The Capital Region was featured in one of the world’s most esteemed medical journals Wednesday for its success in reducing readmission rates among its Medicare population.
The secret to the region’s success? A quality improvement organization (or, because the health care industry loves its acronyms, a QIO).
Hospitals, nursing homes and home health agencies in the upper Capital Region — Schenectady, Saratoga, Rensselaer, Warren and Washington counties — that worked with a QIO showed nearly twice the reduction in hospitalizations and re-hospitalizations as those that didn’t work with one, according to a study published in the Journal of the American Medical Association.
This is because it’s the QIO’s job to identify what causes Medicare patients to end up back in the emergency room, find ways to stop it from happening and then measure the outcome.
“In many cases, those readmissions can be avoided if there is a better coordination of care and better information transfer among all of the providers responsible for caring for a patient,” said Thomas Hartman, vice president at IPRO. “And this was the first effort here in the community to do that, and the first national effort to demonstrate any significant improvement.”
In New York, this work is being done by IPRO — the state’s federally designated quality improvement organization. Founded in 1984, IPRO provides independent health care assessment and improvement services from its headquarters in Nassau County and an office in Albany.
The Capital Region, through IPRO, was one of 14 communities across the nation to participate in the study sponsored by the federal Centers for Medicare and Medicaid Services. Nearly 50 health care providers participated in the CMS study, including Albany Memorial Hospital, Ellis Medicine, Saratoga Hospital, Glens Falls Hospital, Samaritan Hospital and Seton St. Mary’s Hospital in Troy.
From 2009 to 2010, the Capital Region achieved a 5.1 percent relative improvement in hospital readmissions for more than 68,000 Medicare beneficiaries, and reduced hospitalizations by 5.46 percent. Its counterparts (communities without QIOs) averaged more modest reductions with just a 2.05 percent drop in readmissions and a 3.17 percent drop in hospitalizations.
“Thanks to QIOs, these communities created networks of clinicians, facilities, families, social service agencies and others that share a common language in coordinating care for patients — the community’s sickest and most vulnerable people,” said CMS Chief Medical Officer Patrick Conway in a news release. “These communities effectively prevented hospitalizations, resulting in people being more likely to stay home and healthy.”
Sara Butterfield helped Ellis Medicine in Schenectady prevent some of these re-hospitalizations using the Coleman Care Transition Intervention. The intervention method helps patients feel empowered after they leave the hospital — sometimes through something as simple as a follow-up phone call to address medication questions or other times by having a “care transitions coach” visit the home and look for red flags.
Butterfield works out of IPRO’s Albany office as senior director of health care quality improvement, and is able to pinpoint just where in the transition from hospital to home or a nursing home a patient could use some help.
“At the time of discharge, patients are very anxious,” she said. “They’re concerned about going home and are not really hearing everything that’s being told to them. Then they get home and are not really sure of what they’re supposed to do. So for some of these people with chronic diseases, they end up back in the emergency department.”
The study, titled “Association Between Quality Improvement for Care Transitions in Communities and Rehospitalizations Among Medicare Beneficiaries,” also involved nursing homes, home health agencies and private practices. One of these participants — the Visiting Nurse Service of Schenectady & Saratoga Counties — has continued its own care transitions programs since the study ended, seeing continued success with readmission rates in the local community.
“We’ve been working with IPRO for decades,” said VNS President Joe Twardy. “But when these initiatives really started to come together back in 2008 or so, we had been having these conversations already, asking how can we reduce hospitalizations because we were seeing patients sometimes 20 times in the emergency department in one year.”
VNS was involved in bringing the cardiac surgery warranty initiative to Ellis Medicine a few years ago. The program essentially had Ellis and local insurance providers paying for the cost of any complications or readmissions after a patient underwent a coronary artery bypass at the hospital’s Schenectady campus.
The program was certainly in step with the federal health care mandates that sought to avoid costly readmissions. But more than that, said Twardy, it was the hospital system saying it was confident enough to warranty its own procedures.
IPRO officials said the Capital Region was chosen to participate in the study because of its size, geographic diversity, demographics and hospital utilization.