Pilot program: Hospital readmission rates fall to about half of national average
Pilot aims to improve care and patient experience, reduce health care costs
Two years after the start of a hospital pilot program to decrease hospital readmissions for UCare for Seniors Medicare Advantage patients, the rate of readmissions continues to drop, reaching to about half the national average. Begun at Fairview Southdale Hospital in February 2010, and extended in January 2011 to Fairview Ridges Hospital, the project is a joint effort between Fairview Physician Associates (FPA), UCare and the two Fairview hospitals to improve patient care and experience, and reduce costs.
FPA serves more than 14,300 UCare for Seniors patients who typically generate approximately 1,000 hospitalizations annually at the two Fairview hospitals. To date, FPA staff has met with about 2,100 hospitalized patients at Fairview Southdale and Fairview Ridges hospitals as part of the project.
“Our data collection shows readmissions at Fairview Southdale Hospital for eligible Medicare Advantage patients dropped from a high in double digits in 2009 to 9.1 percent in 2011,” says William Nersesian, MD, FPA chief medical officer (pictured). At Fairview Ridges Hospital, the readmission rate now is 7.3 percent. Nersesian compares the rates to the national Medicare readmission rate of about 20 percent. The 2011 data represents the most recent available.
The pilot project is designed to keep UCare for Seniors Medicare Advantage patients from returning unnecessarily to the hospital within 30 days of discharge. Seventeen FPA member independent and Fairview-owned primary care clinics are participating in the pilot. The project extends to all patients in this population, but particularly targets those with diabetes, chronic obstructive pulmonary disease (COPD) and heart disease. Generally, readmissions for cardiology patients exceed those of other conditions.
Included in the study are those patients who are discharged home after a hospital stay. Those who are admitted for observation only, or who are discharged to a skilled nursing facility, currently are not included.
Initially, FPA hoped to see a 20 percent reduction in readmission. In fact, nine months into the project, efforts showed between a 30 and 44 percent reduction, depending on measurement and definition of readmission, says Nersesian.
Each prevented readmission keeps patients healthier and saves at least $10,000 per patient in avoidable cost, according to UCare. This could potentially translate to several million dollars in savings at the two hospitals alone.
“The continued success of this pilot demonstrates how plans and providers can collaborate effectively to improve outcomes for patients and bend the cost curve, says Russel Kuzel, MD, MMM, UCare chief medical officer. “Putting better supports in place after discharge benefits everyone – patients, payers and providers.”
Coordinated efforts by FPA nurse case managers, hospitalists, hospital social workers and pharmacists helped drive results. Interventions ranged from medication education by pharmacists to intensive case management, to streamlined provider follow-up.
“Our long-term goal is to extend the project to other hospitals and other insurance payers so that patients receive the best possible care and primary care doctors are rewarded for what they do best: keep patients healthy and out of the hospital,” says Nersesian.
Fairview Physician Associates (fpanetwork.org), is a provider-led nonprofit of more than 2,000 providers and nearly 400 primary and specialty clinic locations. Member clinics are independent, owned by Fairview Health Services or based at the University of Minnesota. FPA works to promote exceptional clinical care and patient experience at a lower cost of care.
UCare (ucare.org) is an independent, nonprofit health plan providing health care and administrative services to more than 285,000 members enrolled in Medicaid and Medicare programs. UCare partners with health care providers, counties, community organizations and other member-directed groups to create and deliver innovative health coverage plans for members.