Archived Publications eBook: The Dollars are in the Details | Page 17

WHAT’S THE BIG DEAL?
Why is reducing avoidable readmissions such a timely topic? During 2015, one in five elderly
patients was back in the hospital within 30 days. Some 78% of acute care hospitals — 2610 of
them — were assessed a penalty for excessive avoidable readmissions. Those penalties totaled
$428 million. (Source: Robert Wood Johnson Foundation, 2013). Preventable readmissions
represent a substantial portion of unnecessary medical spending. According to data from the
Center for Health Information and Analysis (CHIA), the estimated annual cost of this problem
for Medicare is $26 billion annually — $17 billion of which is considered avoidable.
Organization Solution
St. John Providence Health System (SJPHS) is a leading
healthcare provider in southeast Michigan and part of
Ascension Health, the largest Catholic Health System in the
United States. St. John Providence includes six hospitals, more
than 125 medical facilities, over 3,000 physicians, and 31,000
employees who touch the lives of more than 150,000
inpatients and nearly 4.5 million outpatients each year. Mary Alice was persuasive. The Call Center’s Readmission
Reduction Pilot launched in January of 2011. The initial goal
of the pilot was to reduce readmissions from 25 percent
to 20 percent by the end of 2012. She activated the
following four steps:
The Contact Center was central to their solution for
reducing avoidable readmissions. Here’s what they achieved:
• Readmission rate declined from 25% to 15%
• $2.5 million fine from CMS was reduced by $1.9
million over two years
• Kept appointment rate for post-discharge physician
visit averages at 87%
• The percentage of PCPs with patient follow-up
appointments within 7 days of discharge climbed
from 30% to 85%
Situation
In 2010 the readmission rate for the health system was 25
percent. The Centers for Medicare & Medicaid Services
(CMS) fined SJPHS $2.5 million. Reducing preventable
readmissions became an immediate priority. Call Center
Director Mary Alice Worrell suggested a compelling
solution—that the Call Center pilot a Readmission
Reduction program serving all member hospitals in the
System. The Call Center was IT-centric and data-driven,
and their EchoAccess database included provider information
on all affiliated physicians.
Moreover, s he argued, the Call Center would have the ability
to document and track outcomes in EchoAccess. She
explained that the EchoAccess system would enable them
to call, email, and/or text providers, patients, and patient
caregivers to schedule and confirm follow-up visits. In
short, the call center could play a key role in reducing the
number of avoidable readmissions.
Step 1: Receive discharge reports for Congestive Heart
Failure (CHF) and Chronic Obstructive Pulmonary Disease
(COPD) patients every morning from each member hospital.
Step 2: Contact (call, email or text) the patient and/or the
caregiver to coordinate a day and time for the follow-up
appointment with their physician.
Step 3: Make appointments with appropriate physician
offices for CHF/COPD patients who were discharged
the previous day.
Step 4: Call the physician office after the appointment to
see if the patient kept the appointment. If the appointment
was not kept, call the patient or the caregiver to reschedule.
Because this process utilized telephone, email, and text
communication, Mary Alice and her team chose to replace
the term “Call Center” with “Contact Center.” During
2015, eighteen care coordinators in the Contact Center
managed more than 90,000 contacts.
EchoAccess supported or enabled seven critical
success factors:
Success factor 1: Capture critical data.
EchoAccess enables both patient and physician records to
be kept current, with all data in one central database as a
source of truth. Key data elements include:
• When a follow-up appointment is made for a patient
• The physician with whom the appointment
is scheduled
• Whether the patient keeps the appointment
HealthStream.com/contact • 800.521.0574 •
Reprint from SPRING 2016 Provider Advisor
17