WHITE PAPER. How a multi-tiered strategy can reduce readmission rates and significantly enhance patient experience

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1 WHITE PAPER How a multi-tiered strategy can reduce readmission rates and significantly enhance patient experience Vocera Communications, Inc. June, 2014

2 SUMMARY Hospitals that reduce readmission rates while simultaneously improving patient experience will reap the benefits of maximized reimbursements, lower costs, and higher market share ultimately delivering higher quality care for patients. Stratifying readmission risk of our incoming patients allows our clinicians to apply focused strategies for high-risk patients. Michael Palumbo, MD, White Plains Hospital The most effective strategy for achieving such results involves implementation of a multi-tiered plan involving five key best practices: (1) refined patient risk stratification, (2) coordinated care rounding focused upon patient engagement and communication, (3) recording of discharge instructions, (4) post-discharge patient contact, and (5) collaboration with community healthcare providers during and following hospitalizations. As these best practices are implemented and fine-tuned, a clear need emerges for better patient-centered information capture and flow. Information tools which combine patient engagement, communication, and care coordination under a single platform greatly enhance the effectiveness of the multi-tiered strategy discussed in this report. THE CHALLENGE Failure to Prevent Readmissions and Provide a Better Patient Experience Can Lead to Lower Profitability and Quality of Care In the evolving health care landscape, how a hospital handles two major and interconnected issues readmissions and patient experience will have a profound impact on profitability, growth, and quality of care. The Centers for Medicare and Medicaid Services (CMS) determined that 1 in 5 Medicare patients are readmitted to the hospital within 30 days, resulting in approximately $12 billion spent on potentially avoidable readmissions. 1 In 2010, CMS implemented a fee structure (Value-Based Purchasing) that penalizes hospitals with higher than desirable readmission rates. Penalties ranged from 0 1% in 2013, increased to 2% in 2014, and will rise to 3% in More recently, some private payers have started to use readmission rates to provide reimbursement incentives relating to non-medicare admissions. Akin to the readmissions metric, measurements of patient satisfaction are also directly impacting reimbursements: CMS now penalizes hospitals by reducing payments for low scores on the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey, a standardized set of questions aimed at understanding patient experience during hospitalization. The impact of a poor patient experience, however, extends far beyond HCAHPS penalties. Failure to treat patients appropriately can cause patients and physicians to choose other hospitals, leading to a ripple effect of lost loyalty and market share. While readmissions and patient satisfaction are huge issues independent of each other, they are also interrelated. Simply put, a readmission impacts patient satisfaction, and low patient satisfaction and/or patient engagement can impact outcomes and prove a factor in a readmission. Most hospitals are still struggling to create a unifying strategy for improving all the key metrics that affect the financial health of their institutions while satisfying the growing list of requirements for reimbursement. The challenge includes meeting the following goals: maximized reimbursements through reduced readmissions, improved patient satisfaction (resulting in both reduced readmissions and higher market share), higher quality of care, and maintenance or improvement of profitability. 2 A multi-tiered strategy can reduce readmission rates and significantly enhance patient experience

3 THE SOLUTION Multi-tiered Approach with Enhanced Information Capture/Flow Recent interviews with leading executives at high-performing hospitals, and analysis of outcomes data shared by them, indicate strongly that while there is no silver bullet for meeting the challenges raised previously an optimal solution involves a multi-tiered approach combining five key best practice areas: 1. Refined Patient Risk Stratification: Identifying high-risk patients early and updating the evaluation regularly during hospitalization is essential both for reducing readmissions and improving patient experience. Hospitals should assess patient risk at admission using customized analysis tools tailored to the organizations patient populations. The risk stratification tools can capture medical data as well as social and behavioral attributes, including a patient s fears or concerns, goals for the hospital stay or procedure, health literacy, medication compliance level, patient transportation barriers, access to skilled nursing facilities, and whether a patient lives alone or has a strong support system outside the hospital. Strategy #4: An example from White Plains Hospital The hospital s primary objectives for follow-up calls are fourfold. We want to make sure the patient: 1. Understands his/her discharge instructions 2. Is complying with the medication regimen 3. Has made a follow-up appointment with a primary care physician 4. Understands next steps in the care plan Our call back strategy affects readmissions by helping patients comply with their discharge plan. It also helps improve the relationship between White Plains and the patients and families we serve. Michael Palumbo, MD, White Plains Hospital 2. Coordinated Rounding: Risk stratification continues with care rounding, which helps identify and close gaps in patient communication and experience. By helping set the stage for seamless communication throughout the hospital stay, care rounding builds trust, reduces anxiety, decreases call light frequency, and alleviates care team stress and patient uncertainty. 3 Rounding can be performed by a single care team member or by a multi-disciplinary team that includes a physician, nurse, dietician, pharmacist and/or another member of the clinical or support staff. Regardless of the approach, rounding allows for patient needs to be addressed quickly, which improves patient engagement, satisfaction, compliance, and outcomes. The integration of rounding into the clinical workflow can be further enhanced by the adoption of real-time information capture and feedback systems and tools. Innovative technologies are available to standardize the process of rounding and capture the voice of patients and families to help close the loop on patient requests and provide actionable data and accountability. 3. Recordings of Discharge Instructions: Patient and family engagement plays a vital role in experience and outcomes. Higher overall patient satisfaction with discharge planning is associated with lower 30-day risk-standardized hospital readmission rates after adjusting for clinical quality. 4 To improve engagement, hospitals can adopt tools that allow the care team to record live discharge instructions at the patient bedside. The instructions can be made available to the patient, family, and other caregivers to review at any time using any phone, computer or mobile device. This type of solution hardwires best practices such as teach-back and spaced repetition into the discharge process, which helps bridge gaps in health literacy, and empowers patients and families to take more active roles during and after a hospital stay. 4. Timely Post-Discharge Patient Contact: Follow-up calls to high-risk patients after a hospital stay improve experience and help close clinical gaps before they escalate to readmission. One study showed that patients who receive a follow-up call were 23.1% less likely to be readmitted to the hospital within 30 days. 5 During post-discharge calls, hospital staff members should gauge patient engagement, understanding of, and compliance with the care plan and might also include an overview of discharge instructions, confirmation of follow-up appointments, and medication reconciliation. Follow- 3 A multi-tiered strategy can reduce readmission rates and significantly enhance patient experience

4 up calls also allow care team members to make inquiries about any social and behavioral challenges that were identified during the risk stratification analysis and to initiate interventions as needed. 5. Collaboration with Community Providers: Experts agree that a prominent driver of unnecessary readmissions is the lack of communication and care coordination across the continuum of care. Patients too often make the round trip from hospital to skilled nursing facility (SNF) and back again, putting the health system and patients at risk. In addition, 30% of primary care physicians (PCPs) are unaware when their patients are hospitalized. 6 Such gaps can lead to conflicting care plans, difficult medication reconciliation, poor outcomes, and dissatisfied patients. By providing access to patient risk information and discharge instructions to PCPs and SNFs, these care providers know exactly what the patient was told, what potential issues could arise, and the next steps required to care for the patient. If connections between the hospital, PCP, and SNF are strong, any readmissions that do occur can be reviewed to identify trends and design improvements. SUPPORTING THE MULTI-TIERED APPROACH: Patient-centered Information Strategies In light of recent trends and the industry outlook, hospitals will fare best if they can manage a patient s experience longitudinally from the first impression to the last. At the heart of that challenge is the need to improve patient (and family) understanding while increasing hospital compliance and accountability. To best support the adoption and consistent implementation of the five best practices outlined in this report, it is clear that improvements must be made in patient-centered information capture and flow. Information tools powered by intuitive technology that captures patient feedback and combines patient engagement, communication, and care coordination under a single platform would greatly enhance the effectiveness of the multi-tiered strategy. Discharge Recordings Post-Discharge Contact Enhanced Patient Experience Coordinated Rounding PATIENT CENTERED INFORMATION Risk Stratification Collaboration Community Providers Reduced Readmissions 4 A multi-tiered strategy can reduce readmission rates and significantly enhance patient experience

5 Multi-tiered Strategy Benefits Patient Experience and Outcomes: A Case Study - White Plains Hospital * White Plains Hospital is advancing a unified strategy that contains all five elements of a multi-tiered approach to bettering patient experience while reducing admissions and ultimately improving quality of care. Risk Stratification: Using a modified Geisinger Transitions of Care Model, nurses screen metrics such as the number of medications and the patient s health literacy to determine risk levels and whether pharmacist education might prove beneficial. Coordinated Rounding: Using several different multidisciplinary models, rounding encounters are managed with the support of an internal tool which logs findings, reports to management, and easily allows the next rounder to access previous records. Discharge Recordings: The hospital uses a teach-back system to improve patient understanding and involve the family and/or others who are part of the support team. The Vocera Good to Go Patient Discharge Communication solution has been implemented to record live discharge instructions, attach personalized education materials and next steps, and make the entire record available to the patient and family from home. Post-discharge Follow-up Calls: Objectives include ensuring patients understand discharge instructions, comply with medication regimens, make follow-up appointments with primary care physicians, and understand next steps in the care plan. Collaboration with Community Providers: A multi-disciplinary team keeps physicians, SNFs and other points of care in the loop about their patients. A new Vocera Care Experience application is being evaluated that automatically provides patient updates to PCPs and sends discharge notifications and instructions to SNFs and providers to improve patient safety, satisfaction, and outcomes. Positive results of the multi-tiered strategy include improved HCAHPS scores (measurement of patient experience) and reduced readmissions. ABOUT VOCERA Vocera empowers integrated, intelligent communication in healthcare, hospitality, energy and other mission-critical mobile environments. Vocera is widely recognized for developing smarter ways to communicate that improve patient and customer satisfaction with the Vocera Communication and Care Experience solutions. Vocera provides technology innovations and thought leadership that humanize healthcare for patients, families and care teams and improve customer experience in more than 1,200 organizations worldwide. Vocera is headquartered in San Jose, Calif., with offices in San Francisco, Tennessee, Canada, India and the United Kingdom. * Vocera Customer Biography Michael Palumbo, MD, Executive Vice President and Medical Director, White Plains Hospital, has practiced medicine for 28 years. Dr. Palumbo is responsible for medical staff affairs, employed physician staff management, and quality program oversight at the hospital. 5 A multi-tiered strategy can reduce readmission rates and significantly enhance patient experience

6 REFERENCES: 1. Miller, ME. Report to Congress: Reforming the delivery system. Washington, DC: Medicare Payment Advisory Commission Landro, L. Taking medical jargon out of doctor visits. The Wall Street Journal. July 6, Gardner, GE, et al. Measuring the effect of patient comfort rounds on practice environment and patient satisfaction: a pilot study. International Journal of Nursing Practice. 2009;15(4): Boulding, et al. Relationship between patient satisfaction with inpatient care and hospital readmission within 30 days. Am J Manag Care. 2011;17(1): Harrison, PL, et al. The impact of post-discharge telephonic follow-up on hospital readmission. Popul Health Manag February;14(1): Problems after discharge and understanding of communication with their primary care physicians among hospitalized seniors: a mixed methods study. J Hosp Med Sep;5(7): A multi-tiered strategy can reduce readmission rates and significantly enhance patient experience

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