One of the topics up for discussion at Thursday’s meeting of the UNC Health Care Board of Commissioners was a plan to reduce readmission rates to the hospital, a factor that affects Medicaid payments to the hospital as well as its reputation score.
When a patient leaves the hospital and is readmitted to any hospital for almost any reason within a 30-day period, that event is calculated as a part of the hospital’s readmission rate and negatively affects the hospital’s profile. Currently, Nash UNC Health Care is being penalized by Medicaid for its high readmission rate, said Rachel Brinkley, director of care management for the hospital.
“The board conversation today was about our focus to improve readmissions in fiscal year 2020,” said Davis Greene, vice president of operations for Nash UNC Health Care. “Historically, Nash has had some struggles with readmission rates. Last calendar year, our overall readmission rate was 12.5 percent, while the readmission rate for Medicaid patients was even higher.”
Greene said this rate is about 2 percent higher than it should be.
“While there is no national benchmark for comparing this rate as it involves aggregating rates for every insurance provider, there are relatively good surveys of hospitals our size,” Greene said. “From those, we estimate our rate should be around 10.5 percent. In real terms, we should be having about 100 patients readmit per month but we have averaged about 115 readmitted patients per month. We have a very extensive action plan to achieve our goal of 10.5 percent within at least two years.”
Brinkley said that the hospital will be launching a new tool to help aid in the reduction of patient readmissions. Patients admitted to the hospital will begin receiving a discharge planning folder early in their hospital stay so they can begin thinking about what questions they need to ask and what steps they or their family members need to take to prepare for life after hospitalization.
The document also allows patients to gather phone numbers and other information they will need to follow up with medical professionals after their discharge.
A copy of this document was distributed to each board member at Thursday’s meeting.
“Today, for a bit of show-and-tell, we handed out the discharge planning folder, which is just one of the many interventions we have enacted,” Greene said after the meeting. “It will help prepare patients for understanding their care needs before they leave the hospital. It prompts them to engage their care team and get important questions answered.”
Greene said this is just one aspect of a multi-pronged action plan developed by hospital staff.
“A senior transition liaison and a transition liaison have been hired. These positions will work with community partners to improve relationships and implement strategies for preventing readmissions,” Greene said. “A pneumonia/COPD coordinator has also been hired to focus on disease-specific improvements. This is an addition to existing disease-specific coordinators — diabetes, MI, stroke, sepsis. Initiatives include process improvement for care, collaboration with the care team for improved documentation and treatment and disease-specific education development for patients.”
The hospital is working on developing stronger collaborations with primary care offices, skilled nursing facilities and assisted living facilities to improve patient care after discharge as well, Greene said.
These efforts have been added to the Community Paramedic program that already is in place, but the hospital has enhanced communication and referrals.
“Referrals to community paramedics have increased as a result and outcomes are now more easily measurable,” Greene said.
Greene said the hospital already is seeing results from the parts of the plan that already have been launched.
“Already, due to major staffing overhauls, we are seeing improvements,” Greene said. “For the first four months of 2019, we are already down to 11.9 percent, and the winter is typically one of your harder periods of the year to lower these rates. We are proud of this progress but recognize we have a lot more to do.”