From Hospital to Home:

Transcription

1 From Hospital to Home: For patients and providers, recovery at home means improved outcomes and reduced costs HOSPITAL TO HOME BY THE NUMBERS From July to December 2014, VNA Healthtrends enrolled 51 patients in their Hospital to Home Program. Here are the results, by the numbers: Without proper care, patients leaving the hospital soon after knee and hip replacements are at risk for readmission, which comes at a great price to patients and providers alike. In December 2013, Kaiser Health News reported that a Medicare analysis of hip and knee replacement patients showed a 5.4% chance of rehospitalization. 1 And a 2014 study of 76,289 patients with total hip or knee replacements resulted in more than 1,070 rehospitalizations at a cost of more than $25.5 million. 2 TOTAL PATIENTS AGE RANGE TOTAL KNEE REPLACEMENTS TOTAL HIP REPLACEMENTS AVERAGE LENGTH OF HOME HEALTHCARE AVERAGE NUMBER OF THERAPY VISITS DAYS 9.45 * While the rate of complications can be rare affecting 1% to 2% of knee replacement patients, and 1% to 5% of hip replacement patients 3 4 any complications that require a rehospitalization result in slower recovery, higher costs to both the patient and the insurer due to more time in the hospital or skilled nursing facility (SNF) and a delayed return to good health. Changes in healthcare funding are putting increased pressure on insurance companies, healthcare providers and patients to cut costs and yet the U.S. market for joint replacement is growing. The Centers for Disease Control and Prevention report that in 2010, Americans received 719,000 total knee replacements and 332,000 total hip replacements, 5 while the Journal of the American Medical Association predicts that as many as 3.5 million knee replacements will be performed annually by It s time for a new approach. AVERAGE NUMBER OF NURSE (RN/SN) VISITS NUMBER OF HOSPITAL READMISSIONS 4 0 *(99% Physical Therapy, 1% Occupational Therapy) 1. Medicare Identifies 97 Best and 95 Worst Hospitals for Hip and Knee Replacements. Kaiser Health News. Dec. 17, Readmissions after diagnosis of surgical site infection following knee and hip arthroplasty. Infect Control Hosp Epidemiol Feb;35(2): nih.gov/pubmed/ Do I need a joint replacement? American Association of Hip and Knee Surgeons. 4 Do I need a joint replacement? American Association of Hip and Knee Surgeons. 5 Inpatient surgery (source: National Hospital Discharge Survey: 2010 table, Procedures by selected patient characteristics Number by procedure category and age). Centers for Disease Control and Prevention. 6 JAMA: Demand for knee replacements could reach 3.5M per year by The Advisory Board Company. Sept. 28, JAMA-Demand-for-knee-replacements-could-reach-35-M-per-year-by-2030

2 From Hospital to Home / 2 A different approach = powerful results In an effort to curb the tide of costs from hospital readmissions and other post-surgical complications, VNA Healthtrends instituted a Hospital to Home Program in July The results are powerful: of the 51 patients who participated through December 2014 receiving either total knee or total hip replacement 100% were able to transition to outpatient therapy without a single rehospitalization. For medically stable patients who have non-complicated or laparoscopically performed knee or hip replacements, a quick return to a home healthcare setting can result in excellent recovery at significantly reduced cost, says Jay Neidich, vice president of therapy for VNA Healthtrends. For the right patient someone without co-morbidities and who is motivated to participate actively in their own recovery this approach has enormous potential for success. Unlike the common approach to treating patients post-surgery in a SNF for one to two weeks before sending them home to complete their outpatient care, VNA Healthtrends new Hospital to Home Program leaves out the SNF altogether, sending patients straight home from the hospital to their familiar environment with a fully supportive healthcare team in place. Patients come home to a robust healthcare approach The protocol for Hospital to Home patients includes numerous in-home healthcare provider visits. Patients receive nursing and therapy for their first three days at home, in addition to care for five out of the seven following days resulting in in-home healthcare for a total of eight out of their first 10 days. During the second and third weeks, patients receive therapy on three days. After three weeks, many patients are able to begin outpatient therapy. The Hospital to Home Program includes many features that appeal to patients, caregivers, loved ones and their healthcare providers and insurers: 24-hour on-call nurse manager Gait training and home stair management Instruction in personal care and light housekeeping Home safety assessment and durable medical equipment recommendations Immediate results for physicians with Prothrombin Time and International Normalized Ratio (PT/INR) machines Electronic medical records (EMR) and fully integrated physician communication Patients who are concerned they won t have access to care in an urgent situation

3 From Hospital to Home / 3 are reassured by the presence of an on-call nurse manager. Furthermore, the use of EMRs and other communication tools means their healthcare team is fully coordinated. Patient outcomes are maximized at home A significant benefit of in-home care is easy access to therapy. There has to be some consideration for how we get patients from point A to point B, says Neidich. Patients who receive care in their homes don t have the hassle of arranging transportation to an outpatient facility until they are more stable, nor do they have to deal with inclement weather immediately. The therapy comes to them. Neidich says this model also serves the art of the clinician. In a home health setting, therapists are focused on one patient only, and can use the patient s familiar habitat to tailor therapy. The home healthcare model provides flexibility, accommodating any clinician s treatment protocol. Neidich also stresses that patients who recover at home are not exposed to communicable diseases like they might be at SNFs, which can reduce the rate of surgical site infections and therefore hospital readmissions. The numbers are clear: Patients who participated in the VNA Healthtrends Hospital to Home Program for hip and knee replacement in 2014 fared better than the national average when it comes to readmissions (0%, vs. 5.4%), and the length of episode of care was well within the national average (16.9 days, compared to an average stay at a skilled nursing facility of 10 to 20 days). The numbers are clear: Patients who participated in the VNA Healthtrends Hospital to Home Program for hip and knee replacement in 2014 fared better than the national average when it comes to rehospitalizations (there were none), and the length of episode of care was well within the national average (16.9 days). A BRIEF HISTORY OF JOINT REPLACEMENT TREATMENT Hip and knee replacement surgery has changed dramatically in just a few decades. In the 1980s, it was common for a knee replacement patient to stay in the hospital for five days, then move to a rehabilitation facility for a three- to four-week stay. In the 1990s, changes in Medicare policy influenced a shift away from dedicated rehabilitation facilities and toward skilled nursing facilities (SNF). Nursing homes across the country hurried to add orthopedic recovery services and join the movement, adding a bundle of extra costs to the treatment protocol. Not much has changed since then; it s still common for patients to spend a week or two in a SNF before heading home to complete their recovery. VNA Healthtrends believes this practice can be updated for a number of patients, reducing recovery time, cutting costs and improving outcomes.

4 From Hospital to Home / 4 Costs are reduced, benefits are exponential On average, care in a SNF costs $600 per day, compared with an average daily home healthcare cost of $200. The typical length of stay in a SNF post-surgery is between 10 and 20 days and home healthcare typically lasts about the same amount of time but at an enormous savings. Plus, once patients graduate from VNA s Hospital to Home Program, they are more equipped for the required outpatient therapy and are likely to see better outcomes as a result. Additionally, the potential benefits for patients with successful joint replacement surgery are exponential, including numerous quality of life factors and significant economic impact. The American Academy of Orthopedic Surgeons found that the lifetime societal net benefit for knee replacement patients averages between $10,000 and $30, Beyond Surgery Day: The Full Impact of Knee Replacement. American Academy of Orthopaedic Surgeons. anationinmotion.org/value/knee/ CASE STUDY: NEW KNEE, BETTER RECOVERY Eight years ago, David K. received a right knee replacement using a standard care model, in which he was discharged from the hospital to his home without any home health or therapy. In 2015, he received a left knee replacement using VNA s Hospital to Home Program with much better results. He says he s ahead of where he thought he would be in recovery, and is more comfortable with wound care because nurses came to his home on a regular basis. His wife, Pam, agrees. This wound is eight inches long with 28 staples this isn t a scratch from a bike, she says. Compared to his experience eight years ago, David s healing journey has been much smoother, she says. Nurses who visit them at home teach them both about wound care so they can watch for signs of infection, relieving some of their concerns. Eight years ago, no one came to the house, she explains. It was just me and him. Now, we have people coming and that s important for the caregiver. David s episode of home health and therapy began the day after he returned home from the hospital getting his knee moving immediately. This model has allowed me to start on a regimented physical therapy program that will help me with a quicker and faster recovery, says David. The first two weeks out of surgery are so critical. Because each case is different, you need the personal touch of someone to see where you are, and you work together toward the ultimate recovery. He is more mobile now than he was at the same stage in the recovery from his first knee replacement. The benefit of home health care is that I was able to move off the walker to the cane quicker, and by the end of the home health episode I was completely off the cane, said David. I m glad insurance companies are acknowledging that VNA s Hospital to Home Program can help people recover better and faster.

5 From Hospital to Home / 5 Who is eligible? Not all candidates for knee or hip replacement surgery are good candidates for the home health model. Neidich says ideal candidates are younger, and in good overall health besides their joint issues. But age is not the only factor. We re more likely to accept a 75-year-old who works out every day and has no co-morbidities, than a 55-year-old with multiple co-morbidities, he explains. Patients who have lived with joint pain for many years and have utilized prescription pain medications may not be good candidates, either. Neidich says patients are required to give up pain medications early in their recovery under the home health model, which may be difficult for a person in chronic pain. With the Hospital to Home Program, the patient can succeed in becoming independent in his or her own environment first. Jay Neidich, Vice President of therapy for VNA Healthtrends This is for a very specific kind of patient, one who is self-motivated and ready to do the work, says Neidich. Patients in outpatient therapy are often given a home exercise program to follow; patients in the home health model receive the same kind of program, but weeks earlier and are expected to implement it without around-the-clock monitoring. For this reason, Neidich says, a patient needs to have a caregiver at home providing assistance and support. Patients in the home health model recover in their own environment, using their own stairs, carpet, furniture and more. They learn more quickly how to navigate their living space, which translates to a faster recovery. With the Hospital to Home Program, the patient can succeed in becoming independent in his or her own environment first, says Neidich. Now what? The last six months have shown us that for a select population, we can send patients home earlier, cut costs and achieve similar or better outcomes, says Niedich. With a 100% success rate zero rehospitalizations for patients who use our service we expect to see this model implemented across a wider population in the coming months, and for a greater variety of orthopedic procedures. VNA Healthtrends is a home health provider based in the Midwest. Our services are responsive and technologically advanced, and we strive to create compassionate, innovative and comprehensive relationships with our patients. Our goals include providing the best possible care to our patients and making the lives of our partners easier. We achieve this by remaining true to our overall values. For more, visit