Readmissions Reduction Pilot Program Overview HealthCareChaplaincyispartneringwithSt.Luke’s-RooseveltHospitalCenterand NewYorkHospitalQueensinanefforttoreduceunnecessaryreadmissionsbythe creationofapartnershipamongthehospital,thehospital’schaplaincyprogram, andlocalhousesofworshiptoprovideinformationandsupporttopatientsupon andimmediatelyfollowingdischarge.Thisprojectspecificallyonpatientssuffering fromheartfailure,heartattacksandpneumonia,asstudieshaveshownthatthese arethethreepopulationswiththehighestlikelihoodofreadmissiontohospitals within30daysofdischarge(andthesearethethreegroupsthattheCentersfor Medicaid/MedicareServicestracks).Thepilotprogramismodeledonthe CongregationalHealthProgramlaunchedbyMemphisTennessee’sMethodist Hospital,whichreducedreadmissionsby20%andsavedthehospital$2millionina recenttwoyearperiod. Studieshaveshownthatspiritualsupport-relatedservicescanhaveagreatpositive impactonthereductionofreadmissionrates.Board-certifiedchaplainshave traditionallybeenunderutilizedresourcesinreducingunnecessaryreadmissions. Thisprojectbuildsonchaplains’expertiseinattentivelistening,thetrusttheyhave withpatientsandfamilies,andtheirskillsincommunication.Thereductionof unnecessaryreadmissionswillpositivelyaffecthospitalreimbursements,andalikely sidebenefitisthatpatientexperience/satisfactionscoresmayincrease.HCC researcherswillanalyzethechaplains’impactwithrespecttoreadmissionratesand workwithahealtheconomicsteamtomeasurethesavingstothehospitalof avoiding/reducingreadmissions.Thegoalistoreduce30-dayreadmissionratesfor thetargetpatientpopulationby10%overthecourseofthepilot. Readmissions Program Main Points:  LocalhousesofworshipwishingtoparticipatewillsignacovenantwithSt. Luke’s-RooseveltHospitalCenter/NewYorkHospitalQueensandHealthCare Chaplaincy  CongregationmembersofparticipatinghousesofworshipexperiencingAMI,HF, orPN,whohaveprovidedconsent,willbeenrolledthroughtheEMRupontheir admittancetothehospital  Aspatientsundergomedicaltreatmentinaninpatientsetting,chaplainsprovide themspiritualcarethroughspiritualscreening,history-taking,andspiritual assessments  Chaplainsserveasguidesforpatientsastheyworktheirwaythroughthe dischargeprocess,utilizingHCC’sspiritualcareplanform,whichasksthe patientsinsimpletermswhytheybelievetheywerehospitalizedandwhatsteps mustbetakentocontinuerecovery  Chaplainswilldocumentanyotherconcernsandfearsthatpatientsmighthave regardingdischargeandhelpthepatientidentifywhatresourceshe/shemightbe abletocallupon,e.g.,communityclergy,friends,andfamily  Chaplainswilldophonefollow-upwithpatientsonceaweekforthreeweeksby phonefollowingdischargetoidentifyconcernsthatmaynothavebeen addressed.Issuesthatareidentifiedbythesechaplaincallswillberelayedtothe appropriatememberofthemedicalcareteamorcongregationforfollowup The Affordable Care Act Readmissions Reduction Program TheAffordableCareAct(ACA)includesseveralMedicarereformsintendedto advancethecarethatMedicarebeneficiariesreceive;inaddition,billionsof dollarsinMedicaresavingswillbegenerated.AchiefACAinitiativeisthe reductionofhospitalreadmissions.AsofOctober1st2012,theCenterfor MedicareandMedicaidhasstartedtheHospitalReadmissionsReduction Program,whichwillhelphospitalsmakesmoothtransitionsforpatients,and rewardhospitalsthataresuccessfulinreducingavoidablereadmissions.1 ThebasisfortheReadmissionsReductionProgramstemsinpartfromahistory ofU.S.healthcarewroughtwithmisalignedincentives.PriortotheACA,the existingpaymentstructurerewardedprovidersforthequantityofservices delivered,ratherthanthequalityoftheservices.Thiswasaprincipaldriverof healthcarecosts.Thecombinationofperverseincentivesandfragmentedhealth caredeliveryhavecontributedtotheU.S.havinghigherhealthcarespending thananyotherdevelopedcountry,andalsoscoringamongthelowestonkey healthindicators,suchasinfantmortality,obesity,andhealthsystem performance.TheAffordableCareActseekstoalterthismodelandstrengthen Medicare. BeyondimprovingthequalityofcareforMedicarebeneficiarieswithchronic conditions—whocompriseover80percentofallMedicareenrollees—theCMS OfficeoftheActuary(OAct)projectsthattheReadmissionsReductionProgram, whenfullyimplemented,willreduceMedicarecostsby$8.2billionfrom implementationthrough2019.Specifically,paymentstohospitalswillbereduced forunnecessary30-daypatientreadmissionsapplicabletothefollowing 1 "Readmissions Reduction Program." CMS.gov. Center for Medicare and Medicaid Services, 26 Apr. 2013. http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/Readmissions-ReductionProgram.html conditions:Acutemyocardialinfarction(AMI),heartfailure(HF),andpneumonia (PN).ReadmissionsarereportedonHospitalCompareat www.hospitalcompare.gov,andtheuseoftransparencyhasproventohelpto improvereportedmeasures.Thefinancialpenaltieshavepressuredhealthcare professionalstopaymoreattentiontowhathappenstopatientsoncetheyleave thehospital.Manyhospitalsarenowemployingvariousstrategiesinanattempt tobetterfacilitatedischargedpatientrecoveries.2 2 "Affordable Care Act Update: Implementing Medicare Cost Savings." CMS.gov. Center for Medicare and Medicaid Services. http://www.cms.gov/apps/docs/aca-update-implementing-medicare-costs-savings.pdf Readmission Reduction Program: Pre-Implementation Phase Beforebeginningareadmissionsreductionprogram,healthcarechaplains shoulddevelopaonepageconceptualoverview.Thefollowingstepsbeginthe processtoestablishanimpactfulprogramatthehospital: 1. Gainhospitaladministratorapprovaltoestablishtheprogram. 2. Ifapproved,workwithhospital’sdevelopmentdepartmenttofundthe pilotprogram. 3. Identifywhatotherreadmissionsprogramsareoccurringinthehospital. 4. Plotoutaninterventionplanandcatchmentarea. 5. Decideiftheprogramwillbearesearchinvestigationoraquality improvementstudy. 6. Identifyneededdataforimplementation,aswellasdatasources. 7. Getbuy-infromhospitalleadershipinthekeyareas:socialwork,nursing, andotherdepartmentstobeaffected. 8. Clearlycommunicatetheinterventiontoadministratorsofotherprograms, andcollaboratewiththem. 9. Gainhospitalcommunityliaisonsupportforcommunityoutreach. 10. Identifylocalhousesofworshipwithincatchmentarea,andcreatean assetmap. 11. Reachouttohousesofworship,andconductaninformationalbreakfast launch. Questions: JessGeevarghese,Director,ClinicalServicesandAcademicAffairsSupport Services,HealthCareChaplaincy;212-644-1111x122; [email protected]