READMISSION MANAGEMENT Jacquelyn Paynter , RN, MPH, CCM Executive Director of Care Management

1. READMISSION MANAGEMENTJacquelyn Paynter, RN, MPH, CCMExecutive Director of Care Management

2. Burden of Readmissions How big is the problem?

3. The Top 15 DRG drivers of readmissions at Dekalb Medical are Heart Failure, Renal Failure, Psychosis, Sepsis, COPD, Pneumonia, Respiratory Failure, Red Blood Cell Disorders, GIB, UTI,and Diabetes. These patient populations represent 33% (ND) and 48%(HD) of the overall readmission volume with an average readmission rate of 15.5%. • According to an IHI sponsored demonstration project, the key drivers of unplanned readmissions were driven by health care delivery system failures in 4 key areas: • ENHANCED ADMISSION ASSESSMENT • Patient and family caregiver education • Handover communication • DISCHARGE PLANNING • COMMUNITY CONNECTION • Beginning October 1, 2012 (Federal Fiscal Year 2013), the Patient Protection and Affordable Care Act (PPACA) statute will penalize hospitals and integrated delivery systems with higher than expected readmission rates. Readmission Management Imperatives

4. CMS Hospital Compare FFY13 Pay for Performance Period: 7/1/08-6/30/11 Readmission Achievement • Implemented heart failure focused care coordination • Structured systematic readmission risk assessment • Processes to identify ED and inpatient recidivist populations • Expanded ED social work coverage and scope • Bedside Rx delivery • Post-discharge phone calls • Diagnosis based ZONES discharge education

5. Medicare All Cause All Hospital Readmission TrendFFY12 Q1 PEPPER Report – North Decatur

6. Medicare All Cause All Hospital Readmission TrendFFY12 Q1 PEPPER Report – North Decatur

7. Medicare All Cause All Hospital Readmission TrendFFY12 Q1 PEPPER Report - Hillandale

8. Medicare All Cause All Hospital Readmission TrendFFY12 Q1 PEPPER Report - Hillandale

9. Multidisciplinary Collaborative Care Coordination Program What did we do?

10. Implementation of the 5 Care Transition Pillarsat DekalbMedical

11. CARE TRANSITION FOCUSDISCHARGE PROCESS Implemented Walgreens Bedside Rx Delivery • ND Campus (May 2011) • Hillandale Campus(January 2012) Key Functions • Ensures patient receives the medication upon discharge • Supports patient satisfaction with discharge experience • Pharmacy consultation provided, if needed • Caregiver included in consult • Reaffirms understanding of medication while patient still in healthcare system • Immediate start of therapy on discharge • 15-30 minute turn-around time • Provides 30-day supply of medications • Ability to refill at any pharmacy of patients choice • Follow-up phone call from clinical pharmacist within 72 hours of discharge

12. Methods & Results How well did we do it?

13. CARE TRANSITION FOCUSDISCHARGE PROCESS Dekalb Medical is among the highest volume Bedside Delivery programs in the U.S. Walgreens Bedside RX Delivery Results at Dekalb Medical

14. Results • Submitted study to Dekalb’s institutional review board (IRB) • Approved on April 25, 2012 (DM Protocol #040512) • Retrospective cohort • Census of all discharges (all payors) • Controls from • Hospital’s historic data (a type of retrospective cohort study) • Contemporaneous matches from non-participating facility (i.e., Hillandale campus compared to North Decatur campus) • Multiple logistic regression, controlling for demographic and clinical variables

15. Descriptive Statistics 30 Readmission Rates are comparatively lower for Bedside Rx patients

16. Adjusted risk of readmission The lower readmission rate for Bedside Rx patients is statistically significant

17. Care Coordination Enhancement Opportunities • Facilitate PCP identification/referrals/appointments • Accurate medical history and medication reconciliation • Provide structured patient/family education • Establish nurse navigator/coach programs • Implement ED Case Management 7 day/wk 11a-11p • Provide transitional care clinic for P4P readmission discharges • Strengthen systematic handover communication between care providers • Further enhance use of Care Transition Home Health Visits and 30 day Post Discharge Medication Management

18. DISCUSSION