Centura Health Shares Strategies for Reducing Readmissions in Bundled Payment Arrangements

By Clive Riddle, June 9, 2017 Two experts from Centura Health, the Colorado based healthcare system shared their organization’s strategies in reducing readmissions in bundled payment arrangements for total hip and knee replacements, as part of a panel presentation in a HealthcareWebSummit event held this week on “Advanced Strategies in Appropriately Reducing Bundled Payment Arrangement Readmissions.” Centura’s Kristen Daley, Group Director – Value Based Programs, and Brenda Lewis, RN, MBA-HCM, CCM, ACM Group Manager – Care Coordination started by providing context from the literature for total hip arthroplasty (THA)  and total knee arthroplasty (TKA): ·         5.6% of THA and 3.3% of TKA require Readmission within 30 days of discharge ·         Unplanned Readmissions Costs for Medicare Patients = $17.5 Billion/Year ·         THA costs: $17,103/Readmission ·         TKA costs : $13,008/Readmission Daley and Lewis reminded us that elevated patient risk factors for these readmissions come from increased age; male gender; african american race; and medical co-morbidities including obesity, chronic pulmonary disease, bleeding disorders, cancer history, and psychiatric illness. They cited the leading complication for readmissions is infection: (12.1% of unplanned 30 day readmission) and the many other causes including: systemic: pulmonary, cardiac and circulatory; joint specific:  dislocation, fracture, malposition; hematoma, falls; failure to mobilize; increased pain and social determinants. They noted 50% of these readmissions are unrelated to the patient’s index arthroplasty. Here is Daley and Lewis’ summary of their readmissions reduction strategies: ·         Team Approach: All Providers and Caregivers Engaged, Communicating, and on the same page ·         Every Patient receives preoperative medical evaluation/optimization by Perioperative Hospitalists ·         Perioperative Hospitalists round post-op and collaborate on discharge with the Surgeon ·         Robust Care Coordination Program ·         Prepare Patients for Efficient Discharge ·         Front-Load Discharge Planning ·         Partner with Acute Case Management Team ·         Promote use of Preferred Partners ·         Extend Patient Management Post-Discharge They have undertaken the following to prepare patients for the transition from hospital to home: ·         Begin Education Preoperatively and Re-emphasize throughout Hospitalization ·         Embed Care Coordinator into Joint Education Class ·         Utilize LACE Tool to Assist to Identify Risk of Readmission (The LACE index identifies patients that are at risk for readmission or death within thirty days of discharge) ·         Provide Detailed Discharge Instructions ·         Educate patients on Wound Care, DVT Signs ·         Help patients with understanding Pain Management ·         Emphasize importance of Post-op Rapid Mobilization and Physical Therapy