The Shift From Hand-Off to Hand-Over: How University of Iowa is Lowering Readmissions

Readmissions are a real challenge; in 2013, a full two-thirds of hospitals were penalized for readmissions, missing out on as much as 2 percent of Medicare payments. Financial penalties will only increase for the unprepared, with fiscal year 2015's 3 percent penalty coming down the pipe.

"The opening ante is that hospitals are bearing the risk now more than ever," says Wayne Sensor, CEO of care transitions improvement company Ensocare. "Part of the challenge is financial in nature, and part is clinical. Smooth transitions in care create better outcomes and experience, and in the [hospital] industry this affects dollars," he adds. Lately, Ensocare has been working with the Iowa City-based University of Iowa Hospitals and Clinics to automate transitions and implement post-acute discharge solutions to reduce hospital readmissions.

UIHC's readmissions strategy

Joshua Brewster, UIHC's director of social services, says the hospital is engaged in tackling the readmissions program from a holistic standpoint, focusing on what happens after the patient leaves the hospital. "We're changing the paradigm from a hand-off to a hand-over of care [with the patient]," he says. "We are less often taking the attitude that we have a resource a patient wants, and more often demonstrating we're on equal footing with the patient. For lots of patients, post-acute care is just part of one big episode in care," he says.

The hospital's quest to help inpatients leave sooner and make sure they don't come back unnecessarily is taking on two distinct parts. First, staff members conduct a proactive identification of at-risk patients as soon as patients are admitted. To supplement the effort, staff members are undergoing education to ask about, recognize and input these factors into electronic health records.

UIHC is also strengthening its partnerships with local post-acute care providers, which is where Ensocare comes in. The company offers a software solution connecting acute and post-acute care providers based on patient preferences, parameters for a patient's care and bed availability. In some cases, providers and post-acute care providers can decide whether a patient is suitable for a particular post-acute care facility in 30 minutes or less. The data on high-risk patients in addition to the Ensocare solution has improved communication, reduced medication mistakes and helped patients feel secure in transition at UIHC, according to Mr. Brewster.

"As we identify what's after the hospital, we engage post-acute care providers in which the patient has shown interest, getting them information early about the patient's care and medical needs. We have been mindful about creating a dialogue in this with our community partners," says Mr. Brewster.

Collaboration equates to lower penalties

At the moment, the project is a team effort, involving social work staff, hospital leadership, care navigators and physicians and nurses on the front lines of patient care. The teamwork has paid off. After a 0.6 percent readmissions penalty for fiscal year 2013, UIHC has lowered its penalties to 0.3 percent for fiscal year 2014.

"Some other hospitals solve these challenges through buying post-acute providers," says Mr. Sensor. "Owning a downstream network doesn't get to the root of how hospitals coordinate across care settings. Beefing up care management staff and making regular phone calls is another strategy. It's admirable, but it may not be focusing on where the real risks for readmission and poor outcomes exist," he adds.

Mr. Brewster agrees. "It's about perspective," he says. "Readmissions is a barometer of how [UIHC] is doing, but we also want to make sure we're doing what needs to be done to help our community partners. And of course we're reducing readmissions because it's the right thing to do for our patients."

More Articles on Quality:

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UPMC Sees Improved Readmissions Rates From Telemedicine


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