Nayda Nibe was hospitalized in November 2005 at Mercy Medical Center in Des Moines, Iowa, with a severe heart attack. Nibe, who has lived for nearly 60 years in the same Blairsburg, Iowa, farmhouse her grandfather built in 1882, fit a profile that doctors there expected would land her back in the hospital for readmission. She was then 80, lived alone and suffered from congestive heart failure, the leading admission and readmission diagnosis for patients older than 65, according to federal health statistics.
“I was pretty worried about her,” Mercy nurse and case manager Angela Schulte says. “But her daughter, who is also a nurse and looked after her, recommended she enter our tele-case management program, and we thought she’d be a good candidate. She’s been doing great ever since.”
Nibe is that rare heart failure patient who hasn’t ended up back in the hospital after discharge. She says that’s partly due to Mercy’s tele-case management program that monitors her weight and health signs and intervenes with changes in medication or other therapies before a trip to the emergency room or rehospitalization becomes necessary.
The program has cut hospital readmissions for congestive heart failure patients at several of Mercy Health Network’s Iowa hospitals, saving patients the added trauma and cost of readmission, which places them at greater risk of dying in hospitals, and saving the health care system huge preventable costs.
“It’s really helped me,” Nibe says. “When my weight goes up or down, they call me. If they’re really concerned, they ask me to see my doctor. They’ve kept me out of the hospital and even saved me money on doctor visits.”
Mercy’s tele-case management program, which launched in 1999, is one of a number of promising efforts nationally to reduce hospital readmissions. Patients are regularly screened for heart failure and quarterly for depression. The program appears to be catching on as Iowa’s Medicaid program and private payers invest in tele-case management.
“This has had a very positive effect on patient lives. They feel like somebody is watching over them,” Schulte says. “It’s easy to use and has been free to patients. I tell them they have nothing to lose; it takes only a minute or two out of their day. It’s getting them to know their bodies and is a great way to watch them from afar.”
Sandy Hall, heart failure case manager for Mercy in Des Moines, says enrollment is down from 150 several years ago when a one-time $180,000 grant from the federal Health Resources and Services Administration subsidized the program. “Financing makes a difference in how many you can enroll,” Hall says, adding that the program has worked partly because of the increased education the case managers provide.
At the 10 Mercy hospitals using the tele-case management system, readmissions for congestive heart failure dropped 86 percent among enrolled patients in 2002 over the previous year, 83 percent in 2003 and 88 percent in 2004. Emergency room visits fell by 81 percent in 2004, according to Paul Conlon, senior vice president for clinical quality and patient safety for Trinity Health, Novi, Mich., which co-sponsors the Mercy Health Network with Catholic Health Initiatives, Denver.
Conlon says Trinity has built into its electronic medical records a more rigorous discharge process and plans to add checklists that would make it easier for patients and discharge planners.
“Avoiding readmissions gives us more capacity and helps us with our throughput,” says David Hickman, director of clinical integration for Mercy Health Network. “For some of our hospitals, heart failure is not a profitable DRG and if we can avoid readmissions for it, we do, particularly in Iowa, which has one of the lowest Medicare reimbursement rates in the country. But finally, our values teach us that this is the right thing to do for patients. The grant got us started, but even though we have no grant subsidizing the program now, some of our hospitals continue the program because it’s good for our patients. Our system is low-cost and helps justify patient participation.”—Mark Taylor
This article 1st appeared in the May 2008 issue of HHN Magazine.
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