Nothing excites an audience of health care professionals more than a clinical success story that includes great data. Make those success stories about reducing readmissions and ED visits and you will have them at “Hello…”
That was the case when representatives from the Vizient Practice Transformation Network (PTN), which is comprised of almost 24,000 clinicians in 1,700 physician practices across 26 health systems, shared their work and success on both topics with attendees at CMS’ Transforming Clinical Practice Initiative (TCPI) National Expert Panel held in June.
“National Expert Panel attendees, including CMS, wanted to see how we linked processes, particularly improved access measures, to concrete proof of decreased readmissions and decreased emergency department visits,” said Robert Dean, DO, MBA, senior vice president, performance management at Vizient. Dean leads the Vizient TCPI Practice Transformation Network efforts to prepare clinicians for success in Alternative Payment Models and value-based reimbursement. “We also received positive feedback about our analytics methodology and were happy to share our learnings for everyone’s benefit.”
Decreasing ED visits by understanding the patient ED visit ratio
An integral part of the PTN’s work on decreasing ED visits centered on the use of a metric called Patient ED Visit Ratio. The ratio is determined by assigning a status of empaneled to ED patients who saw a primary care doctor within the PTN more than twice a year.
“We evaluated the number of ED visits for empaneled patients during a baseline period and used the ED visit ratio for these patients to calculate an expected number of visits in a subsequent time period. We then compared the observed number of visits to the expected number of visits. In reviewing ED use, we discovered that a high number of patients who utilize the ED did not have any assignment to primary care,” said Dean.
As a result of this analysis, the resolution recommended for all our PTN members is to empanel unassigned patients and set up appointments with a primary care physician in an effort to break their habit of visiting the ED anytime they have an issue. “This is where our member clinicians’ work to improve access has made a difference. By getting patients in sooner to see a doctor, we saw a decrease in ED visits for this group,” said Dean.
A segment of Vizient’s presentation on reducing ED visits featured a north Texas hospital that demonstrated the work they did in their primary care clinics with team-based care. Their medical assistants, RNs and clinical social workers teamed up to identify the five highest ED utilizers in each of their clinics. They reached out to them and conducted intensive daily intervention and contact.
“One patient actually had 95 visits in six months, and 92 of those were in the first three to four months,” Dean said. “Once they started the intense care management program, that patient was down to one ED visit a month.”
“This example includes some of the core elements that we work on in our transformation work – not only improved access, but team-based care and case management,” Dean said. “That story illustrates each of those concepts and the substantial impact they have on improving patient access to primary care, which then reduces ED visits.”
The second presentation focused on decreasing readmissions. Based on data in the Vizient Clinical Data Base (CDB), patient visits to primary care physicians rose by 10 percent. This resulted in a 1 percent decrease in hospital readmission rates, and a corresponding $4 million in cost savings.
One contributor to the increased number of primary care visits was a decrease in cancellations and no-shows. By tracking faculty cancellation rates, practices became aware of this trend and focused on decreasing their physicians’ cancellations. Patient no-show rates improved through utilization of appointment reminders and providing transportation to appointments.
"The improved access measures of decreased patient no-show rates and decreased faculty appointment cancellation rates mean that we are getting more patients in to their primary care doctors than before. By improving access to primary care specialists, hospitals can reduce readmissions,” Dean said.
Reaping the benefits of PTN participation
Dean acknowledges that transformation of this scope is slow and arduous. In addition to the plethora of normal everyday activities at a clinician’s facility, practices must now incorporate team-based care, risk stratification, quality metrics, improved operational efficiency, patient and family engagement, disparity analysis and care coordination processes into their list of priorities. However, he is confident the network’s members are on the right track toward accomplishing the goals CMS outlined for the program—better health outcomes, reductions in unnecessary utilization of health care resources and cost savings.
“How do you help the practice organizations incorporate all these new requirements? That’s really what the Vizient network is designed to do and, at the same time, improve health for the population and decrease the cost of care,” Dean said. “The things that we do to improve a practice need to lead to the ultimate aims of improved outcomes, quality and cost … and I think we’re well on our way toward achieving that.”
For more information and details on the type of work the Vizient PTN is doing, contact Robert Dean. You can also click here to see what other solutions Vizient offers to help organizations transition to value-based care.
The project described is supported by Funding Opportunity Number CMS-1L1-15-003 from the U.S. Department of Health & Human Services, Center for Medicare & Medicaid Services. The contents provided are solely the responsibility of the authors and do not necessarily represent the official views of HHS or any of its agencies. The Vizient Practice Transformation Network is 100 percent funded with Federal U.S. Department of Health and Human Services (HHS) funds, provided by the Center for Medicare and Medicaid Services.