Reducing Readmissions Collaborative

R2C2 – Multidisciplinary Initiative for 2011- 2012

VHA Georgia offers members a comprehensive program to assist them in reducing 30-day preventable readmissions.  Participants are able to choose one or more of five focus areas and VHA Georgia provides a forum for networking, best practice and information exchange, as well as facilitator assistance to keep your group on task.  

Background

“Hospitals must reduce readmissions as CMS moves to cut reimbursement.   Penalty will be a reduction in reimbursement for every discharge.   In just a few years, your hospital could lose a significant amount of money if its 30-day readmission rate is higher for Medicare patients with certain diagnoses than the rate at other hospitals. Beginning with admissions on or after Oct. 1, 2012, under the Patient Protection and Affordable Care Act, hospitals with risk-adjusted readmission rates in the highest 25% will face a 1% reduction in reimbursement for every discharge in fiscal year 2013, not just the conditions on which they report data.  The penalties, part of the Centers for Medicare & Medicaid Services' (CMS') value-based purchasing initiative, will rise to 2% the following year and to 3% for admissions after that.”

- Case Management, Sept. 2010.

Problem Statement

Readmissions make up an average of 20% of most facilities’ inpatient volume, and in a volume driven financial model hospitals have not previously been focused on developing and implementing programs to track and trend appropriate discharges with follow-up throughout the continuum, thus preventing readmissions.

Objectives

• To offer an organized multi-council collaborative that will assist members in sharing metrics and best practices to reduce readmissions / prevent loss of revenue
• Assist members with coordination of care across the continuum and/ or developing a transitional care model, pulling the hospital and all community caregivers together for the ultimate good of the patient
• Facilitate action plan development and comparative benchmarking between VHA members

Proposed Project Goals

• Identify each facility’s overall readmission rate; graph and benchmark with other VHA members; other metrics will be used internally and benchmarked as needed or desired by the hospitals.
• Review care processes to determine potential gaps in service, including lack of patient / family education and understanding, inappropriate discharge planning, lack of follow-up with physician and / or other care providers, i.e. HHC, pharmacy, etc.
• Identify barriers in each healthcare system that must be addressed by Senior Administration 
• Establish goals for percent reduction in readmission rates, and map out timeline to address

Expected Time

R2C2 kickoff training was in April, 2011, with the hospitals officially starting the collaborative in June, 2011,  with the initiative running through October 1, 2012.  

Team Members

Teams will be created by each participating organization based on the key individuals in their organizations and as part of the transition post discharge that might impact reducing readmissions.     VHA Georgia will assist the hospital team with prioritizing and completing a timeline based on resources available and hospital goals.   A multidisciplinary approach with administrative oversight is recommended for best outcomes.  

VHA Support

The collaborative will be led by the Performance Improvement / Lean Team of VHA GA.   Monthly contact will be done with the members involved in the initiative, and on site visits as needed to help move the facility forward.   VHA local, regional and national resources will be available for use by the facilities, i.e. leading practice blue prints, protocols, forms, and policies.  All clinical councils will be included as needed to ensure the success of the initiative; best practices will be shared from other VHA regions of the country who have already been involved in a reducing readmission initiative.

Proposed Timeline

February 2011	Obtained approval from BOD;   received executive support for participation in initiative
April 2011	Held kick-off training meeting with identified teams created by participating organizations, including executive support; Individual teams reviewed 5 elements that are key to reducing readmissions, taking back information to their hospital team to assist with prioritizing which element to start work on first over the next 18 months.
June – Dec. 2011	VHA GA to follow-up with Teams to assist as needed, including action planning, team focus, best practice sharing, etc.
January 2012	Re-assessment meeting:  update meeting allowing each member an opportunity to share their action plans, what they have implemented as a result of the collaborative and any results.  In addition, identifying any additional help needed or change in focus in 2012 specific to reaching the facility’s readmission goals.
Jan. – Oct. 2012	VHA GA to continue team follow-ups to assist as needed, including action planning, team focus, best practice sharing, etc.