects managers to produce an improvement plan, and provides leadership with the tools to monitor results and achieve hold people accountable. Some successful hospitals have used the term “clinical close” to describe a process they employ similar in rigor and intensity to the “financial close.” In attempting to lower readmission rates and improve outcomes, there is no shortage of work to be done. Most hospitals have the will, many have the ideas, but the challenge is execution. Quality cycle management is designed to help them overcome that challenge. Abbot Whitney is the manager of Performance Services Solutions Marketing at Premier, Inc in North Carolina.
Subscribers’ Corner Subscribers can receive Readmissions News both in print and electronic formats for no additional cost, and that is the default delivery option. However, should you wish to only receive your newsletter in print, or only electronically, you can do so at any time. Feel free to contact us. Subscribers can access an archive of current and past issues of Readmissions News, view added features, change account information, and more from the newly upgraded and enhanced Subscriber web site at: www.ReadmissionsNews.com. If you can't remember your username or password, you can use the reminder link, or contact us. There's no cost to participate in the Readmissions News LinkedIn Group where subscribers can also network and discuss readmissions issues with other health care professionals, review job opportunities, and more in the LinkedIn Readmissions News Group. Sign up now at: www.linkedin.com/groups/Readmissions-News-4220113?home=&gid=4220113. We encourage you to contact us any time with feedback of any kind regarding Readmissions News.
Published by Health Policy Publishing, LLC ● 209-577-4888 ● www.ReadmissionsNews.com
May 2015
Readmissions News
7
Innovation the Theme for 2015 by Josh Luke
I
have had the distinct pleasure of meeting and spending some time with multiple representatives from CMS over the last six months. Each of the CMS regional offices as been generous enough to provide a speaker to present and share with attendees at each of the National Readmission Prevention Collaborative’s conferences so far in 2015. These presentations have stimulated conversation and enthusiasm in many areas related to care coordination, but the two consistent theme’s at each of these meetings have been: • •
Case studies of how hospitals are narrowing their SNF list, bucking the long-time expectation that an entire list of local SNF’s be presented to patients without any input on providers who are providing an enhanced level of quality and care Innovation and creative models to enhance the care continuum
Melanie Evans wrote and excellent article in Modern Healthcare on May 9, 2015 showcasing Banner Health’s case study in narrowing their network, as well as several other Best Practice case studies nationwide. The decision to narrow the post-acute network lies squarely with each hospital and its board and CEO’s willingness to be more aggressive than others in the market and move forward narrowing the list of providers. One representative said to me recently, “I don’t know how a hospital could be successful in a coordinated care model without narrowing the network.” Even with that, those who are narrowing their network, are using innovative strategies to do so. Which brings us right back to theme number two for 2015: Innovation. Last week I had the privilege of discussing innovation and progressive models with representative from the CMS Innovation Center. The work they are doing is ground-breaking. There is no short answer to how to learn and apply for innovation grants, as there are so many different opportunities. To learn more about innovation models and available grants, readers can visit the website: http://innovation.cms.gov/initiatives/Health-Care-Innovation-Awards/. Further evidence of innovation being a key theme for 2015 is the recent attention Wall Street has given to innovations in the care transitions space. With the recent announcement of a pending IPO for remote monitoring company Teladoc and other pending IPO announcements for innovations in the care transitions space, the already cluttered care transitions start-up space is likely to get even noisier in 2015 and 2016. It is my personal opinion that its way too early for any of these companies to conduct an IPO as this is a very long and slow sales process, and I would be hesitant to invest in any of these products that do not have existing partnerships in place with key providers in the acute sector, with EMR companies or with ACO’s. The National ACO and Bundled Payment Collaborative (http://www.nacobpc.com) launched in May 2015 and the first National ACO & Bundled Payment Summit will be held in New York, June 11, 2015 in conjunction with the National Readmission Summit. Additionally, the National Readmission Prevention Collaborative is currently accepting nominations for its first National Innovation Contest. Winners will be announced at the National Readmission Summit in New York on June 11, 2015. One of the nominations already submitted, is already having a significant impact on the acute and skilled nursing sector. The Virtual Medical Assistant, referred to as VMA, is developed by Sensiotec, a startup based inside Georgia Tech's Advanced Technology Development Center. Sensiotec has developed a non-contact, ultra-wideband radar-based patient monitoring system that allows for continuous physiological monitoring. The VMA has been used as a wound prevention and fall prevention tactic in both the acute and skilled nursing sectors. The system currently measures heart rate and respiration rate, which are the two key lead indicators of patient distress, in addition to presence in bed, agitation, and position in bed. The VMA is a thin sensor panel that requires no wires and does not come in contact with the patient, with data relayed to an internet portal. What has set the VMA apart is that it is cost efficient, at $5/day ($150/month) per device with no upfront startup/installation fees. In my experience, the challenge for new technologies in the care transitions space is not just developing a technology that improves the coordinated care model, but the excessive start-up costs for any organization who chooses to implement the technology. This is also the reason that VMA has been implemented in a home setting as well – or $150 a month price is a non-factor in the decision once the technology has been proven to work as in the case of the VMA in SNF and acute settings. “It’s just as cost-efficient to implement the technology in someone’s home and the data is as easily accessed via the internet from home as it would be for the hospital or SNF employee,” said Dr. Jiten Chhabra, Medical Director for Sensiotec. Anyone interested in submitting a nomination for the National Readmission Prevention Collaborative’s Innovation Contest, can do so by visiting http://NationalRedmissionPrevention.com. Other examples of innovation gaining momentum and traction in 2015 are Vree Health’s population management software solution, Rightcare Solutions risk stratification algorithm developed at the University of Pennsylvania, and the predictive modeling of the Community Integration Model MSPB management tool. While innovation is already a key theme for 2015, as we look toward the second half of 2015 you can expect innovation to become even more of a focus in the readmission prevention and care coordination space. Josh Luke, PhD, FACHE is the Founder of the National Readmission Prevention Collaborative. © 2015, Health Policy Publishing, LLC. All rights reserved. No reproduction or electronic forwarding without permission.
page 7
8
Readmissions News
May 2015
Thought Leaders’ Corner Each month, Readmissions News asks a panel of industry experts to discuss a topic of interest to the hospital community. To suggest a topic, write to
[email protected].
Q. What is the relationship between provider workload and preventable readmissions? As a matter of common sense, improving nurse working environments and staffing levels should go some way towards lowering readmissions levels. However, this cannot be seen as a silver bullet. Research indicates that many or the country’s finest medical establishments face high readmissions rates. This could simply be the product of the fact that they deal with patients who are seriously ill. However, there are bound to be numerous other reasons for this, as well. Nonetheless, making changes so that hospitalist workloads are more reasonable would likely improve a variety of measures, not simply readmissions rates, and ought to be explored further.
Shaina S. Kirby, RN Nurse Practitioner Saint Luke’s Hospital of Kansas City
Studies have shown that, while beneficial in other areas, there is unlikely to be a significant relationship between hospitalist workloads and readmissions rates. This is not to suggest that there is no relationship, but it does suggest that more likely culprits are related to the severity of the patient’s condition, the socioeconomic status of the patient population in question, and the processes under which the healthcare institution operates in order to prevent unnecessary readmissions. Managing workloads in healthcare is undoubtedly an important issue, but should not be seen as a silver bullet when it comes to readmissions reduction.
Dennis Cleaver Private Healthcare Consultant Cleaver & Harrison
Managing hospitalist workload is just one component of a readmissions reduction program. Developing and implementing a broader program including patient engagement, proper patient communication procedures, community involvement, coordination with community resources and integration of technological tools all play a big role in what ultimately must be comprehensive, multifaceted readmissions reduction program.
Sun-Yi Chen, MD Cardiac Surgeon St. Joseph’s Hospital and Medical Center
Published by Health Policy Publishing, LLC ● 209-577-4888 ● www.ReadmissionsNews.com
May 2015
Readmissions News
9
Industry News Univita’s Readmission Reduction Solution …continued
Paramedics And Nurses Making Home Visits To Reduce Hospital Readmissions As part of an innovative program aimed at reducing unnecessary emergency room visits and hospital stays, teams comprised of a paramedic, critical care nurse and EMT have begun making house calls on heart patients soon after their discharge from The Valley Hospital in Ridgewood, NJ. Valley's Mobile Integrated Healthcare Program brings together Valley's Department of Emergency Services and Valley Home Care to provide proactive, post-discharge home checkups to try to whittle these numbers down. The program, which launched in August 2014, targets those patients with cardiopulmonary disease at high risk for hospital readmission who either decline or do not qualify for home care services. The team provides a full assessment of the patient, including a physical exam, a safety survey of the patient's home (focusing on fall risks), medication education, reinforcement of discharge instructions and confirmation that the patient has made an appointment for a follow-up visit with his or her physician. The program initially targeted patients with heart failure, but has recently been expanded to include patients who have undergone the transcatheter aortic valve replacement (TAVR) procedure, a minimally invasive treatment option for patients with severe, symptomatic aortic valve stenosis, for whom traditional valve replacement surgery is not an option. The Mobile Integrated Healthcare Program complements Valley Home Care's comprehensive roster of services, which include skilled nursing care, a telemanagement program, rehabilitation therapy, cardiac home care, Valley Hospice, certified home health aides, diabetes support services, and hospital-to-home care coordination and more.
Univita’s Readmission Reduction Solution Attracts International Attention Univita Health, the leader in post-acute and home healthcare solutions, hosts academic physicians from South Korea’s Seoul National University Hospital who have traveled to the United States to learn how telehealth is being used to improve patient outcomes. The visit was organized by Philips, the manufacturer of the state-of-the-art eCare portal used to monitor patients enrolled in Univita’s proprietary, telehealth-backed Re-admission Reduction Solution. Univita is one of only two healthcare organizations in the U.S. using the Philips eCare solution. The other is a major hospital system in Detroit, Michigan. In late 2014, South Korea’s government announced plans to reverse a policy that restricted the use of telehealth, particularly in the chronic care setting.
As a result of the change in policy, physicians in Korea are excited to learn how telehealth has changed care outcomes in the U.S. In July, physicians from Europe are also expected to travel to South Florida to learn more about Univita’s telehealth programs, which are administered by specially-trained registered nurses and are centered on the patient, caregiver and primary care physician. Utilizing this approach, our Readmission Reduction Solution has significantly reduced hospital readmissions among high-risk patients with conditions such as chronic heart failure, COPD, diabetes, hypertension and chronic kidney disease enrolled in the program. Univita’s Readmission Reduction Solution is built on clinical algorithms that utilize the eCare portal and noninvasive equipment to monitor high-risk patients. The devices feature a “one-button” patient-friendly interface, including non-invasive single lead ECG tracing and thoracic impedance, cardiac output, stroke volume and other vital signs that provide early alerts. The vitals are transmitted via the eCare portal and an electronic medical record system to nurses at Univita who monitor patients for readmission avoidance.
Ohio Presbyterian Retirement Services to Tap Technology to Help Chronically Ill Patients from Returning to Hospital An innovative program developed by Ohio Presbyterian Retirement Services (OPRS) will now use technology to help seniors manage their health at home after discharge from the hospital. The Home to Stay program, which debuted in July 2013 through OPRS’s subsidiary Senior Independence, is offered at no cost to patients of the Northwest Ohio Accountable Care Organization. A registered nurse or licensed practical nurse visits a patient within 72 hours after being discharged from the hospital, with an additional follow-up visit within seven to 10 days. The nurses review patients’ medications, take vital signs, establish health records, confirm appointments and more. Results of the program have been better than anticipated. In the program’s first year, participating patients showed a 3.4 percent hospital readmission (return) rate, compared to a regional average of 16 percent readmission. These results represent a substantial financial savings as well as better health management for patients. A $30,000 Verizon grant will allow Home to Stay to include a telehealth component, which will provide patients with glucose monitoring, pulse checking and other health measurements. The monitoring equipment will send data via a computer tablet to a nurse at Senior Independence for review.
© 2015, Health Policy Publishing, LLC. All rights reserved. No reproduction or electronic forwarding without permission.
page 9
10
Readmissions News
May 2015
Industry News Medipense Adds SMS Alerts …continued MHA Keystone Center Expands Relationship with ArborMetrix to Benchmark Readmission Performance ArborMetrix, Inc., a leading provider of real-time healthcare analytics, and the Michigan Health & Hospital Association (MHA) Keystone Center today announced that the MHA Keystone Center will deploy ArborMetrix's Readmetrix solution statewide to more than 100 organizations within its hospital membership. The goal of the initiative is to address the challenges of value-based payment mandates, particularly readmission penalties, through data and analytics to better manage the quality of specialty care delivered in acute care settings. Readmetrix is an advanced, web-based analytics tool that will leverage all-payer data from the MHA's Michigan Inpatient Database (MIDB) to analyze readmission rates across different hospitals in the state and benchmark condition-specific quality measures for dozens of the most important acute care surgical procedures and medical treatments. With access to MHA data through Readmetrix, member hospitals can compare their readmissions rates and other quality metrics to those of peer hospitals across the state, and identify opportunities for improvement. Reducing hospital readmissions is one of many initiatives the Centers for Medicare & Medicaid Services (CMS) has launched to help improve the quality of healthcare in the United States while reducing costs. As hospitals grapple with unprecedented margin pressures and reduction in Medicare reimbursement as a result of the Affordable Care Act, CMS is penalizing a record number of hospitals – 2,610 – and increasing the maximum penalty as part of its Hospital Readmissions Reduction Program. During this, the third year of the program, hospitals can lose as much as three percent of their Medicare payments, and must manage to an expanded number of conditions the government evaluates. The new Readmetrix agreement builds upon MHA Keystone Center's relationship with ArborMetrix for performance measurement analytics. Last spring, the center adopted the ArborMetrix RegistryMetrix solution to measure clinical performance in obstetrics to help reduce obstetrical adverse advents and improve patient safety.
Medipense Adds SMS Alerts to Medication Reminder Service, RxPense-Alert.com Medipense Inc., a Canadian medical device manufacturer has added an SMS alert service to the recently launched RxPense-Alert.com web site. Due to popular demand for a low cost SMS reminder service, Medipense has added the optional SMS alert feature to its popular free email reminder service. The SMS feature is purchased as a monthly subscription starting at $9.95 for North American clients.
RxPense Medication Management and Remote Monitoring solutions are designed primarily for seniors or those with chronic conditions. For those and others who are guilty of not always taking medications on time, RxPense-Alert.com may be the simplest solution to improving medication adherence and staying healthy, longer. RxPense Alert is a very simple, personal email and SMS reminder service that will send an alert every time one needs a reminder to take medications, vitamins or even to perform a regular activity. Registration is FREE and setting up reminders is as easy as filling in a short form. Reminders may be one-time or recurring, daily or specific days. Details or notes may also be added to the email and dispatched as requested. Registration is a snap at http://www.Rxpense-Alert.com. For those who simply want to receive an email reminder to take their pills, the service is always free. However, for those who would like to receive SMS alerts in addition to email, or in place of email, then a monthly subscription is required, starting at $9.95. Countries will be added as requested. Study after study has demonstrated that something as simple as sending daily reminder messages may improve the uptake of pills by over 60% percent. This not only improves adherence, but can also reduce the risk of heart attack, stroke and hospital readmissions.
Vidyo Selected by GetWellNetwork as Video Conferencing Platform for Patient Engagement Vidyo, Inc., the video platform leader in health care, has been chosen by GetWellNetwork, Inc., the leader in Interactive Patient Care (IPC) solutions, as the visual communications choice for its cross-continuum patient engagement platform. The VidyoWorks platform integrates directly into the care process, enabling providers to improve patient satisfaction, quality of care and productivity. In any care setting, GetWellNetwork’s IPC platform educates and empowers patients to participate in and manage their health. Vidyo is used by 39 of the top 100 integrated delivery networks (IDNs) in the U.S., and the integration with GetWellNetwork will enable patients to consult with doctors, specialists and family members in hospitals, homes, or remote areas through video conferencing. The GetWellNetwork solution, accessible through bedside monitors and mobile devices, tailors specific educational content, Interactive Patient Care Pathways and user experiences based upon the patient’s condition and needs. The solution, particularly when integrated with the VidyoWorks platform, can help providers improve Hospital Consumer Assessment of Healthcare Providers Systems (HCAHPS), prevent falls, decrease length of stay and reduce readmissions. Consultations performed using the integrated solution are also Medicare-reimbursable.
Published by Health Policy Publishing, LLC ● 209-577-4888 ● www.ReadmissionsNews.com
May 2015
Readmissions News
11
Industry News Amedisys Announces Homecare Homebase …continued Mevesi 4.0 Integrates Health Care Systems and Pharmacies to Manage at Risk Patients Mevesi, the leading provider of cloud based pharmacy data automation, unified data warehouse and business intelligence solutions, today announced the launch of Mevesi 4.0. which offers healthcare systems an innovative Transitional Care Network solution that integrates seamlessly with Mevesi Population Management Solution for pharmacies. Transitional Care Network solution customers now have a platform from which to refer at risk patients to integrated pharmacies, to increase patient health care out-comes, reduce readmission cost, and increase service quality. Mevesi is committed to helping clients extend the value of their data and patient care management technology investments. The Transitional Care Network offers cloud based bi directional solution, allowing hospitals and pharmacies to secure and seamlessly exchange patient data across their business systems. The Transitional Care Network is an extension of the Hospital in the community and lets pharmacy support enhance patient care that naturally complements the health care systems services.
Amedisys Announces Homecare Homebase as Home Health & Hospice Solution Partner Amedisys, Inc. is a health care at home company delivering personalized home health and hospice care to more than 355,000 patients each year. More than 2,200 hospitals and 61,900 physicians nationwide have chosen Amedisys as a partner in post-acute care. Amedisys is focused on delivering the care that is best for our patients, whether that is home-based recovery and rehabilitation after an operation or injury, care focused on empowering them to manage a chronic disease, palliative care for those with a terminal illness, or hospice care at the end of life. Amedisys also has the industry's first-ever nationwide Care Transitions program, designed to reduce unnecessary hospital readmissions through patient and caregiver health coaching and care coordination, which starts in the hospital and continues throughout completion of the patient's home health plan of care. The company recently announced a strategic decision to partner with Homecare Homebase, the leader in home health software development, to implement the HCHB platform across 396 branches throughout the US. The decision comes after extensive consideration of the evolving needs of Amedisys, the goals of their clinical and operational teams and the desire to provide an integrated, scalable solution for their continued expansion plans. For over 10 years, Homecare Homebase has been dedicated to providing homecare and hospice agencies with a best-ofbreed healthcare information system that is fast, flexible and customizable to their unique operational requirements.
Developed by industry veterans, Homecare Homebase offers a comprehensive, integrated, cloud-based software solution that continues to stay ahead of the curve, as well as the competition, allowing customers to not only manage their business more effectively, but ultimately provide their patients with the best possible outcomes. Homecare Homebase, based in Dallas, Texas, is a leading healthcare software company serving the technology needs of the fast growing post-acute care industry including homecare, hospice and private duty. Homecare Homebase has received the prestigious Best In KLAS for Homecare award for three consecutive years in the “Best in KLAS Awards: Software & Services” report. Homecare Homebase offers a comprehensive integrated web-based software solution to improve the clinical, operational and financial success of homecare and hospice agencies. Homecare Homebase enables real-time, wireless information exchange and communication between office staff, field staff and physicians; automates workflow processes; enables accurate billing through numerous integrated checks and balances; and, provides powerful management reporting via a back-office data analysis tool that ties together all agency operational information. Founded by industry veterans in 1999, every aspect of the Homecare Homebase system was developed to be userfriendly, flexible and customizable to specific agency needs.
Banner Health achieves 27 percent cost savings through joint pilot telehealth program with Philips Working together to address the shift toward value-based care and increased penalties for readmissions, Royal Philips and Arizona-based Banner Health announced the successful results of their at-home telehealth pilot program for patients with multiple chronic conditions. The Intensive Ambulatory Care (IAC) pilot program, part of the overall telehealth program at Banner, focuses on the most complex and highest cost patients – the top five percent of patients who account for 50 percent of health care spend. The IAC program, first launched in 2013, aims to improve patient outcomes, care team efficiency, and prevent IAC patients from entering the acute care environment, where costs are significantly higher. Banner recently enrolled its 500th patient into the IAC program in which intensivist PCPs, nurses and a broader care team collect and analyze objective and subjective health data to identify early stages of deterioration and prevent adverse events. By providing patients with near-instant access to caregivers – including social workers, pharmacists, and health coaches – Banner has delivered patient-centered care and improved patient satisfaction.
© 2015, Health Policy Publishing, LLC. All rights reserved. No reproduction or electronic forwarding without permission.
page 11
12
Catching Up With …
Kyle Everett Founder and Chief Executive Officer Relativity Analytics, Inc. New York, NY Formerly an employee with Yahoo!, Kyle Everett has started his own healthcare analytics startup under the name of Relativity Analytics, Inc. Mr. Everett received an advanced degree in Computer Science at Cornell University. He lives with his wife and two daughters in New York City.
• • •
Graduated with Computer Science Degree from Cornel Former Senior Analytics Researcher, Yahoo! Founder and Chief Executive Officer, Relativity Analytics
Readmissions News: Could you provide an overview of what Relativity Analytics has achieved so far? Kyle Everett:
Relativity Analytics was first incorporated in 2013. So far, we have developed a customized readmission solutions platform for a sizable Healthcare System in Florida, and a smaller Healthcare System in Vermont. The solution we offer is unlike most others in that instead of solely focusing on an individual disease or condition, our service predicts readmissions across all diseases and conditions. Another notable aspect of our solution is that it places a special emphasis on the psychosocial requirements of the patient and the family rather than a narrow clinical approach, which traditionally has been the primary focus of most of the industry. We’re very proud of our product and our initial results have proven that we can be competitive in this dynamic business environment.
Readmissions News: What specifically are your customers hoping to achieve through the use of your services? Kyle Everett: The Healthcare Organizations we work with are attempting to reduce hospital readmissions across the full
spectrum of their patients. They seek to do so through educating patients and their families to more effectively manage their condition while simultaneously coordinating various services within the community to aid in this overall project. Our customers seek the ability to identify the patients who will most likely need interventions, identify which interventions will prove to be the most effective and then to start the intervention process as soon as possible. All too often, interventions occur at the end of a patient’s stay at the hospital. Early interventions provide more time for clinicians to offer instructions and pass on vital information, as well as raise patient and family member comprehension and give time for community services to be arranged so they are already in place for when the patient is discharged. Our solution helps to optimize hospital resources so that are in a comfortable position to provide interventions to those who need them the most.
Readmissions News: Lastly, tell us something about yourself that few would know. Kyle Everett: Aside from raising a beautiful family and trying to succeed in the world of startups, I also am a competitive gamer and have actually won a few (though not many) competitive gaming tournaments. Published by Health Policy Publishing, LLC ● 209-577-4888 ● www.ReadmissionsNews.com
