If Innovation Health patients experience redness or itchiness for a wound related to gallbladder surgery, Sunil Budhrani, MD, chief medical officer and chief medical informatics officer at the Falls Church, Virginia-based organization (which is a partnership between Inova healthcare system that serves more than two million people each year, and Aetna) wants to keep them out of the emergency room. That’s why patients receive verbal and written instructions from case workers prior to discharge as to what changes to watch for near the surgical site, a prescheduled follow-up appointment, and a phone number for a nurse to call if they have questions.
If patients do call, nurses can access their claims data and electronic records, says Budhrani. “We know exactly what was done in real time because we’re also an insurance company. We have access to that data when the patient leaves the hospital.” Patients can even consult a nurse by video and then have a follow-up appointment with a physician the next morning.
As a result of these and other efforts, Innovation Health members who receive their care from in-network doctors are 18% less likely to be readmitted within 30 days of a hospital admission than other Innovation Health members. Overall, members treated by in-network physicians end up in the hospital 7% less than members seen in other networks.
Innovation Health’s efforts are a prime example of how improved care coordination and patient education can reduce readmissions. What follows are six more ways hospitals and health systems around the country are reducing readmissions.
1. Teach physicians and nurses communication skills and empathy
Since 2009, the Cleveland Clinic has trained more than 5,000 physicians on empathy skills. This training is required for all staff physicians, says Vicente Velez, MD, an internal medicine hospitalist who leads the Cleveland Clinic’s Center for Excellence in Healthcare Communication. “We know that certain patients get readmitted more than others, and we know the factors of readmission. It’s all about communication skills during transitions of care, and communicating with patients so that they understand their instructions and they’re empowered in their care,” says Velez.
The full-day training course, which nurse practitioners also attend, covers the foundations of healthcare communications—such as establishing rapport with patients—and includes practicing those skills and receiving feedback. Physicians also learn how to ensure patients feel respected and are invested in their care plans, says Velez, who notes that it’s important for physicians to engage patients in these conversations, rather than lecturing at them—and ask patients to relay what they have learned back to physicians. Each class is small and includes 12 participants at most, so everyone receives meaningful practice and feedback.
“[Learning how to communicate with empathy] is immediately relevant regarding readmissions because physicians need to engage patients as they prepare for transitions of care. Absent that type of preparation, patients often show up to the hospital as readmissions,” says Velez.
He advises physicians to ask patients who are struggling to adhere to treatment plans about their fears, expectations, and worries associated with those plans. He cites the example of a patient who kept getting readmitted to the hospital for diabetic ketoacidosis. This patient’s sugar levels were too high and there was acid in his blood, which was the result of his nonadherence to his treatment plan. After this patient was readmitted approximately twice a month for three months, the physician asked him, “What are the barriers to you not using insulin?” The patient told him his sister had taken insulin, and ended up on dialysis as a result. She died shortly after starting dialysis, due to complications associated with the treatment. Thus, the patient’s perception was that insulin had caused his sister’s death. The physician addressed the patient’s concerns, and since this conversation, the patient has adhered to the treatment plan and hasn’t been readmitted, says Velez.
In 2012, the Cleveland Clinic’s average internal readmissions rate was 15%, according to a spokesperson. Because of this and other efforts, the current average internal readmissions rate is 14%, which represents roughly 2,000 fewer patient readmissions per year.