Care teams at Shawnee Mission Medical Center (SMMC) reduced emergency department (ED) visits by 46 percent with the help of Cerner Care Management.
Care teams at Shawnee Mission Medical Center (SMMC) reduced emergency department (ED) visits by 46 percent and penalties associated with Medicare readmissions with the help of Cerner Acute Case Management.
As CMS adds diagnoses and increases readmission penalties, health systems are responding by developing new ways of identifying and keeping costly, repeat patients out of the hospital.
Part 1: Targeted care plans in the ED
“We know the readmission penalties,” said Kim King, SMMC Administrative Director of Care Coordination. “But when you think about frequent unnecessary ED visits, it’s about patients who don’t need those services but are utilizing them – oftentimes at a cost to the hospital.”
King is referring to the drive behind an SMMC program, Bridge Care, that originally aimed to reduce how often 75 specific patients visited the ED by 25 percent. At the completion of the first year, visits decreased by 40 percent. By the end of 2014, visits had decreased by 46 percent.
“Concentrated management of non-acute ED patients helps reduce unnecessary costs. From a business perspective, those open ED beds increase the potential for other revenue generating patients,” notes King. “Bridge Care also has the potential to help reduce ED bottlenecks and wait times, which is important to our patients.”
SMMC’s Bridge Care uses a 2-person care team. One social worker and one nurse work in tandem to identify and engage with multi-visit patients (MVPs). The program admits patients who utilize the ED more than twelve times over a 12-month period. Typically, MVPs use the ED for concerns that could be better addressed with outside providers, agencies and/or resources.
Once identified, the team uses Acute Case Management to develop a single, shared care plan between all acute venues and tailors it to each patient’s unique needs. A special icon on the ED tracking board tied to the patient’s medical record number helps easily identify Bridge Care patients on admission. This icon calls attention to and instructs physicians and staff to review the Bridge Care patient care plan.
Bridge Care provides health education and coaching, resource referrals, emotional support and financial assistance.
Using a bio-psycho-social approach, the care team collaborates with outside healthcare stakeholders such as local mental health case managers, safety net clinics, managed care case managers, and Emergency Medical Services (EMS). This collaborative approach of intervention disrupts the cycle of frequent visits and in many cases causes positive changes in the patient’s health.
We had a patient who in three months had visited the ED 22 times,” recalls Whitney Benakis, Licensed Master Social Worker.
The patient had a long history of mental illness. One identified reason noted by the care team was that the patient thought her ED visits would lead to more paid caregiver hours, which was not the case.
Bridge Care coordinated a team meeting with the patient and healthcare stakeholders, including Johnson County Mental Health Crisis team, Medicaid Managed Care Case Manager, family members, a paid caregiver and an EMS representative. The repercussions of her over-utilization of medical services was explained in detail.
“One key outcome entailed a plan that the patient call Johnson County Mental Health Crisis Team before calling 911,” said Sue Brettmann, Registered Nurse.
As of April 2015, the patient had not been in the hospital for almost 6 months.
Read Part 2: Reducing readmission penalties with transition coaching.