Reducing readmissions is a top-of-mind concern for hospital administrators around the country. Not only does reducing readmissions have a positive influence on patient experience and community health, but it also affects a hospital's bottom line.
In 2012, CMS began its Hospital Readmissions Reduction Program, which penalizes hospitals based on 30-day readmissions for heart attack, heart failure, pneumonia, chronic obstructive pulmonary disease, hip/knee replacement and coronary artery bypass graft surgery. Since its inception, hospitals have paid nearly $1.9 billion in penalties through fiscal year 2017.
Thus, when Buffy Key joined Cookeville (Tenn.) Regional Medical Center in 2011, the focus was on avoiding costly readmission penalties by reducing readmission rates. Ms. Key is senior vice president of quality and operations at the medical center.
Cookeville Regional Medical Center is a 247-bed regional referral center serving 14 counties. In 2017, the hospital saw 13,200 readmissions, of which 60 percent involved Medicare recipients, Ms. Key said in a March 27 webinar sponsored by Change Healthcare and hosted by Becker's Hospital Review. Readmissions around the country cost Medicare $27 billion yearly, and $17 billion is classified as potentially avoidable cost.
"[We realized], 'Wow, this is a huge issue for us, being such a large Medicare population,'" she said.
Ms. Key and her team went to work looking into the data available in-house, mostly in the form of medical records and CMS reports, to figure out ways to effectively reduce readmissions.
"We were kind of looking at the past and trying to figure out what to do about the future," Ms. Key said. "We did a lot of soul-searching. Not just with the data, but with our patient population."
Establishing a transitional care program
Cookeville Regional Medical Center decided to develop a transitional care program. The transitional care team started looking at every single hospital admission, and using the LACE Index Scoring Tool, they examined patients' length of stay, acuity and emergency room visits. However, this was extremely labor-intensive, with the transitional care coordinator spending nearly half a day calculating LACE scores and developing risk stratifications.
The medical center then implemented the Explorer Analytics product allowing team members to view necessary data in real time. The transitional care team identified the data they needed every day, as well as sore spots; for example, they found pulmonary procedures to be an issue and found a great deal of improvement opportunity in pneumonia care. The platform allowed clinicians to drill down into the data.
"Working with the developers of this program as well as our business decision support analysts in-house and with the transitional care coordinator, we were able to develop an idea of what we needed to see every day," said Ms. Key.
The multidisciplinary care team at Cookeville now includes transitional care coaches, a case manager, a pharmacist, a rotational pharmacy resident and an assistant vice president. The team meets every week for a quick huddle, where they discuss what's working, what needs tweaking, and related concerns. The team decided to regularly meet with high-risk patients, which they defined as any patient with a LACE score of 10 or above.
The transitional care coach works with these high-risk patients to ensure they are educated regarding their care. The coach also helps them manage medications. Additionally, the pharmacist in the transitional care team visits high-risk patients to provide information during discharge.
Effects of the program
According to the latest data, the hospital reduced readmissions for the following procedures:
• Total hip or knee arthroplasty (reduced by 64.3 percent)
• Coronary artery bypass grafting (by 44.9 percent)
• Chronic obstructive pulmonary disease (by 23.1 percent)
• Pneumonia (by 6.6 percent)
Additionally, the hospital did not receive a COPD readmission penalty last year.
The hospital has also used data and Explorer Analytics to refine its transitional care program. Some enhancements include the addition of transitional care coaches, increased time with patients, automated processes and a sharper focus on readmissions from the first day a patient is admitted, to try and address any issues upfront. Cookeville Regional also hopes to have a transitional care coach on every floor in the future, so all disease states are addressed.
"We truly believe that having real-time data has truly made a difference in not only reducing our readmissions and improving our margins, but [also] being able to use this predictive analysis tool to better the community health in our areas," said Ms. Key.
To learn more about Change Healthcare click here. View the full webinar here, and access the presentation slides here.