Hospitals Devise Strategies to Tackle 30-Day Readmissions (Part 4 of 4)

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RA-thumb2Wrapping up our look at how healthcare organizations are confronting readmission rates, especially all-cause readmissions, we move to Mercy Health, where Cheryl Clark writes in the May 2013 issue of HealthLeaders magazine, “care transition teams target specific disease populations,” based on clinical and financial priorities with regards to Medicaid and self-pay patients in particular.

Margie Namie, RN, MPH, CPHQ, divisional vice president of quality, said, “These patients are such a cost burden to the system that it really makes financial and clinical sense to provide support for them because it drives cost out of the system that flows to the bottom line.”

Beginning in October 2012, they began zeroing in “on all-cause diagnoses, tailoring interventions to particular types of patients.” Namie believes that preventing readmissions can mean “doing something for patients that has nothing to do with their physical health but improves their mental outlook so that they work harder to stay out of the hospital.”

One patient had only a bed and no furniture, for example, so her nurse found a chair that allowed her to sit by a window and look at her garden.

Many of Mercy’s patients are illiterate “but had developed great skills at covering it up.” In other words, they couldn’t read the medication bottles given to them.

Clark writes, “Mercy Health worked with these patients to solve the problem by color-coding bottles in patients’ homes…Pills taken once a day were in bottles with one color while those taken twice daily were another color. Diuretic bottles were a third color, so when the physician advised a particular patient to take more diuretics, he would go to the correct container.”

The bottles are color-coded by a physician’s nurse when the patient is in the office, then a Mercy Health parish nurse visits the patient at home as part of follow-up. Adding social workers to the care team also helped, Lynne McCabe, director of the community care coordination program, said, since “the majority of our patients had some sort of financial or social behavioral issue.”

Furthermore, “Mercy Health’s care coordination teams now have a program in which nurses are stationed in physician offices, especially for patients with chronic pain, heart failure, COPD, or uncontrolled diabetes.”

These teams have targeted cholesterol, hemoglobin A1Cs, ACE inhibitor compliance, and smoking cessation.

Clark writes, “So far this effort has worked with about 300 patients who had a history of frequent readmissions. In the first year of the program, between June 1, 2011, to May 31, 2012, these patients had 51 percent fewer admissions, more than 35 percent fewer readmissions, and more than 35 percent fewer trips to the emergency department than the same group of patients had during the previous year. In addition, 12 percent of the patients had stopped smoking.”

“I think we’re probably a little sooner than the tipping point [on all-cause readmissions],” Namie said. “But I know there’s a high level of interest at other facilities. We get calls all the time from other healthcare systems asking us about what we’re doing.”

What are your thoughts on Mercy Health’s approach to reducing all-cause readmissions? How do you handle readmissions for individual members of your patient mix? Do you prioritize based on socioeconomic needs?

-by Pete Fernbaugh

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