Becker's Hospital Review

29 payment program has driven better quality and value in my area." Physician engagement and leadership is crucial as hospitals reorganize care processes around al- ternative payment models. e CMO of 15-hos- pital system in the Midwest said preparing for joint replacement bundles has helped hospital administrators and physicians collaborate on an issue that was important to both parties: re- ducing patients' length of stay. "at allowed us to partner with a subpopulation of orthopedic surgeons and get them on board as well," noted the CMO. "We were able to reduce length of stay, which for me is a proxy for quality." Strengthening transitions of care Care delivered in a hospital determines only so much of a patient's outcome. To ensure quality and reduce risk under bundled payments and other performance-based contracts, hospital leaders underscored the need to better under- stand their post-acute partners and refer patients only to those with demonstrable outcomes. Despite building strong referral relationships with post-acute settings in their market, hospi- tal leaders said they've encountered discrepan- cies in quality among providers as they work to standardize their post-acute care practices. "We realized that we had been discharging patients to skilled nursing facilities and rehab facilities with- out really understanding the variance in quality of care for each," said the vice president of ancil- lary services at a 350-bed hospital in the South- west. "We don't want to own all of the post-acute care, but we want to have good collaborations with our post-acute care partners and referrals." Traditionally, few executives person- ally visited or ob- served care in the post-acute facili- ties to which they referred patients. Once a patient was discharged, the hospital's role in his or her care was complete. But as hospitals begin to bear financial risk for a patient's overall outcome, executives said that standardizing care quality — from the very first patient touch to the very last — is a top priority. For many healthcare leaders, this means enhancing communication between caregivers and getting more involved in the ambulatory space. "We're working hard now on removing the barri- ers and walls between acute care and ambulatory care — even prehospital stuff," said the VP of an- cillary services. "We're trying to talk to everyone in the continuum, from the paramedics, to the folks in the hospital, to the folks in the clinics and then beyond. at's something we haven't done a lot of, but we're watching a lot of other organi- zations that are and trying to learn from them." Closing gaps in care and executing seamless transition services requires various organizations and caregivers working in concert. e ideal pa- tient handoff, described by executives, is one in which a patient is not simply discharged from the hospital to a post-acute setting, but instead enters a care pathway where he or she remains connect- ed to the hospital system. "Our president and CEO has been trying to re- frame the mindset so there isn't such a divide be- tween the inpatient and post-acute setting," said the VP of ancillary services. "Instead, patient care exists on a continuum that includes inpatient, ambulatory, outpatient and post-acute care. We are trying to get rid of the word 'discharge' from our lexicon. Instead, the post- acute care space is simply the next phase of care." Improving patient access Creating a comprehensive, integrated care sys- tem is another way healthcare organizations are working to improve care quality. Finding ways to deliver care to high-need patients in remote, hard-to-reach places emerged as an important quality initiative among healthcare executives. Patient access in- volves everything that affects a pa- tient's ability to get the right care at the right time, in the right place. Several factors determine a patient's ability to access care — cost, health insurance status and other socioeconomic factors. Given this reality, healthcare providers are getting creative about what they can control to give patients better op- portunities to access and receive preventive and necessary care. "Increasing patient access is our No. 1 quality initiative," said the vice president of ambula- tory growth for a four-hospital system in the Northeast. Her system established an access center which connects patients with care teams in different ways. e center includes home health services as well as telehealth in the form of e-consults, texting and web chat. A growing number of hospitals and health systems are find- ing these e-visits or other telehealth solutions to be viable ways of expanding access at a relatively controlled cost. In addition to telehealth, the VP of ambulatory growth said her system's access center has a pa- tient-physician pairing program, in which each patient who arrives as the emergency depart- ment is matched with a primary care physician before discharge. e center has proven espe- cially useful for vulnerable populations who seek care from competing hospitals in the area. Leaders raised chronic condition management as an opportunity for improving quality and ac- cess through new and creative delivery models. One option mentioned: shared medical appoint- ments. e COO of a major academic medical system in the Midwest with satellite sites in two other states said the biggest complaint she heard from patients in the past, "I can't get in." e sys- tem's CEO set out to change that. "is was unbelievable to me as a nurse, but shared medical appointments for certain diagno- ses have really been successful," she said. e ap- pointments are one way for patients to not only check in with their care teams, but to connect with a community facing similar challenges, questions and lifestyles to manage their condition. "ey have virtual visits with their doctor and they access the virtual group by phone once a week," said the COO. "Shared appointments are not for e v e r y t h i n g , but obesity and diabetes are two great examples — those patients really did want access." Like group appointments, some systems are see- ing that not every patient nor case demands a traditional appointment at the general medical group office. One leader proposed clustering ser- vices by specialty so the entire episode of care is delivered under one roof. is would improve access by reducing the handoffs, appointments, wait times, rescheduling and other barriers pa- tients face for even the most routine care. "Certain conditions like diabetes, we should be building centers of care, both virtual and physi- cal, where your diabetic patients come to a place that's easily accessible," said the chairman of or- thopedics at a 535-bed teaching hospital in the Northeast. "ere, they are not just seeing endo- crinologist, but a team — including nutritional counseling — at the same site. eir testing done there, their medications can be dispensed there — we should be doing that for many conditions." Stay tuned for this continued dialogue, part three of this series, to be published in the October issue of Becker's Hospital Review. n

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