As such, both payer and provider organizations are looking for creative, sustainable ways to reduce waste and improve the quality of care for patients, especially those who are living with chronic or complex medical conditions. With CMS already collecting data for its first oncology performance measure, OP-35: Admissions and Emergency Department Visits for Patients Receiving Outpatient Chemotherapy, which will affect payments come 2020, many healthcare organizations are taking a long, hard look at where they can prevent, or at least significantly reduce, cancer readmissions.
It’s not a surprise. As noted by the Agency for Healthcare Research and Quality (AHRQ), hospital readmissions, regardless of condition, are remarkably expensive, with collective costs hovering just over $41 billion a year for patients who return to the hospital within 30 days of discharge. But Alok Khorana, MD, a medical oncologist at the Cleveland Clinic, says readmissions are becoming more of a focal issue for cancer care, as more patients are treated in an outpatient setting.
“In the past, cancer patients were generally admitted while they were worked up, staying in the hospital for 10 to 14 days,” he explains. “Today, there is pressure to make hospital stays as brief as possible, which means that many patients are discharged without all of their issues being completely resolved. Since cancer is such a complex condition, with both acute and chronic elements, we often see that readmission rates in the cancer population are higher than those in the general medical population.”
But given cancer’s complexity, what can healthcare stakeholders across the industry do to better prevent cancer readmissions?
Considering care Transitions
Given how little time patients stay in the hospital today, the Cleveland Clinic embarked on a process improvement project to improve outpatient care transitions. Khorana says the project started as a way of looking at “common sense” steps to reduce readmissions. He said their first lesson learned what that a significant portion of cancer readmissions are simply inevitable given this disease’s level of complexity.
“This is important for regulators and for payer organizations to understand,” he says. “In many cases, readmission is the right thing to do for patients. It cannot be avoided no matter what the provider may do.”
Yet, to help reduce the number of readmissions in cases that were preventable, he and his colleagues focused on improving care transitions, providing patients with more support once they were discharged.
“Cancer patients receive really intensive care while they are in the hospital, from a variety of different clinical staff,” he explains. “The key is to not take all of that away once they went home. We started a program where an oncology nurse checked in with patients within 48 hours of discharge, and then they had a follow-up appointment with the provider within five days of discharge, to help provide continuity of care and answer any questions. We discovered that there were a lot of areas where we could help prevent readmissions just by adding in those extra contacts.”
In fact, by putting this standardized discharge protocol in place, the Cleveland Clinic was able to reduce the readmission rate in medical oncology by approximately 4.5%.
“It was a modest improvement—but a sustainable one,” he says. “In terms of dollars, we are talking about millions of dollars in savings over the long term. And the patients, of course, have the benefit of not ending up back in the hospital.”