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Reducing Avoidable Readmissions Effectively
(RARE)
Kathy Cummings, RN, BSN, MAInstitute for Clinical Systems Improvement
Martha and James
•Acute Episodes•Family Doctor•Life Expectancy from chronic diseases was shorter•Care giver in the home•Limited number of specialists available•Patient knew who to call with an issue
Hospital Compare Data
Heart Attack Heart Failure Pneumonia
MN US MN US MN US
Better than national average 0 29 2 147 0 64
Same as national average 30 2403 102 3869 118 4223
Worse than national average 0 45 1 193 0 163
Too Small 91 1999 25 550 13 363
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MN Hospital 30-Day Readmission Rates from Heart Failure
Nat'l Avg.: 24.8%
Federal
1% penalty on Medicare for “greater readmissions than expected” in 2013
Looks at heart attacks, congestive heart failure, pneumonia, COPD, and potentially other conditions
Penalty increases .25% per year until reaches 2%
Only big hospitals (so far)
MN Medicaid payments reduced by 10%, can earn back 5% if reduce avoidable admissions over 2 years
What are business issues?
Why Is Campaign Needed?
• Almost 20% of Medicare patients in Minnesota are readmitted within 30 days of discharge
• Huge opportunity to fix gaps in fragmented system
• Reduce unnecessary burden on patients, families
• Preventable readmissions are contributing to unsustainable climb in health care costs
• CMS penalties for low-performing hospitals – “clock” begins ticking Oct. 1, 2011
RARE Campaign
• A campaign across the continuum of care to reduce avoidable hospital readmissions across Minnesota and surrounding areas
• Regional approach, supported by hospitals, providers, health plans, other key stakeholders
Goal: Prevent 4,000avoidable readmissions by Dec. 31, 2012. With average hospital stay at 4 days, help patient spend 16,000 more nights in their own beds.
RARE Campaign
• Campaign seeks commitment from all hospitals in Minnesota
• Particularly those hospitals that account for roughly 80% of readmissions
• Campaign is engaging other care providers, acknowledging that readmissions are the result of a fragmented health care system
Triple Aim Goals
• Population health– Prevent 4,000 avoidable readmissions within 30 days of
discharge OR in other words,
– Reduce overall readmissions rate by 20% from 2009 base by 12/31/12
• Care experience– Recapture 16,000 nights of patients’ sleep in their own
beds instead of in the hospital
– Improve by 5% on HCAHPS survey questions on discharge
• Affordability of care– Save an estimated $30 million for commercially insured
patients; additional savings for Medicare patients
Broad Community Support
• Operating Partners:
– Manage operations, secure involvement, support rapid progress, provide the majority of staffing and resources
• Institute for Clinical Systems Improvement (ICSI)
• Minnesota Hospital Association (MHA)
• Stratis Health
Broad Community Support
• Supporting Partners:
– Provide significant resources and support to develop and implement specific aspects of the campaign
• Minnesota Medical Association
– Working to link providers with hospitals to address fragmentation together
• MN Community Measurement
– Developing measures for public reporting in 2012
Broad Community Support
• Community Partners:
– Endorse and actively support the campaign
• A growing list of providers, health plans, state health agencies, home health agencies, nursing homes, patient advocacy groups and other community organizations
Campaign Design
• Two approaches:
– Collaborative, evidence-based approach:
• RARE Operating Partners provide resource consultant and best practice toolkits
• Flexibility in choice of starting times
– Innovator approach:
• Intensive/highly compressed approach (i.e., Lean) to identify new ways to achieve results faster
• Link with other efforts of Supporting ad Community Partners, e.g., health care homes
Five Focus Areas
• Comprehensive discharge plan
• Effective communication for transitions of care
• Engagement of patient and family in discharge process
• Medication management
• Transition care
Participating Hospital Requirements
– Commit to specific readmission reduction goals based on MHA analysis
– Conduct an organizational assessment of its readmissions; tools provided by the RARE Operating Partners
Participating Hospital Requirements
– Share organizational assessment results and readmissions data with the RARE Operating Partners
– Commit to improving performance in key areas identified through the organizational assessment
– Agree to publicly disclose participation in the campaign
Operating Partners Support
– Each hospital is assigned a resource consultant from one of the Operating Partner organizations
– Operating Partners’ staff works with hospital on analysis to identify gaps contributing to avoidable readmissions
Operating Partners Support
– Hospitals are supported in selecting and implementing interventions most likely to accelerate their work and achieve success
• Hospitals will focus on 1 to 5 areas
• Each focus area incorporates details of recognized best practices; has designated list of activities
Support for Hospitals
• Best practice toolkits
• Face-to-face sessions
• Webinars
• Conference calls
• Peer coaching
• Data reporting
• “Innovator” approach: intensive, rapid process improvement work
Analysis and Measurement
• MHA Potentially Preventable Readmissions (PPR) data used to establish each hospital’s goal
• Progress monitored with quarterly PPR results
• Hospitals collect data on variety of process measures; report their progress
• 30-day all cause readmission rates for select clinical conditions will be publicly reported on MN HealthScores for hospitals and provider groups in 2012
Campaign Rollout, Timing
• Hospital engaged July/August 2011
• Participation secured through September 2011
• Hospitals can choose among several modalities of improvement activities
• Improvement work, measurement continues through Dec. 31, 2012
Results to Date
• Key medical systems have committed their hospitals to the campaign
– Allina
– CentraCare
– Essentia Health
– Fairview
– HealthEast
– HealthPartners
Results to Date
• 64 hospitals have signed up
– Includes 18 of 25 hospitals with most readmissions
– Includes 32 of top 50 hospitals with most readmissions
– Participating hospitals cover broad geographic area in Minnesota
Community Partners to Date
• AARP• Aging Services of Minnesota• Area Agency on Aging• AXIS Healthcare• Blue Cross Blue Shield of Minnesota• Care Choice• Care Providers of Minnesota• Central Minnesota Council on Aging• Courage Center• Healthcare Discharge Planning
Resources LLC.• HealthPartners Health Plan• Land of the Dancing Sky Area Agency on
Aging• Medica• Metropolitan Area Agency on Aging• Metropolitan Health Plan
• Mission Healthcare, LLC• MN Alliance for Patient Safety• MN Chapter of the Society of Hospital
Medicine• MN Council of Health Plans• MN Department of Health• MN Home Care Assn.• MN Organization of Leaders in Nursing• MN Network of Hospice & Palliative Care• MN River Area Agency on Aging• MN Visiting Nurse Agency• PreferredOne• Southeastern Minnesota Area Agency on
Aging• Tubman• UCare• Walker Methodist Health Center
16,000 Nights At HomeWill Make Our Day.
Thank You ForHelping Everyone Sleep
More Peacefully.
