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Reducing Hospital Readmissions

PHAD 863 Project 2
by

Michelle Tharp

on 28 December 2012

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Transcript of Reducing Hospital Readmissions

Place your own picture
behind this frame! Double click to crop it if necessary San Francisco Budapest (cc) photo by Metro Centric on Flickr (cc) photo by Franco Folini on Flickr (cc) photo by jimmyharris on Flickr Stockholm (cc) photo by Metro Centric on Flickr outlook Pharmacists' Role in Reducing Readmissions Action Plan: Marketing & Action Plan Our program is based on cost-savings since our hospital has 150% increase in readmission rates
By reducing our readmission rates to the national averages, we can save $2,166,715 per year, based on reimbursements lost from Medicare patients Financial Analysis Documentation of services by pharmacists

Continually monitor readmission rates and patient satisfaction (survey)

Evaluate efficacy and fiscal sustainability at 1 year
If success: consider expansion of services
If failure: reevaluate staffing Outcomes Assessment Background -The Pharmacist Discharge Counseling and Follow-Up Program

-Counseling is required for patients with COPD, pneumonia, CHF, and myocardial infarction.

-Pharmacists and trained pharmacy students will:
Compare admission and discharge medications
Counsel patients on disease state(s) and medications
Give patients their own personalized medication info sheet
Conduct follow-up phone calls within 3-5 days
Document any findings in the patient chart during this whole process Program Description Environmental Analysis SWOT Analysis Plenty of available staff for new positions or extra job responsibilities
100 full-time pharmacists
110 full-time technicians
160 pharmacy student hours each month
Large teaching hospital
Large outpatient pharmacy
Large outpatient infusion center- 50 chairs. Strengths Insufficient amount of Automated Dispensing Cabinets (ADCs)
Frustrated nurses and missed doses

No medication safety program or officers
Nurses mixing doses on floors
Increasing number of readmissions due to medication-related errors Weaknesses Medication safety program
Create a position for a Medication Safety Officer
Counseling guidelines upon discharge
Increase the pharmacists' roles in patient care
Direct patients to use outpatient pharmacy Opportunities Funding

Training the staff

Patient Acceptance

Staff cooperation Threats Hire 4 new pharmacists; promote 6 Pharmacists to counseling pharmacist position

Train all 10 pharmacists

Review disease states/medication counseling points

iPad demonstration

Proper documentation

Proper phone follow-up procedure

Scheduling Implementation Phase Counsel every patient that has a diagnosis of acute myocardial infarction, heart failure, pneumonia, or COPD for 30 minutes at discharge
New medications
Adjusted medications
Compliance/Burden

Follow-up with each patient 3-5 days after discharge with a phone call for 15 minutes, or more if needed

Ensure follow-up visits for doctors are scheduled for 7 days or less after discharge

Document counseling sessions and interventions Action Phase Continue to evaluate numbers to ensure program is on track

Evaluate patient satisfaction through surveys

Evaluate need for additional expansion
Other disease states Maintenance Phase Program Initiation:
May 1st, 2012 The Centers for Medicare and Medicaid Services will begin to assign penalties to hospitals that have higher than expected 30-day readmission rates starting in 2013 with commercial payers likely to follow this movement.
Reducing readmissions can reduce costs, provide better reimbursment rates, reduce floor volume, and improve patient outcomes.
According to an article published by Hospitals and Health Networks Daily, some commonly used and effective strategies to reduce readmissions are patient education, medication reconciliation, patient-friendly discharge plans, and post-discharge follow-up and intervention. After 1 Year:
Evaluate program's success
Determine need for expansion/discontinuation
Evaluate for billing in the future Evaluate quarterly:

Readmission rates

Patient responsiveness via survey

Need for additional pharmacists

Room for expansion

Budget evaluation Monitoring Parameters Evaluate readmission rates for acute myocardial infarction, heart failure, pneumonia, and COPD quarterly. Assessment of Service Performed Program Evaluation Marketing Plan: Provide pamphlet to patient explaining service
Emphasis that service is free
"Continuing your care even after you leave" National average for heart attack readmission: 20%
National average for heart failure readmission: 24%
National average for pneumonia readmission: 18%
National average for COPD readmission: 7.1%

2/3 of readmissions are avoidable

National averages for preventable readmissions:
Acute MI: 20% * 2/3 = 13.2%
Heart failure: 24% * 2/3 = 16%
Pneumonia: 20% * 2/3 = 12%
COPD: 7.1% * 2/3 = 4.7%

Our hospital had 150% increase in hospital readmissions; so our averages for preventable readmissions are:
Heart attack: 13.2% * 2.5 = 33%
Heart failure: 16% * 2.5 = 40%
Pneumonia: 12% * 2.5 = 30%
COPD: 4.7% * 2.5 = 11.75% Preventable Readmission Rates Overview Of Calculations:
Current costs of high readmission rates
Projected costs if our readmission rates were at the national average
Amount our program can save our hospital by reducing rates to the national average

Heart Attack Example:
75,000 discharges * 1.61% = 1,205 heart attack cases
1,205 * 33% readmitted (preventable) = 398 readmitted (preventable)

Average national cost of heart attack: $18,261
Current Costs: 398 * $18,261 = $7,267,878

If we can reduce preventable heart attack readmissions to the national average, 13.2%, the cost would only be:
1,205 * 13.2% = 159 readmissions
159 readmissions * $18,261 = $2,903,499 Calculation Example: Heart Attack By applying previous calculations to each disease state, we found that the total current costs to our hospital
Heart attack: $7,267,878 +
Heart failure: $8,098,671 +
Pneumonia: $5,968,326 +
COPD: $1,209,623 +
= $22,544,498 total costs

"Costs" = how much it costs the hospital to treat the patients
Some of this will be reimbursed

However, 16% of Indiana’s population is on Medicare, and we are risk for not being reimbursed for this proportion of our costs
$22,544,498 * 16% = $3,607,120/year

Using a similar calculation, if our readmission rates were at the national average, we would only be at risk for not being reimbursed for $1,440,403/year
$2,903,499 (MI) + $3,231,130 (HF) + $2,385,530 (Pneu) + $482,365
=$9,002,524 total costs * 16% = $1,440,403

If our readmission rates were at the national average, we could be saving up to:
$3,607,120 - $1,440,403 = $2,166,715/year Adding It All Up Savings:
Total Savings - New Costs = Annual Savings
$2,166,715 - $542,640 = $1,624,075/year New Costs Breakeven Analysis Market Analysis Our hospital's readmission rates are much higher than the national average
Reported by CMS
analyzed by TJC

Increased number of medication safety events
No Medication Safety Officer on staff

Bringham and Women's Hospital reduced preventable, medication-related readmissions from 8% to 1% using pharmacist counseling Competitor Analysis Estimated start-up costs:
$542,640
$2,166,715 savings/year -->→
$180,559 savings/month
No variable costs
~3 months to breakeven We will not be billing for our services since our program is based on cost-savings
May consider after pilot program 1. Medicare Payment Advisory Commission. Report to the Congress: Promoting Greater Efficiency in Medicare. Washington, DC: MedPAC, 2007. Available at: http://www.medpac.gov/documents/jun07_entirereport.pdf. Accessed April 5, 2012.
2. Barndt-Maglio B, Hines P. Reducing Hospital Readmissions. hhnmag. 2012; Available at: http://www.hhnmag.com/hhnmag/HHNDaily/HHNDailyDisplay.dhtml?id=8620007299 Accessed on April 2012.
3. The Joint Commission. CMS Hospital 30 Day Rate of Readmission compared to U.S. National Rate. Available at: http://www.qualitycheck.org/QualityReport.aspx?hcoid=5503%20%20%20%20%20%20%20%20%20%20%20%20%20%20&x=mrtReadmission&program=Hospital. Accessed April 2012.
4. Elixhauser A, Au D, Podulka J. Readmissions for Chronic Obstructive Pulmonary Disease, 2008. hcup. 2011. Available at: http://www.hcup-us.ahrq.gov/reports/statbriefs/sb121.pdf. Accessed on April 5, 2012.
5. Schnipper J, Kirwin J, Cotugno M, et al. Role of Pharmacist Counseling in Preventing Adverse Drug Events after Hospitalization. Arch Intern Med. 2006;166: 565-571.
6. Taking Charge of Your Medication Safety Challenges. (2011, November 3) Presentation given at Maryland Patient Safety Center’s Annual Medsafe Conference. The Conference Center at the Maritime Institute.
7. Minott J. Reducing Hospital Readmission. Academy Health Available at: http://www.academyhealth.org/files/publications/ReducingHospitalReadmissions.pdf. Accessed on April 2012
8. Agency for Healthcare Research and Quality. Healthcare Cost and Utilization Report. Available at: http://hcupnet.ahrq.gov/HCUPnet.jsp. Accessed on April 2012.
9. The Kaiser Family Foundation. Kaiser State Health. Available at: http://www.statehealthfacts.org/comparemaptable.jsp?cat=6&ind=291. Accessed April 5, 2012.
10. Foster D, Harkness G. Healthcare Reform: Pending Changes to Reimbursement for 30-Day Readmissions. Thomson Reuters Research Brief. August 2010. Accessed April 4, 2010. References Heart Attack 20% Heart Failure 25% Pneumonia 18% COPD 7.1% National Average
Readmission Rates: Nationally: High readmission rates for MI, HF, pneumonia, and COPD

University Care: 150% increase in medication-related readmissions within 30 days

The PPACA gives Medicare the ability to reduce a hospital's reimbursement based on its readmission rates In addition to our counseling services, we will also be designatining a pharmacist to Medication Safety Officer Medication Safety Officer 2 1 1 1 1
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