Mastering Readmissions: Laying the Foundation for Change

March 22, 2011
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Pioneers are Laying the Foundation for Serious Readmissions-Reduction Work

EXECUTIVE SUMMARY

At a small number of patient care organizations nationwide, pioneering clinician, executive, and healthcare IT leaders are engaging in the serious work needed to lay the foundation for reducing avoidable inpatient readmissions, in such important areas as congestive heart failure. Not surprisingly, intelligently leveraging clinical IT is turning out to be a critical success factor.

Dallas, Texas remains noteworthy in the minds of many Americans for good steaks, ten-gallon hats, the Dallas Cowboys football franchise, and the 1970s soap opera Dallas (filmed in Hollywood, of course), among other things. But as a center for pioneering efforts to reduce potentially avoidable inpatient hospital readmissions? Even most healthcare professionals might not guess that point of distinction. Yet that is the reality, as a groundbreaking effort between two major Dallas hospital organizations is yielding results that could provide a model for hospital organization-based work in that important area. Meanwhile, just fewer than 300 miles to the southeast, in the city of Beaumont, a pioneering medical group seems to have cracked the code on medical group-driven readmissions optimization work.

What do the readmissions initiatives taking place in Texas have in common? In the first instance, the collaborative effort is being undertaken between Parkland Hospital in Dallas and the 24-hospital, Arlington-based Texas Health Resources (THR), in what could ultimately become a community-wide effort on readmissions. In the second instance, in Beaumont, the leaders of the 22-physician multispecialty medical group Southeast Texas Medical Associates (SETMA) are blazing new trails on behalf of their patients with chronic conditions. The leaders of all three organizations are using clinical IT strategically and innovatively to support their readmissions initiatives. And they are achieving significant results.

Very importantly, the work that the leaders at Parkland, Texas Health Resources, and SETMA are involved in will become increasingly critical to the providers' bottom lines. It's worth noting that two different sets of provisions in the federal healthcare reform legislation passed in March 2010 call for reductions in “unnecessary” readmissions under Medicare, with one of the sets of provisions linked to the soon-to-be-established Medicare value-based purchasing program. In short, federal healthcare policy makers are zeroing in on avoidable inpatient readmissions, and the time is now for providers to begin making progress in that area. Significantly, leaders in the organizations doing pioneering work in readmissions agree that leveraging clinical IT and the electronic health record (EHR) are essential elements to success in this sphere.

SOPHISTICATED RISK STRATIFICATION

Ferdinand Velasco, M.D.
Ferdinand Velasco, M.D.

In Dallas, a fortuitous collaboration has emerged between leaders at Texas Health Resources, led by Ferdinand Velasco, M.D., vice president and CMIO, and Ed Marx, senior vice president and CIO; and a team at Parkland Hospital, led by Ruben Amarasingham, M.D., who is both director of the hospital's Center for Clinical Innovation, and its associate chief of medicine services. How did that collaborative work begin?

Ed Marx
Ed Marx

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