Successful Collaborations Between Respite Programs and Hospital Partners

1. Recuperation Care Program 2008 HCH Conference Respite Care Provider’s NetworkJune 11, 2008Phoenix, AZ

2. Successful Collaborations Between Respite Programs and Hospital Partners Toni Propotnik, MN, RN, CMACDivision Director, Care Management & Psychiatric Nursing Ted Amann, MPH, RN - Director of Healthcare and Improvement Corey Padron, EMT-B - Manager, RCP

3. Hospitals & Respite Care • Why collaborate? • How to begin collaborating? • Why would hospitals support respite? • What do hospitals want? • What to do and what not to do in proposing a program to a hospital partner • How to sustain the collaboration?

4. OHSU Healthcare at a Glance Licensed Beds: 560 Occupancy Rate: 84 percent Average Length of Stay: 5.3 days Case Mix Index : 1.8 Hospital Stays: 29,000 (total hospital discharges) Emergency Department Visits: 36,000 Specialty Children’s Hospital Level I Trauma Center Level III NICU Transplant Programs – Solid organs to BMT

5. Commitment to care for the Underserved “Adapting to the changing fiscal and healthcare landscape while maintaining essential social benefits requires foresight, innovation, and new sources of revenue. Together, OHSU, the state, the broader health care community, insurers, and patients must craft solutions that are financially viable and compassionate so that medically underserved populations, including rural communities, receive adequate healthcare now and far into the future.”

6. OHSU as a Resource for Care OHSU cares for a disproportionate share of people with Medicaid or Oregon Health Plan coverage that pays providers less than the cost of health care. OHSU cares for the state’s most vulnerable citizens; it serves individuals with cultural and language barriers, people who can’t afford care, and the most seriously ill. One-third of OSHU’S hospitalized patients are unable to afford their care In 2007, OHSU sustained uncompensated costs totaling about $53 million to provide health care to people who could not pay.

7. About Central City Concern (CCC) • Formed in 1979 • Operates continuum of affordable housing integrated with healthcare, addictions treatment, recovery support, and employment services • Over 15,000 low-income and homeless individuals access services annually • 501(c)3 Non-profit • $28 million annual budget • 450 employees 8NW8 Residents in the community room

8. The Collaboration of RCP and OHSU • The RCP began with a meeting between Central City Concern and OHSU • Acknowledgement that we have clients in common who are high utilizers of ER; with considerably longer inpatient stays due to living on the streets. • These factors contribute to higher hospital expenses and difficulty with coordination of patient care and follow up.

9. How to begin? • Reach out and make contact • Case Management (usually a RN/CM or CSW) • ED CM or RN Manager • Other options: Patient Advocate, Chaplain, Psych • Find out the hospital’s needs and concerns • Offer another discharge “option” • Examine how your program can address those needs and concerns • You are selling them a product, so make a product they will want to buy

10. What does OHSU Care Management need? Challenges: • Maintain Low LOS • Ensure patient flow/capacity management/through-put • Ensure cost effective, quality care Staff: • RN Case Managers, Social Workers, Clinical Nurse Specialists Care Management Functions: • Utilization Review • Discharge Planning • Social Services • Outcomes (Clinical & Financial) • Resource Management

11. Targeting Long LOS cases 2004 Top Reasons for “avoidable days” • Inadequate / no funding for post hospitalization ongoing care needs • Very complex placements (ventilator care, bariatric and wound care) • Inadequate patient support at home • Homelessness

12. How to make a proposal • Do your homework first • Find the win-win • You don’t need to have identical goals; agree on systems & processes that achieve multiple goals • Your primary care engagement is their decreased ED usage • Your housing placement is their decreased inpatient recidivism • Speak the same language • To a hospital “rooms”/“units”/“apartments” = “beds” • A hospitals primary focus is medical

13. Making your pitch:Why would hospitals support respite? • Shorter length of stay for patients • You can sell an early discharge service • They can fill that bed with an insured patient • Less inpatient recidivism • Stabilizing the client both medically and socially decreases the likelihood of repeat admits • Less unnecessary ED utilization • Primary care engagement • Client education on how to use the healthcare system

14. What not to do • Don’t design a program in a vacuum and expect a hospital to pay for it • Don’t sell beds, sell referrals or intakes • Don’t create a program that sounds good but doesn’t actually meet hospital needs • Ease of referral • Timeliness of response • Feedback • Don’t assume the moral high ground • Hospitals do a lot of charity care & community benefit • Don’t expect to get without giving

15. How to sustain the relationship • Communicate, communicate, communicate • Check in with the people “on the ground” and “at the top” • How well does it work for the people who actually make the referrals? • Respond to their concerns – don’t be rigid • Share your concerns – don’t fester • Provide timely data

16. Case study – Mr. F • attacked by 2 people & pit-bull • required facial reconstructive surgery • homeless for over 10 years; no job; no insurance; no family; no primary care • D/C planner calls RCP; same day eval; next day intake to RCP • Hospital provides 30 d Rx & specialist appts • RCP provides housing, meals, primary care, transportation, case management, access to CCC continuum of care • Today: housed, healthy, clean & sober

17. Outcomes - RCP In the last year, RCP patients resolved 83% of their acute medical issues and 59% of RCP patients left to Stable Housing (23% of which includes permanent)

18. OHSU pilot projects Catastrophic Financial Case Management Pilot program to develop new projects to increase discharge options • Community partnership for skilled nursing placement of complex care patients • Recuperation Care Program • Salvation Army Infirmary

19. Outcomes - OHSU RCP is the most successful program to date • “Homelessness” is now off the list as a barrier • 2005: 18 cases / 6mo. • 2008: 30 cases / 6 mo. • 3 year OHSU costs $570,0000 • 3 year OHSU savings (cost avoidance and back fill ) $3.4 M + • 13 day reduction in Length of Stay for a sampling of 10 OHSU patients referred to RCP • Outcome: patient centered care across the continuum