Who's Truly Accountable for Care, Part 2

By Matthew Weinstock	December 15, 2011
Quality contracts instituted by a large insurer shine a bright light on discharge planning.

As regular readers of this blog know, my family has been through the health care ringer recently. My 79-year-old father in-law had a complicated surgery in mid-October as part of his cancer treatment. The surgery went well, but that was about it. Due to horrendous discharge planning ? there's no other way to describe it ? my father in-law found himself right back in the hospital after spending a challenging week at home.

Following three more weeks in the hospital battling post-surgical complications and doing a stint of rehab, my father in-law was finally sent home last Sunday. This time around, the discharge planning was much better. Perhaps it's because he was in a different hospital, perhaps it was because the family had a better idea of what to expect, or maybe it was a little bit of both. Regardless, the family was much better prepared to face the advanced home care that he still needs. We hired a live-in nurse to help monitor his condition and assist with his feeding tube. We know what medications he should and shouldn't take. A plan was in place.

As we know from the Joint Commission, IHI, AHRQ and others, poor discharge planning is a major cause of the nation's high readmissions rate. Of course, the finger can't only be pointed at providers. A recent study from the Center for Studying Health System Change found that 1 in 3 adults aged 21 or older failed to see a physician within 30 days of being discharged from the hospital. "Many people who do not see a physician are at high risk of readmission," the authors noted.

So, the onus is on everyone to improve the process. That seems to be part of the focus behind a new program that Blue Cross Blue Shield of Rhode Island and the state's hospitals are trying out. The Blues recently restructured its contracts with 90 percent of the state's hospitals to focus more on quality and outcomes. Driven by a state regulation that limits the guaranteed updates that insurers can offer to the Medicare market basket, BCBS instituted incentives for hospitals that meet agreed-upon quality measures and patient satisfaction scores. Interestingly, 60 percent of a hospital's score is tied to discharge planning, or what BCBS likes to call safe transitions (actually, the Blues borrowed that term from an initiative spearheaded by the state QIO on discharge planning).

Gus Manocchia, BCBSRI senior vice president and chief medical officer, says the growing problem of readmissions, poor communication between providers and the poor continuum of care most patients face are partly why the program is so heavily weighted toward discharge planning. Safe transitions, he said, is "huge and incredibly important." So much so, that BCBS has issued a series of best practices for hospitals to follow.

Mary Reich Cooper, M.D., senior vice president and chief quality officer at Lifespan, said that the focus on quality and, in particular, discharge planning is the right emphasis. The five-hospital system has an aggressive program in place to ensure that patients leave with a solid care plan, a follow-up appointment and that medication reconciliation has taken place. In fact, a patient cannot be discharged until his/her physician has signed off on a continuity of care document that includes many of these elements. The CCD is sent electronically or faxed to the patient's next provider.

I'm sure there are initiatives out there similar to what's going on in Rhode Island. We'd like to hear about them. Email me at mweinstock@healthforum.com.

Matthew Weinstock is senior editor of Hospitals & Health Networks.

The opinions expressed by authors do not necessarily reflect the policy of Health Forum Inc. or the American Hospital Association.

in general. All comments will be reviewed by a moderator before being posted.

Please note: Your browser cookies must be enabled to leave comments and remember your login information. If you are having trouble posting a comment please enable your browser cookies or email us your comment at hhndaily@healthforum.com.

Source: http://www.hhnmag.com/hhnmag/HHNDaily/HHNDailyDisplay.dhtml?id=850002009

wellness center health and wellness melaleuca the wellness company wellness programs