Lexington, KY - Health care is a topic rife with complications - from who gets it and who pays for it to how it's administered and whether it's up to par - and the industry has been the focus of much attention in recent years, on both the practical and policy fronts. In some ways, there may not have been another time that health care has spurred quite so deep a debate, but the changing market, payor structures, higher quality standards and tightening budgets have also spurred improvements in processes within the industry.
For the consumer, the quality and availability of care is always a concern. And in a time when the population is living longer, the treatment of chronic diseases and other ailments that require rehabilitation sees patients on an extended continuum of care that can become a maze of hazards. Medication reconciliation, transfers from facility to home or a skilled nursing location, and consistency in treatment plans from provider to provider are all areas that can affect a patient's health and outcomes throughout a treatment or recovery process, and they can also affect the bottom line for the health care industry if they aren't handled well.
A new union of providers has been formed in the central Kentucky area, the Bluegrass Community Health Coalition, to develop policies and increase cooperation to address challenges and improve processes.
Two of the leading organizations within the group are Central Baptist Hospital and Brookdale Senior Living, the largest senior housing company in the nation, which operates Richmond Place in Lexington. Richmond Place is part of a pilot program within the company that has placed transitions of care as a top priority for patient care and best business practices.
"A couple of years ago, when the health care regulations were coming out from the federal government and everything was changing, there was a portion in health care called accountable care, and basically accountable care is that, as a country, we want higher quality of care for less cost," said Rita Vann, senior vice president of clinical services at Brookdale Senior Living. "Part of the quality of care is that when, for example, a patient is discharged from the hospital, if that discharge is not successful and that patient has to go back to the hospital for any reason, of course, it's going to escalate the cost. And under accountable care ... hospitals that discharge a resident to the community who has a diagnosis of congestive heart failure, pneumonia or heart attack - an acute myocardial infarction - if they go back to the hospital within a 30-day period, the hospital is going to suffer economic penalties from that from Medicare."
For a patient, discharge after a major health-care event can be overwhelming - even when they are headed for rehabilitation or skilled nursing - and that is why communication between the providers is critical.
"Traditionally, the hospital has been responsible for the quality of care they deliver, we have been responsible for the quality of care we deliver, but (by) making us both accountable, there's really no longer a hospital discharge or a discharge from our community. It's really a transition; you're moving that patient from one area of health care to a different level of health care where services are provided," Vann said. "And so we are partnering with hospitals in the area to make sure that we do everything we can to have a smooth hand-off."
"We developed a program, and we're calling it the Brookdale Bridge, because we're ensuring safe passage from one location of care to another location of care - kind of getting them over that big body of water safely, and we have put several things in place," Vann said. Richmond Place has now hired a transitional care nurse, Vann said, who will communicate with the hospital and patients during the transition process.
Though Brookdale has been in front of the trend, they're not the only providers searching for a way to increase accountability, cooperation and communi-cation for greater patient care - and greater stability of reimbursements from Medicare and Medicaid under new regulations, which is where the partnership and coalition comes into play. Terry Altpeter, executive director of quality and outcomes at Central Baptist, is also a member of the coalition.
"Central Baptist realized [last year] the emphasis that CMS was placing on readmissions and transitions of care," said Altpeter. "We started disease management programs for most of the chronic diseases. And that's the patient that's going to come back - the patient with multiple chronic diseases, multiple co-morbidities, most of our senior patients, those who don't have help in the home, those who can't get to another service provider to continue care. There are a lot of patients who fall between the cracks, if you will, or who, without someone navigating them through the system, are going to return to our hospital. So we are very excited about CMS selection of care transition as the goal this year, because we've really been working on care transition."
Relationship building between pro-viders and mutual trust are key to developing plans for higher quality care and better outcomes for patients, which should result in higher reimbursements, patient satisfaction and a more stable business plan for most providers.
"When we have a patient whom we are going to discharge to the nursing home or the skilled nursing facility, we think, what can we tell them about that patient's experience? What can they continue to work on? What can they provide to help them rehabilitate the patient so that the patient can transition back to the home?" said Altpeter.
At the heart of the coalition is the state's quality improvement organization, Healthcare Excel.
"Each [state's] QIO takes its guidance for the work it will do from CMS (Centers for Medicare and Medicaid), and CMS has a variety of things they're working on. Currently that stems from the national quality strategy," said Duane Spurlock, quality improvement administrator for Healthcare Excel. "Part of the impetus for the work we're doing comes from that, from those CMS priorities, and one of those is to reduce hospital readmissions. And those do take up a big part of the Medicare budget. Part of the big health-care expenses that Kentucky and the whole country deal with is hospital readmissions, particularly those preventable read-missions, and that is a big push that is behind this effort."
The goal for readmissions is a reduction of 20 percent by 2013, in addition to overall process improvements.
"Our goal is for patient transitions to be smoother, to be seamless - so that patients understand the education they're given in the hospital, so they're able to self-manage their disease state at home, so that all providers are speaking to each other and giving the patient the same information, so that the patient is not confused," Joyce Wright, the senior project lead for the Care Integration Project and a member of the coalition, said. "We also need to take a good look at their medications and be sure that they are not having any drug-to-drug interactions or potentially inappropriate medications when they go home."
Vann agreed. "About 65 percent of returns to the hospital within the first 30 days are medication related," she said. "It's making absolutely sure that the setting they're in today and the medications they're on meet all their needs. And so you don't want to have to dismiss what they were on previously. For a long time, they came here from the hospital (and) they'd come with a list of what medications they were on and we'd get them on that. But no one checked to see what medications they were on previously, and so we have recognized that that communication is so important."
"Nothing about this program is to deny a patient who needs to go back to the hospital going back. If you need to go back to the hospital, absolutely that resident will go back to the hospital," she said. "Really the goal is to just heighten the overall quality of care and document that quality of care through outcomes in our post-acute care."