Curbing Readmissions: Tricky Business, but URMC Named ‘Top Performer’

When it comes to the thorny problem of cutting hospital readmissions rates, a new report cites URMC as a top performer.

In early October, leaders from “Best Practices for Better Care”—a patient quality- and safety-improvement initiative quarterbacked by both the University HealthSystem Consortium and the Association of American Medical Colleges—reached out, asking URMC leaders to spill their secrets for success. The Best Practices initiative aligns 225 teaching hospitals and medical schools, aiming to do just what the name says: help participants implement best practices and create meaningful improvements in care.

Specifically, the UHC/AAMC initiative said URMC was a top performer in reducing 7-day readmissions, achieving a stunning 18 percent decline between the third quarter of 2011 and the first quarter of 2013. This 7-day metric is particularly important; as much as 40 percent of all 30-day readmissions (tracked doggedly by the Centers for Medicaid & Medicare Services, or CMS) typically occur in the first days after discharge. What’s more, literature suggests this precarious first week is more closely linked to factors within the hospital’s control—as compared to readmissions occurring in later weeks (CMS’s full 30-day metric).

Thanks to its solid improvement and outcomes, URMC will be one of a handful of organizations invited to participate in a Best Practices for Better Care case study, which illustrates promising improvement strategies and serves as a guide to peer hospitals.

Readmissions: Costly on Every Front

Avoidable readmissions are stressful for patients—not to mention expensive for hospitals, robbing them of revenue, reputation, and market share. By next October (2014), the Centers for Medicaid & Medicare Services will be withholding up to 3 percent of URMC’s total overall reimbursement payments, and only dispersing the money back to us if we keep readmission rates low. That means, come 2014, $3.6 million of Strong Memorial’s revenue will be at risk annually.

“The good news is that our efforts are bearing fruit,” said URMC Chief Quality Officer Bob Panzer, M.D. “This latest news from the Best Practices effort reinforces the value of our maintaining several broad-based interventions—including our Safe Transitions project, championed by Marc Berliant, Kelly Luther, and Anna Lambert.”

Since the first quarter of 2011, the three have led Strong Memorial’s “Safe Transitions” project, the hospital’s first large-scale attempt at systematically improving the discharge experience and cut readmission rates. Signature elements of the now- two-year-old program involve flagging “high-risk” patients (persons predisposed to readmission later on), providing them with “check-in” phone calls at home, and getting fast follow-up appointments on the books with their PCPs. The program has markedly improved care quality and specific facets of the discharge process (smoothing out information transfers between providers, or enriching patient education, for instance).

Of special note, another new readmissions-reduction effort—a new ‘virtual care unit’, also honchoed by Berliant—kicked off earlier this month. The effort virtually shepherds some of Rochester’s most vulnerable patients as they move into community- or home-care settings.

 

10/11/2013

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