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Tag Archives: readmissions

The Caregiver Act and AARP’s CARE Act Aim to Reduce Readmissions

Hospitals nationwide have gone to great lengths in an effort to reduce readmissions and improve patient quality. However, despite these concerted efforts, hospitals continue to incur fines from Medicare for excessive rates of patient readmissions, which are projected to total more than $428 million. Even worse, readmissions cost patients a collective $17 billion.

Eric Heil, RightCare

Eric Heil, RightCare

However, these numbers and rates are starting to drop thanks to new tools and programs, such as the Delivery System Reform Incentive Payment (DSRIP) Program. We’re also seeing new legislation being introduced in several states aimed at reducing readmissions by ensuring hospitals and their patients communicate better after they are discharged.

The Caregiver Act and AARP’s model state bill, called the Caregiver Advise, Record, Enable (CARE) Act, are examples of legislation currently being discussed in several states. Together, they have the potential to prevent hundreds of thousands of unnecessary hospital readmissions. Oklahoma was the first in the nation to pass legislation back in November 2014 and New Jersey followed suit later the same month.

The new laws would require hospitals to work directly with a patient’s caregiver (usually a family member) to ensure that necessary preparations are in place for the patient to successfully recover at home after being discharged. This process includes providing discharged patients and their caregivers with a clear path to follow for addressing medication, nutrition and living needs in-home.

To achieve this level of customized, high quality care, technology is essential to streamline the care coordination process and support the unique needs of patients. RightCare, a growing medical technology company, has an end-to-end software solution designed to assess patient risk and needs at the time of admission, ensure the most appropriate post-acute care plan is offered, and seamlessly transition patient information to post-acute care providers. RightCare’s software is based on 10 years of academic and clinical research and has helped hospitals nationwide optimize workflow, reduce length of stay times, reduce readmissions and ensure hospitals meet Medicare-mandated standards for preventable readmissions.

We’ve seen time and time again how effective post-care planning with providers, community organizations and technology can significantly decrease readmissions, so it’s encouraging to see these efforts are now supporting caregivers.

Readers: Are you a family caregiver? What are some of the challenges you face, and what tools are you using to help? Let us know in the comments.

Speaking With: Neil Smiley on the Advantages of Narrow Healthcare Networks

Editor’s Note: Narrow healthcare networks have evolved as health insurance companies attempt to control costs and manage care. Even though these systems limit participants’ choice of doctors and hospitals, they are serving to better align services with patient needs. Neil Smiley, CEO, Loopback Analytics shares his thoughts on why the number of narrow healthcare networks continues to increase.

RealWorldHealthCare: What is unique about these narrow healthcare networks that have increased over the past couple of years? What advantages do they bring to the healthcare landscape?

Neil Smiley, Loopback Analytics

Neil Smiley, Loopback Analytics

Neil Smiley: Healthcare reimbursement models are changing.  The traditional fee-for-service model incentivizes providers along the care continuum to maximize utilization of their services, not improve clinical outcomes or reduce total cost of care.  However, over the past couple of years, readmission penalties, bundled payments and ACOs are moving providers to collaborate with care partners across the continuum to ensure patient transitions are successful and the providers they refer their patients to are delivering high quality, cost effective care.  Narrow networks of highly collaborative, quality providers can improve care coordination, reduce fumbled handoffs and better align services with patient needs.

RWHC: How are these narrow networks being optimized to improve access to care and reduce the cost of care?

NS: You have to have good data to assemble and optimize a narrow network.  Narrow networks require high levels of collaboration between care partners.  Narrow network participants have to come together on standard quality and outcome measures, and create an effective feedback loop to target areas for improvement.

RWHC: The cost of hospital re-admissions is an increasing concern. What can be done to reduce hospital readmissions?

NS: There is no silver bullet.  There is a diverse set of reasons why patients readmit to the hospital.  Consequently, readmission reduction programs must be multifaceted.  A “one-size fits all” approach is prohibitively expensive and probably ineffective.  Data analytics can rank patients by risk of readmission and match them to right interventions at the right time to mitigate patient-specific risk factors that would otherwise lead to hospital readmissions.

RWHC: What is the “sweet spot” for big data analytics in terms of improving positive patient outcomes? Can you provide a real-world example of how data capture and analytics has improved patient outcomes?

NS: Big data analysis of real-time data can be used to proactively identify patients that are most vulnerable to having a bad outcome.  Data patterns can also flag patients that are likely (or unlikely) to benefit from a specific interventions.  For example, medication adherence problems are a major cause of hospital readmissions.  Big data can be used to analyze the history of prescription fill patterns, the number and complexity of medications and available clinical markers to proactively identify patients for pharmacist consultations.

RWHC: How is the role of community based organizations changing in terms of improving access to care, reducing the cost of care, providing for more patient-centered care, and generally improving patient outcomes?

NS: There is growing recognition that the root cause of what ultimately results in a hospitalization may begin with some simple unmet need out in the community. Patients may lack transportation to the doctor or need help in translating their care instructions in a language they understand.  There may be fall risks in their home or old prescriptions that should be thrown out to avoid a medication error.  Community-based organizations can engage patients in their home and address risk factors that would otherwise go undetected.  Hospital systems and payers are adding community-based organizations to their existing clinical interventions to provide more holistic, cost-effective, patient-centered care.

What advantages do you think narrow healthcare networks have? What about disadvantages? Let us know in the comments section.

Lowering Hospital Readmissions through Remote Monitoring of Post-Acute Patients: The University of Virginia Health System – Broad Axe Care Coordination Model

One of the less known policies of the Affordable Care Act, the Hospitals Readmission Reduction Program, requires that hospitals with higher than national average readmission rates for certain medical conditions and surgical procedures be penalized.  For many hospitals, the readmission penalties result in millions of dollars in profit lost.

David Sheon

David Sheon

A recent Wall Street Journal article shines a light on remote patient monitoring and post-acute care coordination, a service that is experiencing rapid growth and focusing on readmission rate reduction.  The service not only helps more people recover successfully from hospital stays, but it also keeps costs down for payers and helps hospitals avoid the risk of growing penalties.

According to an October 2014 article from Kaiser Health News, “Medicare is fining a record number of hospitals – 2,610 – for having too many patients return within a month for additional treatments, federal records released {recently} show. Even though the nation’s readmission rate is dropping, Medicare’s average fines will be higher, with 39 hospitals receiving the largest penalty allowed.”

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Leading manufacturers of remote-monitoring equipment include Medtronic Inc., Philips NV and St. Jude Medical Inc., according to the Wall Street Journal article. Sales are expected to total about $32 billion this year, with a compound annual growth rate of 9.2% between 2014 and 2019.

In addition to addressing readmissions, effective remote monitoring represents an outstanding care redesign technique that can be implemented as part of a CMS bundled payment initiative, or as part of the quality program of an accountable care organization or clinically integrated network. The benefits accrue well beyond avoiding the penalties.

“The remote monitoring technology and implementation drives revenue issues beyond the CMS readmission penalties,” said John Kirsner, Partner, Jones Day, an expert on the implications of the ACA on hospitals. “In addition to the penalty avoidance component, this technology can assist in creating shared savings that result in additional topline revenue enhancement.”

Some remote monitoring programs are further along than those mentioned in the Wall Street Journal article. For instance, over a year and half ago, Broad Axe Care Coordination and University of Virginia Health System (UVA) partnered to design and execute a comprehensive platform combining services and technology to reduce readmissions for key conditions where Medicare was imposing penalties, including heart attack, heart failure, pneumonia and COPD.  Because of the success of the program and Medicare’s expansion of the penalty conditions, Broad Axe expanded its service at UVA to remotely monitor patients who had total joint replacements as well. The result for UVA has been a dramatic decrease in joint readmission rates, and a ready for prime time remote monitoring/care coordination program that can be put into place at hospitals across the country.

The system, called C3 at UVA, is a remote care management platform that combines telehealth services from experienced clinicians with robust analytics and an IT platform integrated with the health system’s EMR to provide UVA with a fully-outsourced care coordination solution.

BACC_Image for blog_SM (1)“Broad Axe offered us something unique: a care coordination center that combines outstanding technology with dedicated clinicians — RNs, LPNs, and CNAs — to deliver ongoing care transition and care coordination services,” said Amy L. Tucker, MD, Associate Professor of Cardiovascular Medicine, University of Virginia Health System.  “We’ve seen a great impact on the readmission rate.”

UVA and Broad Axe work together to look closely at those patients who are readmitted to see if the program can be further optimized.

For example, C3 can track not only readmission but when patients have follow-up visits.  The system also can help to ascertain whether patients are following their medication instructions. This provides important feedback to see what areas of opportunity are most important for the health system to target to improve patient care.

Broad Axe executives are pleased with readmission rate performance between 25 and 45 percent below historical benchmarks, depending on the condition and payer population, and the associated penalty savings for the hospital.

“Historically, the adoption of remote monitoring technology has been stymied by the lack of financial incentives to use the technology,” said Scott Edelstein, also a Partner at Jones Day, specializing in regulated medical technologies. “Recent CMS initiatives such as the Hospital Readmissions Reduction Program and new reimbursement codes for remote chronic care management are fueling a renewed interest in this technology. This should create significant opportunities to increase access to, and quality of, care while lowering costs.”

Do you work in a hospital consider remote monitoring? What are your concerns? Or are you a recent patient who has participated in remote monitoring? www.RealWorldHealthCare.org welcomes your feedback.

Categories: Cost-Savings, General

(Medical) Home is Where the Care and Cost-Savings Are

The word “home” has many connotations: the building in which you live, the place you come from, and even the end point of a game. Now, there is a new type of home: The Patient-Centered Medical Home (PCMH).

Linda Barlow

Linda Barlow

PCMH is a model of primary care that is patient-centered, comprehensive, team-based, coordinated, accessible and focused on quality and safety. It has become a widely accepted – and cost-effective – model for how primary care should be organized and delivered, encouraging providers to give patients the right care in the right place, at the right time and in the manner that best suits their needs.

“The magnitude of savings depends on a range of factors, including program design, enrollment, payer, target population, and implementation phase,” explains Michelle Shaljian, MPA, Chief Strategy Officer of the Patient-Centered Primary Care Collaborative (PCPCC). “Most often, the medical home’s effect on lowering costs is attributed to reducing expensive, unnecessary hospital and emergency department utilization.”

When the Affordable Care Act (ACA) was signed into law in 2010, medical homes got a boost because of numerous provisions that increased primary care payments, expanded insurance coverage and invested in medical home pilots, among other programs.

The model has been adopted by more than 90 health plans, dozens of employers, 43 state Medicaid programs, numerous federal agencies, hundreds of safety net clinics and thousands of small and large clinical practices nationwide since then. Among the results:

  • In Michigan, Blue Cross Blue Shield – the nation’s largest PCMH designation program — saved an estimated $155 million in preventative claim costs over the first three years of implementation.
  • CareFirst Blue Cross Blue Shield in Maryland reported nearly $40 million savings in 2011 and a 4.2 percent average reduction in expected patient’s overall health care costs among 60 percent of practices participating for six or more months.
  • In New York, the Priority Community Healthcare Center Medicaid Program in Chemung County saved about $150,000 or 11 percent in the first nine months of implementation, reduced hospital spending by 27 percent and reduced ER spending by 35 percent.
  • In Pennsylvania, Pinnacle Health achieved a zero percent hospital readmission rate for PCMH patients versus a 10-20 percent readmission rate for non-PCMH patients.

The PCPCC is the leading national coalition dedicated to advancing PCMH. According to PCPCC, the medical home is an approach to the delivery of primary care that is:

  • Patient-centered: A partnership among practitioners, patients and their families ensures that decisions respect patients’ wants, needs and preference, and that patients have the education and support they need to make decisions and participate in their own care.
  • Comprehensive: A team of care providers is accountable for a patient’s physical and mental health needs, including prevention and wellness, acute care, and chronic care.
  • Coordinated: Care is organized across all elements of the broader health care system, including specialty care, hospitals, home health care, community services and supports.
  • Accessible: Patients access services with shorter wait times, “after hours” care, 24/7 electronic or telephone access, and strong communication through health IT innovations.
  • Committed to quality and safety: Clinicians and staff enhance quality improvement through the use of health IT and other tools to ensure that patients and families make informed decisions about their health.

According to Melinda Abrams, Vice President of Patient-Centered Primary Care Program at the Commonwealth Fund, to have the greatest impact, a medical home must be located at the center of a “medical neighborhood” inhabited by hospitals, specialty physicians, physical therapists, social workers, long-term care facilities, mental health professionals and other service providers. She notes that it is the role of the primary care provider to coordinate care and make sure that patients don’t slip through the cracks, or receive tests or procedures they’ve already had – a particular concern for patients who see multiple doctors.

The National Committee for Quality Assurance (NCQA) – a non-profit, independent group dedicated to improving health care quality – accredits and certifies a wide range of health care organizations and is the leading national group that recognizes PCMH with the most widely adopted model. Currently, there are almost 5,000 NCQA Recognized PCMHs across the country.

Other organizations with PCMH recognition programs include Accreditation Association for Ambulatory Health Care, Inc. (AAAHC), the Joint Commission, and URACVideos from the American Association of Family Physicians (AAFP) feature family physicians who discuss practice redesign aimed at lowering costs, maximizing staff expertise and improving patient care.

“Practices seeking to initiate a patient-centered medical home will find that an assessment process is very helpful to understand where they are,” said Shaljian. “Some practices have electronic health records, a very strong history of team-based care, and strong connections with specialists, hospitals, and other stakeholders in the community, while others do not. Some are deeply affected by an internal culture of quality improvement, which makes a huge difference in how successful some medical homes are.”

Want to learn more about PCMH? Visit the U.S. Department of Health & Human Services’ Agency for Healthcare Research and Quality content-rich Resource Center.

How can health care continue to move the nation to PCMH? And how can the model tackle its number-one challenge: the current fee-for-service payment system?

Walgreens Unveils Solutions to Boost Medication Adherence

How can health professionals enable their patients to take medications more consistently as prescribed?

Personalized counseling from pharmacists and prescription refill reminders are two effective ways now shown to fuel better drug adherence, according to research from Walgreens presented March 15 at the World Congress Summit in Philadelphia.

Walgreens’ community pharmacy programs – in addition to successful intervention models – are equipping patients with powerful tools to self-manage their health.

One finding, for example, revealed that individuals receiving in-person counseling from their pharmacist saw 7.2 percent higher adherence than those with more conventional pharmacy care. Meanwhile, one of Walgreens’ pilot programs demonstrated that patients who receive prescription refill reminders (also called automated refill reminders or ARR) are more likely to consistently take medications for chronic conditions.

“In order to improve medication adherence among patients, providers need to understand the key challenges and contributors to non-adherence, and how to address them,” said Jim Cohn, Walgreen Co. spokesperson. “The research findings demonstrate how programs at the community pharmacy level designed to target common barriers to adherence, such as the challenge of learning a new medication therapy or simple forgetfulness, can significantly improve patient health and outcomes.  Ultimately, these types of pharmacy initiatives can help providers do their part to ensure more people get, stay and live well.”

Walgreens isn’t alone in recommending evidence-based approaches to enhance adherence outcomes. The Medication Adherence Project’s (MAP) 2010 Training Package also offers strategies for both providers and pharmacists that stress individualized patient engagement, with solutions that include writing 90-day instead of 30-day prescriptions, prescribing generics, communicating directly with providers, and more.

Securing increased medication adherence will not only go far in helping patients live longer and healthier, but will deliver considerable savings for the health care system too.

How do we know? Underscoring the benefits of adherence, MAP cites “lower disease-related medical costs” for diabetes and hypercholesterolemia in addition to related “reductions in health care costs.”

The New England Health Institute (NEHI) also provides compelling evidence in its October 2012 Issue Brief that reducing medication non-adherence, which contributes to hospital readmissions, helps lower hospitalizations and saves on associated expenses, noting: “One study found that one-third of adverse drug events resulting in a hospital admission were related to non-adherence. The aggregate cost of hospital admissions related to medication adherence has been estimated to be roughly $100 billion per year and estimates of the share of hospital admissions related to non-adherence are as high as 10 percent.”

Successful strategies generating increased medication adherence are clearly worth pursuing and replicating, both to strengthen the quality of health services and to lower the cost of care.

Now we want to hear from you. As a medical professional, what approaches do you incorporate to encourage patients to properly take their meds? If you’re a patient, what has worked for you?

Making Costly – and Deadly – Medical Errors and Unnecessary Hospital Visits Something Only Grandparents Can Remember

“She died from a breakdown in the system. She died from a breakdown in communications.”

These heartbreaking words, from patient safety advocate Sorrel King about the loss of her young daughter Josie King, are words that no one should ever have to say or hear.

Her 10-year commitment to end hospital errors led to a $1 billion war on errors, funded through the Affordable Care Act.  The resulting Partnership for Patients program has already signed up more than 8,000 partners – including organizations and individual medical care providers – in a shared effort to save thousands of lives, prevent millions of injuries and take important steps toward a more dependable and affordable health care system.  According to the Centers for Medicare and Medicaid Services (CMS), the participants include:

  • Hospitals and national organizations representing physicians, nurses and other frontline health care and social services providers committed to improving their care processes and systems, and enhancing communication and coordination to reduce complication for patients.
  • Patient and consumer organizations committed to raising public awareness and developing information, tools and resources to help patients and families effectively engage with their providers and avoid preventable complications.
  • Employers and States committed to providing the incentives and support that will enable clinicians and hospitals to deliver high-quality health care to their patients, with minimal burdens.

In the April 2011 announcement launching the program, Health and Human Services Secretary Kathleen Sebelius shared two goals of the Partnership for Patients:

  1. To reduce preventable injuries in hospitals by 40 percent by the end of 2013, preventing 1.8 million injuries and saving 60,000 lives.
  2. To cut hospital readmissions by 20 percent, saving 1.6 million patient complications that force them to return to the hospital.  Achieving this goal by the end of this year would mean more than 1.6 million patients will recover from illness without suffering a preventable complication requiring re-hospitalization within 30 days of discharge.

{For a video of Ms. King explaining her work and Secretary Sebelius announcing the Partnership for Patients program, please click here.}

According to CMS, a recent study by the Office of the Inspector General (OIG) (PDF) found that 13.5% of hospitalized Medicare beneficiaries experience adverse events resulting in prolonged hospital stay, permanent harm, life-sustaining intervention, or death. Almost half of those events are considered preventable.

A recent article in the Journal of the American Medical Association showed that specific community-wide quality improvement activities are proven to reduce hospital readmissions.

Do you want to find providers and hospitals near you who have signed the pledge? It’s as easy as clicking here.

Do you want to learn more about the specifics of what actions will be taken to reduce accidents and re-admittance, and the studies conducted to determine the solutions?  Check out Altarum Institute’s blog post on the topic.