REDUCING READMISSIONS FOR CHF PATIENTS

4. REDUCING READMISSIONS FOR CHF PATIENTS DO DIETITIANS HAVE A ROLE? Renee Wing, Sodexo Dietetic Intern Orange Park Medical Center January 22, 2013

5. AGENDA Highlights of the legislation Statistics Interventions Dietitians’ role

6. WHY NOW? • Section 3025 of the Affordable Care Act - Readmission Reduction Program. • Starting October 1, 2012, payments to hospitals exceeding a formulated readmission ratio will be reduced. • Up to 1% in 2013 – Estimated savings of $300 million • Up to 2% in 2014 • Up to 3% in 2015

7. CURRENT RULE Discharge diagnoses of CHF, AMI, and Pneumonia are used as measures to evaluate readmissions. Additional discharges to be considered include: COPD, CABG, PTCA, and other vascular surgeries. To be reviewed in 2015.

8. WHAT COUNTS? Readmission – admission to a hospital within 30 days of discharge from the same or other hospital. Readmission does NOT need to be for the same condition or a related condition.

9. EXCLUSIONS Transfer to another acute care facility. Planned readmissions. Same day readmissions for the same condition. Discharged against medical advice. Patient without at least 30 days of post-discharge enrollment in FFS Medicare Maryland

10. CHF STATISTICS http://www.cdc.gov/DHDSP/data_statistics/fact_sheets/fs_heart_failure.htm 1 million hospitalizations in 2010 Costs $34 billion annually Among the conditions associated with 30% of preventable readmissions. Highest volume and expenditure (along with pneumonia)

11. CHF STATISTICS

12. CHF STATISTICS http://www.hospitalcompare.hhs.gov/details.aspx?msrCd=prnt3grp1&ID=100226&stCd=FL&stName=FLORIDA National average readmission rate for CHF is 24.7%

13. OPMC http://www.medicare.gov/hospitalcompare/profile.aspx#vwgrph=1&profTab=3&ID=100226&state=FL&lat=0&lng=0&name=orange%20park

14. LOCAL COMPARISON *Based on calculation which combines data on CHF, AMI, PNA

15. WHAT CAUSES READMISSIONS? http://www.capanet.org/uploadedFiles/Content/Conferences/2012_Handouts/1006-1600_Kersh-CausesOf30DayHospReadmissionInHeartFailurePatients.pdf Factors beyond anyone’s control Disease Specific Factors Patient Factors Physician Factor System Factors

16. WHAT CAUSES READMISSIONS?

17. WHAT CAUSES READMISSIONS? Nassar AI, Hasaneen AG, Alshikha MA, Enany BE (2012) Three Months Morbidity and Mortality of Newly Diagnosed Systolic Heart Failure Patients after their First Admission. J Clinic Experiment Cardiol 3:183. doi:10.4172/2155- 9880.1000183

18. WHAT CAN BE DONE?

19. INTERVENTIONS http://ah.cms-plus.com/files/STAAR_A_Compendium_of_Promising_Interventions.pdf • Enhanced transitional care • Education and self-management • Multi-disciplinary team

20. PROJECT RED 12 Steps: • Assess language need • Make follow-up appointments • Pending labs • Post d/c services and equipment • Medication plan • Develop d/c plan • Teach d/c plan • Education • Assess understanding • How to manage a problem • Transmit d/c summary • Telephone reinforcement https://www.bu.edu/fammed/projectred/publications.html

21. CARE TRANSTIONS INTERVENTION http://www.caretransitions.org/

22. TRANSITIONAL CARE MODEL http://www.transitionalcare.info/

23. RECENT STUDIES • Multidisciplinary Outpatient Management • Team includes a dietitian • Follow-up individualized • Significantly lower readmissions in intervention group • Tele-monitoring • Daily calls to automated system • Answers would trigger “red flags” to clinician who would then contact patient • No significant difference in readmissions

24. WAYS WE CAN HELP • Nutrition and Healthy Aging in the Community – IOM workshop held in 2011 • Include nutrition assessment goals in d/c plan • Improve integration of hospital and post-d/c care • AND Recommendations • MNT – initial visit of at least 45 minutes with 1-3 follow-up visits of at least 30 minutes. • CHF patients shown to reduce sodium and fluid intake and improve quality of life

25. DISCUSSION Do dietitians have a role in the efforts to reduce readmissions? What implications does this have for the RD’s role in the hospital? What do you think about the transitional care strategies?