1/23/2013 – National – Quality Improvement
QIOs Advance Health Care for Millions of Medicare Patients
Hospitalizations and re-hospitalizations among Medicare patients declined nearly twice as fast in communities where Quality Improvement Organizations (QIOs) coordinated interventions that engaged whole communities to improve care than in comparison communities, according to a study in the January 23 issue of the Journal of the American Medical Association (JAMA). The results show that interventions aimed at improving care transitions—when patients move from one care setting to another, such as from a hospital to their home—reduced rehospitalizations for Medicare patients by almost six percent in select communities nationwide.
Readmitting Medicare patients to the hospital within a month of discharge is a frequent—and costly—occurrence. Almost 25 percent of heart failure patients on Medicare, for example, are readmitted to the hospital within 30 days of discharge. The federal government says avoidable hospital readmissions cost the Medicare program billions of dollars a year.
The study shows how state-based QIOs, funded by the Medicare program, systematically coordinated community-based efforts with hospitals and other providers to improve the quality of care transitions and avoid rehospitalizations. The communities in the study averaged a 5.7 percent reduction in rehospitalizations. A less expected result was that Medicare beneficiaries in the communities also experienced a 5.74 percent reduction in hospitalizations over the two-year period. Communities of comparable size, demographics and hospital utilization—but where there were no concerted efforts to improve care transitions—averaged considerably more modest reductions, just a 2.05 percent drop in rehospitalizations and a 3.17 percent decline in hospitalizations.
“The JAMA article highlights the good work of the QIO program and the ability the program has to test quality improvement initiatives on a small but diverse scale across the country,” said Jill McArdle, MSPH, RN, CPHQ, PMP, director of federal programs & services at The Carolinas Center for Medical Excellence (CCME), the QIO for North and South Carolina. “The work that these QIOs did with their communities, as described in the JAMA article, has informed our current work with hospitals and communities in North and South Carolina. We’ve adopted and adapted their ideas and techniques as mentors to the rest of us who were not part of The Centers for Medicare & Medicaid Services (CMS) pilot project, and this has been very valuable.”
Through the CMS QIO initiative, CCME has been working with hospitals in the Carolinas to provide technical assistance for its care transition program. CCME has been providing community-level readmissions data and trends analysis, conducting community-specific root cause analysis, and helping convene meetings of community partners. Although CCME was not part of the same special project work described in the JAMA article, CCME conducted a pilot project of its own to reduce the readmission rate for heart failure patients at a small South Carolina hospital during its previous QIO initiative under CMS in 2009–2010.
“This small scale project allowed us to learn what type of QIO support was needed by hospitals to improve care transitions,” McArdle said. “Our project results were presented at the 2010 CMS Quality Net conference. The former CMS administrator, Dr. Don Berwick, said we owe all patients and families better ‘journeys’ as they move through our complex health care system, so ‘they don’t feel forgotten, lost or confused.’ We learned through our own pilot project in South Carolina, and it is a lesson that all QIOs now know and are spreading. Standardizing our health care systems approach to care transitions and securing commitment to using standardized communication tools will take us a long way toward providing good journeys.”
McArdle said when patients move from one setting to the next, there are numerous opportunities to lose valuable information in “translation.” Vital information should be conveyed to other providers and settings, such as outpatient physician offices or home health agencies, and to patients and families who may not even be provided information or who do not understand the information they are provided.
“We need to do a better job to ensure vital information is communicated effectively so unnecessary hospital readmissions can be prevented,” McArdle said.
Karen Southard, MHA, RN, CCME program manager for patient safety and care transitions in North Carolina, said the information gained during the previous contract cycle provided QIOs an insight on the complexity of bringing a community of health care providers together, to find common areas they work on together.
In the current QIO initiative, QIOs have been commissioned to recruit and formalize relationships among community partners to improve communication across the care continuum. CCME assisted three communities in North Carolina and four communities in South Carolina with completing and submitting an application for Community Based Care Transitions funding (CCTP), which is a provision of Section 3026 of the 2010 Affordable Care Act. CCTP, which was launched in 2011, tests ways to make transitions of care safer and smoother.
Theresa Seaberg, RHIT, CCS, CCME program manager for patient safety and care transitions in South Carolina, said of the four communities in her state, one recently received approval. “The others are strong contenders,” Seaberg said. “Community strengths include active partnerships with the local Area Agency on Aging, federally qualified health centers, nursing homes, home health agencies, rehabilitation centers, hospice agencies, and community technical colleges. These partners are key in providing different services ranging from medical transportation, training for lay coaches, and working together to streamline processes for patients as they transition through the care continuum.”
QIOs are guided by the Partnership for Patients Initiative, which offers support to physicians, nurses, and other clinicians working in and out of hospitals to make patient care safer and to support effective transitions of patients from hospitals to other settings. The goal is to reduce 30-day hospital readmissions by 20 percent over three years for the nation. CCME continues to support South Carolina hospitals and communities by collaborating with The South Carolina Partnership for Health (Blue Cross/Blue Shield of South Carolina, Health Sciences South Carolina, and The South Carolina Hospital Association) to improve care transitions. Collaborative efforts have included statewide and regional meetings and webinars, with a special emphasis on promoting best practices and lessons learned.
Of the three communities who received funding in North Carolina, Southard said CCME had a pivotal role in helping them complete a trends analysis and define their drivers of readmission.
“We assisted them in selecting evidenced-based interventions and supported them with data and budget preparation for CCTP application submission,” Southard said. “These communities who received the funding all had previous experience with some care transitions work. It is also noteworthy to say that all of the funded communities had high admissions and readmissions, which is the focus of the care transitions work.”
CCME is continuing to support North Carolina hospitals and communities by collaborating with state partners to spread the work of care transitions across the state. CCME is a member of the leadership committee for the North Carolina Alliance for effective Care Transitions (NC ACT), along with the North Carolina Center for Hospital Quality and Patient Safety, The North Carolina Department of Aging and Adult Services, Community Care of North Carolina, and Carolwoods Retirement Community. NC ACT will be holding an annual state meeting on March 1 in Greensboro, NC, to provide updates on the Care Transitions work that is going on in at the national, state, and regional level, provide care transitions strategies in a variety of health care settings, and showcase best practices from local communities. CCME is promoting best practices among many of the communities by having them share their successes and barriers in an effort to learn strategies to improve the quality of care.
“CCME is leading the care transitions work across the country with most recruited communities in this initiative,” Seaberg said. “We help promote successes and lessons learned from many of the communities that are working with CCME, and we are committed to quality improvement and continue to utilize the drivers that contribute to 30-day avoidable readmissions.”
This material is distributed by The Carolinas Center for Medical Excellence, the Medicare Quality Improvement Organization for North and South Carolina, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. 10SOW-BI-C8-13-5
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