improving the quality of care: reducing readmissions
DESCRIPTION
Presentation by Bonnie Britton, MSN, RN, ATAF Telehealth Program Administrator, Vidant Health and Seth VanEssendelft, Vice-President for Financial Services, Vidant Medical CenterTRANSCRIPT
MATRC 2nd Annual SummitMarch18, 2013
Improving The Quality of Care:
Reducing Readmissions
Bonnie Britton, MSN, ATAF Vidant Health Telehealth Administrator
Seth Van Essendelft, MBAVice President, Financial Services Vidant Medical Center
Today’s talk involves…… Examining the “Boomerang Effect”
Discussing financial implications for Telehealth
Discussing Vidant Health’s Telehealth Program and outcomes
Questions and Answers
2
Who is in the audience?
3
Chronic Illness & the “Boomerang Effect”
4
Mr. Doe’s Hospital Admission 81 y.o: CVD, HF, DM, Arthritis Exacerbation of Heart Failure
◦ Not following his diet
◦ Not taking all of his medications (8 meds)
◦ Not keeping PCP visits
◦ Low engagement level
8 HF ER visits and 6 hospitalizations < 12 mos.
5
Mr. Doe prepares for Discharge Told he will be d/c home tomorrow
PCP not alerted that Mr. Doe was hospitalized
Given new prescriptions
Told to schedule a PCP appt. in the next month
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Educating Mr. Doe at Discharge
Patient education:
◦ Smoking cessation
◦ Diabetes care
◦ Nutrition and cooking advice to him and his wife
◦ Must take BP meds even if he feels fine
◦ How to take his diuretics
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Mr. Doe’s First Day Home Forgets most of what was told to him @ D/C
Can’t remember much/feeling OK-
Not consistently compliant with diet, medication
Doesn’t make PCP appointment
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The Boomerang Effect Patient issues
◦ Don’t understand their medications
◦ Don’t understand how to follow prescribed diet
◦ Can’t afford their medications
◦ Can’t afford foods to follow their diet
◦ Low engagement level
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The Boomerang Effect Hospital issues:
◦ Focus: inside walls of the hospital◦ Post d/c service focus: HH & LTC ◦ Incorrect or absent medication reconciliation◦ Extremely limited system of care transitions◦ Brief & fragmented patient education◦ PCP not contacted during hospitalization◦ Fragmented communication between
clinics/specialists/hospital◦ Dictate to patients vs. engage them in their care
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Vidant Health
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Vidant Health’s Mission:
To enhance the quality of life for the people and communities we serve, touch and support.
Discharge Options
Portfolio of Tools
Patient Hospital
Physician/Home
SNF
Home Health
Hospice
Palliative Care
Remote Monitoring
LTAC
Rehab
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What if . . .
Remote Monitoring
DoctorPatient
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Telehealth Can Alter the Path
Telehealth Intervention
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Health System Strategies Expand access to care Improve healthcare value Continuum of care Best utilize capacity Connect with local employers Improve physician network Improve employer health plan cost position Develop care models of the future
Reimbursement
Reform penalties
Capacity utilization
It is all relative
Challenges
17
Overview and process
Expectations
Lessons learned◦ Adaptation varied◦ Operational details ◦ Length of monitoring assumptions◦ Data requirements◦ Keep the big picture in focus
Business Case
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Stop Bonnie from beating on my door!
Pilot enhanced continuity of care model
Capture & quantify financial levers
Financial Goals and Objectives
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Telehealth
Back tothe Future
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Driving the Telehealth Bus!
Hey Norton - you will get out of your telehealth program exactly what you
put into it!
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Diagnostic
Transitions
In Care
Friends & Family
September 2012
Chronic Disease Mgt.
VH Telehealth Conceptual Model
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Transitions in Care Goals Access to Telehealth and care management
for hi-risk hi-cost patients
Reduce 30-day readmissions, hospital bed days and ER visits
Improve clinical outcomes
Improve the patient’s perception of care
Improve quality of health information
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Transitions in Care Services Population: In-patient CVD and Pulmonary
patients PAM Level I & II Frequent ER
visits/hospitalizations Medicare/self pay/un/underinsured
Services: In-home medication reconciliationHome Safety AssessmentDaily Biometric data monitoringWeekly telephonic assessment,
education, coaching
LOS: 3 months
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Chronic Disease Management Goals
Access to Telehealth and care coordination for hi & medium-risk VMG patients
Increase patient access to care Improve quality of health information and
communication between hospital- home – PCP Improve clinical outcomes Improve the patient’s perception of care Reduce health care costs
Chronic Disease Management Services
Population: Clinic based patients
PAM Level I & II – VMG PatientsPAM Level III with frequent
ED/hospitalizationsTransfer from Transition in Care Program monitoring
Services: In-home medication reconciliationHome Safety AssessmentDaily Biometric data monitoringDaily telephonic assessment, education, coaching as neededBi-weekly assessment, education, coaching
LOS: 6 months
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VH Telehealth Family & Friends
Population: Graduates of TH TIC, TH CDM
VH EmployeesContracted Services (Nash,
BasisHealth)
Services: Self management monitoringBiometric data monitoringFee for service
LOS: TBD
Clinical Data◦LDL, BP, Pulse, Height, Weight, HgA1c,
oxygen saturation
Patient Satisfaction
Financial Outcomes- 90 days pre TH, during TH, 30 days post TH◦Hospitalizations◦Bed Days
Metrics
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Demographics – Primary Insurance
56%
12%
10%
22%
(N=926)
Medicare
Medicaid
No Insurance/Self
Commerical
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Demographics – Patient Gender
44%
56%
(N=926)
Male
Female
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Demographics – Patient Diagnosis
54%
33%
4%
3%2% 1% 3%
(N= 926)
HTN HF
COPD CHF/HTN
Asthma Asthma/ HTN
HF/HTN
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13%
19%
24%23%
18%
3%
(N=926)
18-49 50-59 60-69 70-79 80-89 90-99
Demographics – Patient Age
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Average Time Utilizing Remote Monitoring Services
2%9%
18%
28%
34%
10%
< 30 days 30 days 60 days 90 days current > 90 days
(N =926)
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Patient Satisfaction Surveys
56%
43%1%
STRONGLY AGREE AGREE DISAGREE
(N=325)
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Hospitalizations
Reductions Of Hospitalizations0
100
200
300
400
500
600
700
800
900
772
257
143
Total Patients (N=695)Discharge Patients (N=544)
90 Days PriorDuring30 Days Post
• Decreased by 69% Prior to During
• Decreased by 76% Prior to Post
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36
Hospital Bed Days
Hospital Bed Days0
500
1,000
1,500
2,000
2,500
3,000
3,500
4,000
3,458
1,124
753
Total Patients (N=695)Discharged Patients (N=544)
90 Days PriorDuring30 Days Post
Decreased by 67% Prior to During
Decreased by 81% Prior to Post
Hospital Cost and ReimbursementTotal Patients approximately 700
Hospitalization Costs -
1,000,000.0
2,000,000.0
3,000,000.0
4,000,000.0
5,000,000.0
6,000,000.0
7,000,000.0
8,000,000.0
90 Days Prior During 30 Days Post
Reimbursement -
1,000,000.0
2,000,000.0
3,000,000.0
4,000,000.0
5,000,000.0
6,000,000.0
7,000,000.0
8,000,000.0
90 Days Prior During 30 Days Post
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Financial Benefits – Total Healthcare
Lower hospitalization cost Readmission aversion
More effective and efficient care
Improved access to care at the appropriate levels
Greater patient satisfaction
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Financial Benefits – Hospital System
Reduces readmissions penalties exposure Capacity – increasing CMI & fewer lost
admissions Expands margins Reduces bad debt losses Improved discharge planning process Reduces employer health plan costs Creates value proposition Created retail opportunities
Mr. Doe readmitted to Hospital with HF
At Hospital Discharge:
◦ D/C with the same medications & education
◦ Cardiologist & hospitalist make referral to TH
◦ TH referral received by Telehealth Team
◦ In-hospital enrollment
◦ PCP visit appt. made
◦ Home visit appt. made
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Mr. Doe’s First Day with RPM Patient conducts reading. Wt. increased by 2
lbs.
TH RN calls patient to review medication and diet compliance
See - Feel Change
TH RN provides nutrition counseling
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Mr. Doe’s Fourth Day with RPM
Objective data:
◦ Wt. increased by 4 pounds
◦ O2 sat. decreased to 92%
◦ BP slightly elevated @ 145/90
Subjective data:
◦ Reporting SOB and ankle edema
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Mr. Doe’s Fourth Day with RPM Actions
◦ TH RN calls patient, conducts health assessment and provides education
◦ Discovers patient ate Country Ham last night
◦ Didn’t take his Lasix because he had no money
◦ See - Feel Change
◦ TH RN contacts PCP
◦ PCP instructs pt. to come to clinic today
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Take Home Points Conducting in-home med. rec. & providing
RPM services result in:
◦ Early identification and tx of disease exacerbation
◦ Reduced hospitalizations
◦ Reduced bed days
◦ Reduced ER visits
◦ Reduced health care costs
◦ Ending the Boomerang Effect
◦ Active engaged patients
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Questions and Answers
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Bonnie Britton, RN, MSN, ATAFTelehealth AdministratorVidant [email protected]
Seth Van EssendelftVice President Financial Services Vidant Medical [email protected]
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