Fitting the Pieces Together

1. Fitting the Pieces Together Utilizing a Hospitalist in the ED to Reduce Admissions Presented by: Patty Williamson, CFO Isidoros Vardaros, M.D.

2. Quincy Medical Group Multi-specialty medical group serving Quincy, IL and surrounding tri-state area 100 Physicians, 135 Total Providers All primary care physicians are Level 3 NCQA PCMH certified Blessing Hospital is independent and is not part of the UnityPoint system

3. Strategy = Triple Aim QMG’s strategic plan is the Triple Aim Focused on developing change agents within the organization 3 physician led committees • Quality – 5 physician led teams around diabetes, hypertension, COPD, osteoporosis, and CHF • Patient Satisfaction – providing transparent Press Ganey results with a goal of achieving the 90th percentile • Total Cost of Care – focused on reducing hospital admissions

4. 10 Initiatives After Hours Nurse Triage Phone Service via UnityPoint Home Health Care via UnityPoint at Home Expand ACC and/or Primary Care hours Expand Infusion Center and Imaging hours Hospitalist assessing patient in Emergency Room Use Nurse Care Coordinator Model – BCBS Int. Medical Home Discharge Nurses to ensure good transition to outpatient Nursing Home NP model of care Patient education about preferred access points Educate physicians on preferred ER referral process

5. Logistics of the Practice Located in the ER: Direct access to patient care before final admission or discharge is determined by ER physician Compare labs/notes from QMG’s record and hospital’s record to assess patient’s change in medical status

6. Logistics of the Practice Service for QMG Patients: Exclusively for QMG patients Direct patient toward the correct admitting physician or discharge to the primary care provider

7. Logistics of the Practice Ages Served: Discharge patients as young as 6 months old with appropriate follow up

8. Logistics of the Practice Identifying Patients: Blessing Hospital provides QMG census report Able to view QMG patients that are currently in the ED under “ED Status” Directly assess patients once the ER physician has completed their initial encounter

9. U-Turn to Appropriate Care Assess Patients with Status of: Inpatient Admission Observation Admission 30 Day Re-admission

10. U-Turn to Appropriate Care Observation Status: Does not meet inpatient criteria 30 Day Re-admission: Returns to ED less than 30 days from previous discharge Goal is to treat “observation” or “30 day re-admission” patients in the outpatient setting when appropriate

11. Improving Patient Care by… Educating Patients on Preferred Access Points: Scheduling appointments with specialists if warranted Ordering future lab studies or investigative procedure as an outpatient Scheduling PT / OT / Rehab / Home Health Care when appropriate

12. Improving Patient Care by… Redirecting Patients to Primary Care: Scheduling “same day” or “next day” appointments with PCP or specialist Leaving available time slots for future appointments

13. Improving Patient Care by… Scheduling Next Day Appointments: QMG schedule hotline Available during regular office hours to schedule appointments Available on-call during hospitalist work hours

14. Improving Patient Care by… Care Coordination with Primary Care Physician: Work closely with ED physician and relate any current outpatient labs / investigative procedures Document “ED encounter” in hospital’s record Document note in QMG’s record

15. Improving Patient Care by… Directly Admitting to Nursing Homes: Directly admit to NH when clinically indicated Communicate with ED physician and PCP if admission is appropriate Document initial encounter and provide initial NH admitting orders PCP to follow thereafter

16. Improving Patient Care by… Ordering Home Health, PT, OT, Etc.: Certain encounters have required new or continued orders for physical or occupational therapy Several encounters have given the opportunity for home health care referral

17. Barriers Encountered Initial resistance from hospital Heavy volume days Time delay for patients to show on census Unknown PCP status

18. Success Stories 88 year old female who is homebound 56 year old male with intractable back pain The “chest pain rule out” patient Educating new parents on appropriate ED visits

19. Results Acceptance by Emergency Department physicians QMG physician feedback Data

20. Results 145 patients have been assessed and not admitted • 74 patients discharged that would have been admitted • 71 patients assisted in discharge 20 average avoided admissions per month Average length of stay at Blessing Hospital is 3.6 days Average estimated cost savings of $2,160,000 annually

21. Questions?