Local healthcare systems need high-quality post-acute care providers to avoid Medicare readmission penalties and minimize accountable care organization (ACO) costs.
Dallas-Fort Worth systems currently are creating networks and have definite ideas of what they are looking for, according to panelists at a recent Health Industry Council luncheon in Las Colinas.
Ken Adams, MD, medical director of inpatient rehabilitation at Texas Health Resources (THR), said his company discharges patients to 300 skilled nursing facilities and 500 home health agencies, representing about $1 billion in business.
Adams said THR has five key criteria for its post-acute partners: breadth of facility services; case management with medical oversight; facility healthcare providers that have a good medical understanding of their patients; good case management within the facility, and robust data exchange between the hospital and facility.
Jack Tinsley, vice president for network administration for the Baylor Quality Alliance (BQA) ACO, said it has participation and performance criteria. Participation criteria include care coordination within the facility and whether the medical director is a member of the BQA and proper licensure. Performance criteria include quality measures such as pressure sores and hospital readmission from the facility.
Tinsley, who said BQA would begin building its network in earnest in January, said he would ask facilities how they would like to be evaluated to give them a voice in the process as well.
Jackie Middleton-Tischler, vice president of innovation and transformation for Methodist Health System, said communication and consistent quality measures would be important.
“You have to make me feel good about transferring my patients there. Patient satisfaction should be high and patients should return to daily activities as good or better than they were,” she said.
Scott Robins, MD, chief medical officer of HCA North Texas, said there has been a problem with post-acute care facilities not communicating with providers.
“The competence of the medical director and facility are very important. For example, you have to weigh congestive heart failure (CHF) patients every day. One facility said it weighs them on admission and every 30 days. That means the patients are back (in the hospital) before they are weighed a second time,” he said.
The panelists said they are taking different approaches to attempt to cut 30-day readmission rates.
Adams said THR uses hospital-specific strategies. Some have CHF outpatient clinics that see patients the day after discharge. Others have nurse practitioners visit the patients in their homes. He said Arlington Memorial uses emergency medical personnel to make house calls when they are not on emergency calls.
Robins said HCA has a real-time alert system when patients have returned to the emergency department within 30 days of discharge. He said HCA has found that about one-third do not have to be readmitted.
Middleton-Tischler said Methodist “puts the onus on the patient to make the doctor appointment and give them a template of what to say and what to ask. We have them take ownership. We also have them do their own medication reconciliation by writing down the reason for each and how often they take it. This has made a low-cost impact on readmits.”
Tinsley said Baylor has nursing-home pilot programs under way in Garland and Irving, using nurses and case managers. The system also uses a nurse transitions program at its HealthTexas Provider Network.
Steve Jacob is editor of D Healthcare Daily and author of the new book Health Care in 2020: Where Uncertain Reform, Bad Habits, Too Few Doctors and Skyrocketing Costs Are Taking Us. He can be reached at steve.jacob@dmagazine.com.
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November 6, 2012