Re­duc­ing read­mis­sions

Data sys­tem helps ad­dress com­plex ques­tions, im­prove medicine

Modern Healthcare - - OPINIONS COMMENTARY - Dr. Ken An­der­son, El­iz­a­beth Behrens and Mark Nea­man

The fed­eral gov­ern­ment has tar­geted bil­lions of dol­lars of sav­ings for the Medi­care pro­gram by re­duc­ing the num­ber of pre­ventable read­mis­sions.

Fi­nan­cial penal­ties to hos­pi­tals with ex­ces­sive read­mis­sion rates be­gin Oct. 1.

Much of the in­for­ma­tion re­ported on at­tempts to lower read­mis­sion rates, in­clud­ing that on the CMS web­site Hospi­tal Com­pare, in­di­cates lit­tle doc­u­mentable progress in this re­gard. Why is this so? What is the anatomy of a read­mis­sion that makes the clin­i­cally ap­pro­pri­ate re­duc­tion of read­mis­sions ap­par­ently so dif­fi­cult?

NorthShore Univer­sity HealthSys­tem fully im­ple­mented a com­pre­hen­sive elec­tronic healthrecord sys­tem across all of its hos­pi­tals and am­bu­la­tory-care cen­ters nearly a decade ago. Data from the sys­tem feeds the data ware­house and cre­ates the op­por­tu­nity for the ap­pli­ca­tion of data an­a­lyt­ics to ad­dress com­plex clin­i­cal ques­tions. Ap­ply­ing such data an­a­lyt­ics at NorthShore to the ques­tion of read­mis­sions led to in­sights into the num­ber and type of read­mis­sions and the op­por­tu­nity for im­prove­ment.

Be­gin­ning in the spring of 2011, a team at NorthShore ap­plied data an­a­lyt­ics tools to fo­cus on read­mis­sions—par­tic­u­larly con­ges- tive heart fail­ure (CHF). Data an­a­lyt­ics cre­ated a unique and spe­cific pre­dic­tive mod­el­ing tool that iden­ti­fied NorthShore pa­tients at high, medium and low like­li­hood of read­mis­sion. By suc­cess­fully de­ploy­ing peo­ple, pro­cesses and tech­nol­ogy to­ward the high-risk pop­u­la­tion, NorthShore re­duced its read­mis­sion rate from 21% to 17% over a pe­riod of six months in ini­tial units. It be­came ap­par­ent that care­givers also needed to re­think their be­liefs about read­mit­ted pa­tients. Rather than con­sid­er­ing a read­mis­sion as usual or a “fre­quent flyer” (re­peat of­fender), the care team em­braced a cul­ture shift for pos­i­tive tran­si­tions to home or skilled fa­cil­i­ties.

What did NorthShore find as to the anatomy of read­mis­sion pa­tients—their char­ac­ter­is­tics? The CHF read­mis­sion pro­file of more than 2,000 Medi­care CHF pa­tients re­veals an ex­traor­di­nar­ily com­plex and ex­tremely ill pop­u­la­tion re­quir­ing the man­age­ment not only of the orig­i­nal rea­son for ad­mis­sion, but also the ef­fects of mul­ti­ple chronic dis­ease con­di­tions. In sum­mary, the typ­i­cal pa­tient’s pro­file in­cluded: Av­er­age age: 84 Mul­ti­ple si­mul­ta­ne­ous di­ag­noses: CHF, ar­rhyth­mia, pneu­mo­nia, di­a­betes

Av­er­age of be­ing on 10 med­i­ca­tions

Lit­tle/no func­tional fam­ily sup­port

The im­pli­ca­tion of this se­vere anatomic pro­file is that so-called pre­ventable read­mis­sions will be nearly im­pos­si­ble to erad­i­cate, let alone sig­nif­i­cantly re­duce in num­bers. There­fore, a CMS pol­icy that fi­nan­cially pe­nal­izes and ex­co­ri­ates providers as “bad ac­tors” on the stage of health­care “re­form” may, in ex­tremis, un­nec­es­sar­ily lead such health sys­tems in the fu­ture to hes­i­tate in tak­ing on such high-risk pa­tients. The im­pli­ca­tions for such a state are sub­stan­tial not only to the CMS and providers, but to Medi­care par­tic­i­pants and their fam­i­lies.

The ap­pli­ca­tion of data an­a­lyt­ics in the health­care field is an ex­cit­ing op­por­tu­nity to bet­ter un­der­stand and im­prove the prac­tice of medicine. No at­tempt is made in this brief sum­mary to claim sta­tis­ti­cal sig­nif­i­cance on read­mis­sion re­duc­tions from this NorthShore study, only a glimpse into bet­ter un­der­stand­ing the anatomy of a read­mis­sion and the com­plex­ity providers face each day.

The typ­i­cal read­mit­ted pa­tient was el­derly and suf­fered from mul­ti­ple med­i­cal con­di­tions.

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