Becker's Hospital Review

36 Executive Briefing: The Patient-Centered Hospital Home • Avoiding unanticipated ICU admissions • Preventing cancelled/delayed surgery • Reducing length of stay • Improving patient satisfaction • Managing and facilitating the transition of care at discharge • Preventing unnecessary readmissions • Decreasing the need for blood transfusion • Decreasing risks from post-operative infection Building the PCHH To create an environment where all departments work together, hospitals must integrate service lines. Departments must be will- ing to communicate with one another to treat patients in a way that considers the patient's entire hospital experience and poten- tial outcomes, not just the treatment delivered by the individual provider at a fixed point in time. Hospitals should convene the most important participants in the PCHH to build consensus around this new approach to delivering care, including the following departments: • Emergency medicine • Hospital medicine • Anesthesiology • Surgery Once all team members understand their roles, hospitals should begin looking at the specific diagnoses where they can best col- laborate to produce better outcomes for the patient and hospital. Surgery and anesthesia In most hospitals, somewhere between 70 percent and 90 percent of all patients will need some sort of procedure or surgery during their stay, and approximately 65 percent to 70 percent of the costs of inpatient care come from surgical or procedural practices. The importance of surgical services makes it a natural place to begin a new focus on a coordinated, integrated inpatient care model. In fact, the American Society of Anesthesiologists is developing the Perioperative Surgical Home model as a way to provide better co- ordinated care throughout a surgical patient's stay. In the Perioper- ative Surgical Home, patients who need surgery are managed by a coordinated, multidisciplinary team from pre-operative assessment through the post-discharge period with the goal of reducing issues such as duplicate testing, surgical complications and lengthy hospi- tal stays while providing safer, more cost-effective care. For hospitals looking to become a patient-centered hospital home, the perioperative surgical home provides a strong base for expand- ing a coordinated model of care throughout the inpatient setting. Challenges and opportunities Re-engineering care protocols for a PCHH model can be a chal- lenging process. Because physicians coming together under a PCHH are used to working independently, garnering the necessary buy-in and achieving practice pattern changes may be very diffi- cult. This is particularly true if all the participating departments are operated by independent physician groups that have no incentive to work together, stay later or undertake whatever additional tasks may be required under new care models. One way to overcome this challenge is through consolidated ser- vice lines. Hospitals that choose to partner with a clinical outsourc- ing provider with the resources and experience in integrated care "home" models can, for example, create shared incentives for pro- viders to work together on new care protocols. Together, the hospi- tal and clinical partner create a shared-risk pool based upon mutu- ally desirable metrics that are tied to quality and service outcomes. If the provider teams achieve those metrics, then all involved physi- cians would benefit from the shared savings. This approach helps ensure that all providers are sufficiently motivated to do their part, even if it requires additional effort, so hospitals and patients can reap the rewards of better patient outcomes and lowered costs. Conclusion Transformations in the healthcare industry linking payments to quality are requiring hospitals to develop new approaches to de- livering care to operate more efficiently, improve outcomes and achieve high levels of patient satisfaction. By adopting the PCHH approach to care, hospitals can break down the internal siloes that cause costly inefficiencies, providing care in a multidisci- plinary, coordinated way that allows for better health outcomes for patients and better financial outcomes for the hospital. n Without Patient-Centered Hospital Home Model Duration: 6.5 days Cost: $20,275 With Patient-Centered Hospital Home Model Duration: 2.5 days Cost: $17,275 (15% reduction) TeamHealth is one of the largest providers of outsourced physician staffing solutions for hospitals in the United States. Through its 19 regional locations and multiple service lines, TeamHealth's more than 9,800 affiliated healthcare professionals provide emergency medicine, hospital medicine, anesthesia, urgent care, and pediatric staffing and management services to more than 860 civilian and military hospitals, clinics, and physician groups in 46 states.

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