Case Managers Have Success Reducing Readmissions

Aug. 9, 2012 - PRLog -- Rockville, Md., Aug. 6, 2012. Seeking to avoid the financial penalties that the Medicare program may impose if too many patients need to be rehospitalized, hospitals nationwide are asking case managers, nurses, and other providers to take on the challenging task of reducing readmissions rates. The Affordable Care Act (ACA) calls for penalties for hospitals that have higher than expected readmission rates within 30 days of discharge for patients who have congestive heart failure (CHF), pneumonia, and acute myocardial infarction (AMI).

Reducing readmissions is a challenge for any hospital, and particularly for urban hospitals such as the Newark Beth Israel Medical Center in Newark, N.J., says Cindy Neumany, RN, the medical center’s director of case management. To help her staff meet the challenge of reducing readmissions, Neumany enrolled the medical centers’ 50 nurse-case managers and social workers on Athena Forum, a 4,000-page online continuing education course curriculum offering business and clinical courses on CHF, pneumonia, and AMI. The result was a drop in 30-day readmissions from 30% to 24%, Neumany reports.

“To ensure that staff understood our goals, our team needed to educate everyone involved in patient care not only those who work inside the hospital, but also those who would care for our patients after discharge,” Neumany says. “By assigning our team these courses, we boosted the core competency level or our case managers and social workers. After taking courses online from Athena Forum, our case managers and social workers are better equipped to navigate the various and sometimes conflicting guidelines that hospitals and health plans follow, while also learning the best practices needed to reduce readmissions.”

Hospitals that have higher than expected readmission rates within 30 days of discharge for these three medical conditions could face financial penalties equal to 1% of Medicare reimbursement next year, 2% in 2014, and 3% in 2015.

Any hospital or medical center the size of the 673-bed Newark Beth Israel Medical Center, which has 25,000 admissions annually including a high rate of Medicare and Medicaid in-patient business, could face a potential penalty of millions of dollars. Recognizing the risk from having too many readmissions within 30 days, hospital administrators directed department chiefs to form a task force to improve discharge planning and care management of patients with these three conditions, Neumany explained.

“Well before any hospital would face a penalty, we began this effort,” Neumany said. “It was two years ago that the staff at the medical center established a team of experts to identify the steps necessary to improve all the processes involved in discharge planning. Thanks to these efforts, we know we have been successful in reducing our readmission rates so far this year. We don’t have exact numbers yet, but so far we know we are doing well.

Newark Beth Israel Medical Center’s Process Improvement Team included a heart surgeon, the chief of heart transplant program, the director of home care, the director of physical therapy, the director of case management, and physicians and nurses.

“The problem is that in most hospitals, inpatients get excellent care but once patients are discharged, it’s almost impossible for the hospital staff to monitor the care of patients at home or in other facilities, such as nursing homes or rehabilitation hospitals,” she explained.

The regional teaching hospital is a major referral and treatment center for patients throughout the northern New Jersey, including those who are poor and minorities. It is one of two New Jersey hospitals where heart transplants are performed and the only hospital in New Jersey certified to perform lung transplants.  Therefore, the effort to reduce readmissions is particularly challenging.

Shortly after beginning this effort, the medical center joined Project RED (Re-Engineered Discharge), initiative organized by the Joint Commission Resources, an affiliate of the Joint Commission, a hospital accrediting agency in Oak Brook Village, Ill.

Project RED is a patient-centered, standardized approach to discharge planning and discharge education that was developed through research funded by the federal Agency for Healthcare Research and Quality (AHRQ). JCR is using AHRQ funding to help more than 250 hospitals in 29 states to implement Project RED. The program aims to improve each patient’s preparedness for self care and thus reduce the likelihood of readmission.

The goal of reducing readmissions is important because out of the 39.5 million hospital discharges in the United States each year, 19% of those patients have a post-discharge adverse event and 20% of Medicare patients are readmitted within 30 days, Project RED reports.

“As a result of working with Project RED, the team at Newark Beth Israel realized that we needed to work closely with the nursing homes in our area because often when CHF patients do not go home after discharge, they are transferred to a nursing home,” Neumany commented. “Therefore, we formed a partnership with a number of these facilities.”

“We also needed to revise our discharge processes so that all staff involved in the care of these patients understood that we were not simply discharging these patients. Not only did the staff need to be educated about the need to cut readmissions, but the patients themselves and their providers outside of the hospitals needed to understand our new requirements,” she said.

“To ensure that everyone understood our goals, our team needed to educate everyone involved in patient care not only inside the hospital, but also those who would care for our patients after discharge,” Neumany added. “That’s where the Athena Forum courses were most useful and made a significant difference in helping our staff to understand the issues involved in reducing readmissions.”