Before cardiac surgery patients are discharged from St. Luke’s Boise (Idaho) Medical Center, they are referred to the hospital’s cardiac rehabilitation program.
The 12-week program offers routine monitoring by clinicians for patients who recently underwent open-heart surgery, a valve replacement or any other type of cardiac procedure.
The rehab center is staffed with a multidisciplinary team of healthcare professionals including physicians, nurses, respiratory therapists, dietitians and social workers. The program provides patients additional education about their disease, help with personal issues that might prevent them from following the treatment plan, and exercise and nutrition courses that can help speed their recovery.
About 95% of cardiac surgery patients enroll in the program, and it has contributed to lower readmissions since it launched in 2009. About 14.7% of heart attack patients are readmitted to the hospital after 30 days, below the national average of 16.8%.
“We try to standardize follow-up within our practice,” said Dr. Stefanie Fry, chair of the department of cardiovascular services at St. Luke’s Boise.
The sharp focus on ways to address every aspect of the care continuum is a hallmark strategy of St. Luke’s Boise and other hospitals recognized this year in the Watson Health 50 Top Cardiovascular Hospitals (formerly known as the Truven Health 50 Top Cardiovascular Hospitals) study. Hospitals considered to be leaders in cardiac care standardize and invest in approaches that not only improve the health of their patients during their inpatient stay but long after discharge as well.
Focus on the continuum of care is in line with the move to value-based payment, said Jean Chenoweth, senior vice president of the Center for Performance Improvement at IBM Watson Health.
“Value is starting to increase over time,” Chenoweth said. “When hospitals are focused on the continuum of care and they don’t let it go, they maintain their focus on that quality of care and the industry changes as a whole.”
The 19th annual study reviewed 1,016 hospitals and recognized 50 that provide exemplary care in one of the industry’s largest specialties. Heart disease is the leading cause of death for men and women in the U.S., accounting for 1 in 4 deaths every year. And each year about 735,000 Americans have a heart attack, according to the Centers for Disease Control and Prevention.
The 50 hospitals on Watson Health’s list scored higher than their peers on clinical outcomes for heart attack and heart failure treatments, as well as coronary bypass and angioplasty surgeries. The hospitals performed better on mortality and complications, as well as 30-day mortality and readmissions. On average, their procedures cost less and patients had shorter hospitals stays.
Similar to previous years, Watson Health divided the top hospitals into three categories—15 teaching hospitals with a cardiovascular residency program, 20 teaching hospitals without such residency programs and 15 community hospitals.
To get its results, Watson Health uses the most recent CMS data from the Medicare Provider Analysis and Review file, CMS Hospital Compare and Medicare cost reports. Watson Health also added two new measures this year to its analysis: 30-day episode payment for heart attack and heart failure patients. The additional measures reflect the movement toward population health management as hospitals are expected to manage the quality of care of patients after discharge, said Julie Shook, 100 Top program director of value-based care at Watson Health.
Chenoweth said it’s increasingly difficult for 50 Top hospitals to beat their peers because cardiovascular care overall is improving. Indeed, the 50 Top hospitals performed less than 1% better than peers on 30-day mortality and readmission rates for heart failure, heart attack and coronary artery bypass surgery patients.
“The fact is quality is improving in cardiovascular care over time,” Chenoweth said. “The hospitals are benefiting from newer technology and treatments.”
The vast majority of the 50 hospitals being recognized for their cardiac care were veterans on the list, but there were also eight newcomers, including Wake Forest Baptist Medical Center, a teaching hospital in Winston-Salem, N.C. The hospital has recently focused on ways to prevent costly readmissions and streamline post-discharge care among its heart patients, said Dr. David Zhao, chief of cardiovascular medicine at Wake Forest.
In 2014, the hospital began to incorporate pharmacy technicians into the discharge protocol. The patients receive a 30-day supply of their prescribed medication before they leave the hospital, up from just a seven-day supply. The longer time period ensures patients stick to their medication regimen and have time to sort out a prescription refill, Zhao said.
Additionally, 48 hours after patients are discharged, a nurse calls to check in on their health status and to make sure they are following the care plan. A mandatory follow-up appointment also occurs at the hospital seven days after discharge.
The hospital has seen its readmissions rate fall since the initiative was launched. “We can understand if there are issues medication-wise, or with their living circumstances like transportation—those are things we can catch earlier and intervene so they won’t be readmitted,” Zhao said.
But ensuring appropriate follow-up with patients after discharge isn’t without challenges. Wake Forest cares for a large rural and Medicaid population, so the hospital needs to coordinate care for complex patients, Zhao said.
“Enough manpower has always been a challenge,” he said. “Who is going to make phone calls to patients and make sure they can care for themselves?”