PHILADELPHIA – Twenty-nine hospitals in Greater Philadelphia cut readmission rates by 7 percent and saved $3.8 million in the third quarter, according to Transitions of Care Survey Summary Report from the Health Care Improvement Foundation.

The hospitals participating in the 18-month Preventing Avoidable Episodes (PAVE) Project showed significant improvement in their implementation of 21 of 28 proven strategies to enhance transitions of care and prevent hospital readmissions, the report concluded.

Of these 29 hospitals, 18 submitted monthly data on the number of patients readmitted within 30 days, demonstrating an aggregate 7 percent reduction in 30-day same-hospital readmission rates, from a baseline of 12.2 percent in the second quarter of 2010 to 11.4 percent about a year later, in the third quarter of 2011.
 
The reduction represents more than 400 patients who avoided being readmitted to the hospital and more than $3.8 million in savings on unnecessary healthcare spending for the quarter.

The progress achieved through the PAVE Project should also help the region's hospitals avoid an estimated $7 million in potential health reform related Medicare penalties for higher-than-expected readmission rates in fiscal year 2013, according to the report.

"Readmission rates are important indicators of the quality and effectiveness of healthcare," said Kate Flynn, president of the foundation. "Many readmissions are unavoidable due to the complexity and severity of patients' medical conditions. Nevertheless, each hospital discharge represents an opportunity to better coordinate prompt and effective follow-up care, keep patients from returning to the hospital, and save thousands of dollars in hospital costs.”

According to an analysis of data submitted by the 18 reporting hospitals, Delaware Valley Healthcare Council of HAP, a partner in the project, found that these hospitals would have had 8,625 readmissions during the third quarter of 2011 if readmission rates had remained at baseline levels.

Instead, the hospitals reduced their aggregate, average readmission rate for the quarter to 11.4 percent, or about 8,220 readmissions, and more than 400 patients avoided re-hospitalization. Based on the Centers for Medicare & Medicaid Services' estimate that each avoided readmission saves on average $9,600, this reduction in readmissions saved $3.8 million for the quarter or more than $15 million annually.

"Anytime we can prevent an avoidable hospital readmission, it's a positive step toward providing more affordable, better quality care and good news for patients," said Richard Snyder, chief medical officer, Independence Blue Cross, which along with hospitals helped fund the PAVE Project. "We're very pleased to see our area hospitals making significant investments to ensure patients follow through on the care plans and medical regimens established during hospital stays and devoting valuable resources to help patients get the health care the need after they leave the hospital," said Snyder.

Using proven strategies
According to findings from pre- and post-project surveys, hospitals have adopted many measures designed to enhance communication with patients and families and make sure they understand health conditions and how to follow instructions for ongoing medical care. More than 90 percent of hospitals are now evaluating or implementing a screening tool to identify inpatients at high risk for readmission, so that patient education and other readmission-prevention efforts can be targeted accordingly.

During discharge:

• The number of hospitals that have implemented improved processes to educate patients about their medical conditions has more than doubled.
• Most hospitals now have transition coaches or nurses to help patients and families understand ongoing medical needs and care.
• The number of hospitals that give patients check lists and other reminders has nearly doubled.
• All hospitals provide patients with detailed discharge plans.

As part of PAVE, hospitals have also worked to improve coordination and communication across the continuum of care, so that physicians, nursing homes, home health agencies, and insurers have the information needed to provide patients with the best possible healthcare and the best chance of avoiding readmission.

Proven strategies include:

• Almost all hospitals now coordinate with patients while they are still in the hospital to make follow-up physician appointments; more hospitals are coordinating follow-up testing.
• Nearly 50 percent of hospitals send patients' discharge summaries to patients' primary care physicians; more than 40 percent of hospitals are evaluating and implementing ways to share summaries with primary care physicians.
• Nurses at nearly 60 percent of hospitals are doing nurse-to-nurse handoffs when discharged patients transition to nursing homes or other care settings; the remaining hospitals are evaluating or implementing such handoffs.

"Preventing readmissions takes the concerted effort of patients and absolutely everyone who takes care of them in any capacity, not just hospitals," said Patricia Yurchick, PAVE program director. "A crucial aspect of the project was bringing together stakeholders from the various provider segments of our too-often fragmented health care system, to break down barriers and develop a shared appreciation of how important effective communication and coordination are to the well-being of our patients."

Continuum of care
The PAVE Project involved 150 healthcare professionals representing 47 organizations, including consumer advocacy groups, primary and specialty care physician practices, hospitals and health systems, nursing homes, home health agencies, pharmaceutical manufacturers, and insurers. Participants served in three main workgroups charged with developing tools to improve key aspects of readmission prevention: medication management, care transition, and personal health management.

The PAVE Project was conducted as part of the Partnership for Patient Care, a collaborative, multiyear patient safety initiative funded by Independence Blue Cross and the region's hospitals and health systems.
PAVE began in May 2010.