Benchmarking and collaboration reduce readmissions

One particularly vexing challenge healthcare providers face is reducing readmissions. An estimated 15% of Medicare patients are readmitted to hospitals for unplanned treatment within 30 days of leaving, costing Medicare about $17 billion per year. The Hospital Readmission Reduction Program (HRRP), established under the Affordable Care Act [ACA) in 2012, provides further incentives to curtail readmissions. Under the HRRP, hospitals are financially penalized if they have higher than expected risk-standardized 30-day readmission rates for acute myocardial infarction, heart failure, and pneumonia.

A nationally recognized academic health system, RUSH University System for Health comprises RUSH University Medical Center, RUSH Copley Medical Center, and RUSH Oak Park Hospital and features an extensive provider network and numerous outpatient care facilities. The system also includes RUSH University, which has more than 2,500 students and comprises RUSH Medical College, the College of Nursing, the College of Health Sciences, and the Graduate College. Given that extensive reach, RUSH was no stranger to struggles with readmission rates. So to address this systemwide priority, RUSH instituted a three-pronged approach: data, collaboration, and real-time adjustments.

Stronger data partnerships

To accomplish its objectives, RUSH partners with Vizient to better leverage data in its efforts to reduce readmission rates. RUSH is a longtime user of Vizient’s data and analytic tools, specifically the Clinical Data Base [CDB). The CDB allows for the creation of custom reports and dashboards and provides the capability to measure benchmark performance against peers and conduct annual planning.

Vizient programs are critical in helping improve patient care. Through participation in Vizient’s Performance Improvement Stroke Collaborative, RUSH was able to standardize care by maximizing internal resources. Stroke outpatient nurses conducted follow-up phone calls within 48 hours to review discharge summary notes, care plans, and patient status. During a 12-month period, the collaborative realized 27 fewer readmissions, avoiding an estimated $694,000 of potential costs. Data from the CDB enabled RUSH to measure key metrics in real time and make informed, data-driven decisions.

Collaborating to improve patient care

RUSH also participated in the High Utilizer Collaborative, which consisted of more than 80 participants. Members implemented an evidence-based, multi-visit care pathway tailored to meet the needs of patients who frequently access the acute care setting. Since RUSH was working to build its own systemwide readmission strategy at the time, its participation in this collaborative proved especially useful in helping its caregivers address the root causes of frequent use of acute care.

Case management met with each patient at bedside, using motivational interviewing techniques to help them better understand the underlying issues for utilization, which often extend to behavioral, social, and environmental drivers. Patients were set up to receive post-acute services. Analytics played a pivotal role in identifying high-utilizer patients and measuring progress. CDB insights continue to provide trend analyses, progress updates, and serve as a baseline for future planning. RUSH remains committed to improving care for its highest utilizers through dashboard management, care pathway refinement, and process improvement methodologies.

Real-time improvements, one patient at a time

RUSH has achieved value from scaling leading strategies to solve contemporary challenges, garnering support from Vizient Analytic Improvement Managers, and working with like-minded organizations in real time.

“Being able to quantify and compare metrics against some of the world’s best hospitals helped our teams accelerate what we’re doing well and identify opportunities to make everything go right, one patient at a time,” says Dr. Stein.

RUSH will continue to leverage Vizient’s offerings and performance data to identify top opportunities for improvement and continue the health system’s journey to be a top performer nationally.

Reducing readmission rates: 4 vital steps

RUSH’s Dr. Brian Stein, pulmonary critical care physician, and Tom Webb, associate vice president of quality analytics, offer their top learnings for a successful readmissions-reduction initiative.

1. Have the right data
2. Understand your patient population
3. Connect the dots across multiple services
4. Gain leadership buy-in