Featuring: Georgia Feuer from Emerson Hospital
Name: Georgia Feuer, MPH
Job Title: Project Manager
Hospital: Emerson Hospital
Favorite Holiday Song: The Christmas Song. Such a classic.
Would you rather have a red nose that lights up or have pointy elf ears and why? : Well I guess the red nose lighting up would be useful. That way when I’m not at my desk at work, people can find me.
In this episode of Merry Medisolving, we feature Georgia Feuer, Project Manager at Emerson Hospital. Here she explains to us how they got started with their goal to reduce hospital readmissions by 20% in two years. She also shares some of the success that they’ve already experienced.
Today we are talking about a State run initiative that your hospital took place in. Can you talk about what that initiative was?
The state of Massachusetts has an independent agency to review Healthcare spending called the Health Policy Commission. They developed a grant program to give funds to community hospitals throughout the state to help them to improve their care transitions and improve the quality of care in their hospital.
Emerson Hospital received one of those grants. Our goal is to reduce readmissions among a group of high-risk patients by 20% by the end of the two-year grant period, which is September of 2017.
How does the program measure your success?
We are evaluated based on the percent of high-risk inpatient or observation status patients that come back into the hospital within 30 days.
The state requires that we submit our readmissions data every month. They gather data from all 30 of the hospitals to evaluate how the program is doing overall. We use the Medisolv Business Intelligence Dashboards to report on our measures each month.
How do you identify who is counted in this high-risk patient population?
When a patient is admitted to the hospital, we have indicators set up to tell us if the patient is counted in our high-risk population. For instance, we will identify patients with a high-risk chronic condition such as diabetes, cancer, stroke or those who have already had two or more hospital admissions in the last six months.
When a patient qualifies as being part of this high-risk group, they have a flag that carries over to our dashboards.
This allows us to track the patient to monitor for readmissions within this population. All of these measures are put into our custom dashboards. This allows me as the program manager to make decisions that will improve our effectiveness and move us towards achieving the goal.
Tell us a little more about these dashboards and how they enabled your team to monitor your readmission rates.
We have several different custom dashboards that we developed with Jorge Machado from Medisolv. Some of these dashboards are specifically for the measures that we submit to the state’s Health Policy Commission. It’s been very useful to login whenever I need to and get all of the numbers that I need for submission to the state. Some hospitals struggle with how to get all of this data to the state every month. It’s a program requirement to submit monthly and having the dashboards helps me to do that.
We have other custom dashboards that focus more specifically on the experiences of different care team members. It allows us visibility into how we might adjust their services to help even more patients at Emerson. Do you want an example?
We have a social worker who follows patients in the community after they leave the hospital. He works with them specifically on behavior change goals.
For instance, let’s say a patient had heart failure. He will try to work with them around developing healthy habits such as weighing yourself every day and eating well after they leave the hospital. He evaluates whether to get them different help services if they’re having difficulty getting healthy food into the home.
We wanted to know how effective he was with patients with different diagnoses. So one of the measures we developed looked at the diagnosis of patients that he follows. We found that his success rate with patients with heart failure was significantly better than our general hospital readmission rate with people with heart failure. So what we learned from this measure is that we need to give him more patients with heart failure, because he’s having a lot of positive success with them.
What was the timeline for this entire project?
Our official program launch date was October 1st 2015 and we have two years to complete the project. The planning for the launch date started long before that. We had to hire people, develop assessments and find vendors like Medisolv that would enable us to meet our goal. We have until September 30th of 2017 to reach our goal. We are just over the halfway point now. We are doing well and keeping our end goal in sight.
Any major successes you’d like to point to?
Yes! We have a pharmacy intervention program and we developed a number of different measures to figure out how the pharmacy work was going. Turns out, it is having significant positive impact on patient care.
Our pharmacist does a medication reconciliation when patients are first admitted to the hospital. This is a much more detailed medication reconciliation than what the hospitalists might do. The pharmacist reaches out to all of the patients’ different health care providers in the community, calling their primary care doctor and accessing different systems to try to figure out what medications they are actually taking. Then the pharmacist interviews patients and families to figure out what supplements they take, how well they are doing at following their doctor’s instructions, etc. and evaluates how well the patient understands their medications. Sometimes the pharmacist will do a discharge medication reconciliation as well to give the patients additional teaching before they leave. And finally, the pharmacist follows up with phone calls to patients after they are discharged.
We developed measures to look at the readmission rate of the patients that our pharmacist follows as compared to high-risk patients who she does not work with. The readmission rates of the patients that the pharmacist follows are consistently lower.
The LACE score helps me assess these patients and measure outcomes.
Can you just quickly explain what that means to readers who might not be familiar with the LACE score?
Sure. The LACE score is a way of evaluating the patients that are at the highest risk of readmission. It’s a predictive analytics tool. It uses the data from Length of Stay, Acuity of Admission, Comorbidities and Emergency Department Visits to create a percent of the patients’ chance of readmission to the hospital. The higher the percentage, the higher the risk of the person being readmitted.
Great, so back to the story.
So, I pulled a report of the patients that our pharmacist worked with. I then pulled the LACE scores on our high-risk patient population. I looked at the average LACE score for patients she saw and patients she didn’t see and I found that the patients that she saw in the past few months have a higher LACE score than the patients she did not see. This suggests to me that her patients were at higher risk for readmission to the hospital. This gives further power to the impact of our pharmacist’s intervention. She’s having much success with high-risk patients by educating them and working to really understand their medication strategy and practices. This results in fewer readmissions of this patient. That’s not a good thing; that, in our eyes, is a great thing.
Just hearing you talk about all of the different departments that were involved makes me wonder if it was difficult aligning all of those teams?
We have a very strong leadership team for this program with representatives from departments throughout the hospital. Putting together this team was a great idea that started before I came to Emerson Hospital. We come together to see what’s working and what’s not. We discuss where we are at and what changes we want to make to further reduce readmissions of high-risk patients. We have support throughout the hospital, which is critical to a project of this scope.
Are there other ways your hospital uses the LACE Predictive Analytics tool?
We started giving the LACE report to all of the care managers in the morning. The LACE score gives them some indication of how high-risk the patients are that they care for that day. We give the list to care managers in the morning and they use that list to pay particular attention to their patients who need extra care, or look into different services that the patient might require because they have a higher risk of coming back in.
Do you have any recommendations for someone in your position who is starting an initiative similar to yours?
I would say that having the custom dashboards has been really key. There are specific changes that I have made to the program using the measures that I have gotten from our dashboards.
We met with each of the care teams and talked about what was important. We then used that information to craft the dashboards that would allow us to meet the state’s requirements and also provide a focus on the things that are a priority for our hospital.
Anything else you’d like to share?
The people at Medisolv have been great! Our consultant was relentlessly optimistic, which was appreciated when you’re trying to implement a major project with many different facets. He was very helpful. I am very pleased with the work Emerson is doing to help high-risk patients not only get healthy, but also stay healthy. This is core to our mission as a high-quality community hospital that provides the best care to our patients and core to the goal of the grant we received from the state of Massachusetts.
the 2018 quality reporting bundle
Check out what you’ll find in this handy bundle below.
CMS IQR Program:
- Reporting requirements
- Measure list
The Joint Commission ORYX® Initiative for Quality Improvement:
- Reporting requirements
- Measure list
Oh, AND an Acronym Reference Guide. No more guessing game.