Section 1: Introduction A. About This Course B. Ambulatory care providers are the first line for preventative care in the healthcare industry. However, as the healthcare industry shifts away from a “fee for service” model, and towards a “pay for performance” model, outcomes have become the new currency. As such, a change in behavior and health practices are needed to reduce readmissions. Common reasons for readmissions can be alleviated via several common practices and prevention measures. These measures address: a. Reminders for Yearly Preventative Care b. Exercise Recommendations for Older Adults c. Aspirin Use for Comorbidities d. Vaccines for prevention of communicable Infections C. In this course, you will explore several ways in which you as a healthcare provider can contribute to the reduction of readmissions. D. Learning Objectives Section 2 Case Study A. Meet Cathy a. 67/F. Volunteers at church daycare. Admit AMI r/t sedentary lifestyle. Goes home and has another AMI 8 mos later. Readmitted, gets pneumonia (kids at church? Hospital acquired?) B. What went wrong? a. No PCP follow-through, no exercise plan/inadequate discharge planning and teaching, no children’s aspirin for AMI prevention, no vaccine C. Review D. Summary Section 3: Reminder for yearly preventative care and exercise recommendations A. Need for preventative care • Did you know that the top 5% of patients (by individual healthcare dollars spent) account for almost half of the dollars spent on healthcare costs, totaling nearly $623 billion? On average, this patient is paying nearly $41,000 annually. But what does this patient look like? As one might expect, they are typically over the age of 64, and while they make up just 13% of the US population, they account for 40% of the top 5% of spenders on the healthcare system. Typically, these patients have at least one chronic condition. Due to the costs associated with these patients, their outcomes can be very impactful from a financial standpoint to a healthcare system. To help prevent readmissions, it is advisable that facilities take the necessary steps to cut down on readmissions and address the potential health issues of these patients before they happen. One of the prevention measures in place to address preventative care involves the use of data for population management. • At least annually, practice proactively identifies populations of patients and reminds them, or their families/caregivers, of needed care based on patient information, clinical data, health assessments and evidenced-based guidelines including: i. At least two different preventive care services. ii. At least two different immunizations. iii. At least three different chronic or acute care services. iv. Patients not recently seen by the practice. v. Medication monitoring or alert. • By proactively reaching out to patients or their families with health advice or addressing health concerns, the patient is at a lower risk of being readmitted for a complication that could have been addressed before it progressed to something more serious. B. Exercise Recommendations • Although the benefits of regular exercise have been consistently demonstrated, over half of the United States’ older adult population is considered sedentary. Older women in particular are at a higher risk of morbidity and mortality related to sedentary lifestyles, according to the CDC Behavioral Risk Factor Surveillance Survey. • In order to help combat this, a measure was created to “assess the percentage of Medicare members 65 years of age and older who had a doctor’s visit in the past 12 months and who spoke with a doctor or other health provider about their level of exercise or physical activity.” • With this measure, the healthcare system itself is able to help drive an increase in physical activity within the elderly population. According to the CDC, older adults need at least 2.5 hours of moderate aerobic activity (such as walking) every week, AND some sort of muscle training 2 or more times per week. • AHRQ states that there is currently a low prevalence of physicians counseling patients to exercise. However, care providers can do their part to encourage physical activity in their patients by: i. Setting physical activity goals with patients ii. Writing exercise prescriptions, or iii. Referring the patient to a physical trainer C. Review D. If Cathy had been reached out to by her PCP, or encouraged to exercise, she might not have come back Section 3: Aspirin and Comorbidities A. Cardiovascular-related conditions are the leading cause of death in the United States. Over 1/3rd of the adult population in the United States has some sort of cardiovascular disease, and on average, one death is caused by it every 40 seconds. B. Encouraging aspirin use can reduce heart disease and improve clinical outcomes in patients with a cardiovascular history. HEDIS (Healthcare Effectiveness Data and Information Set) defines the measure around Aspirin use as the “percentage of members currently taking aspirin. A single rate is reported, for which the denominator includes: Women 56-79 years of age with at least two risk factors for cardiovascular disease, men 46-65 years of age with at least one risk factor for cardiovascular disease, and men 66-79 years of age, regardless of risk factors.” C. As a primary care provider, you can encourage your patients to use low-dose aspirin to reduce the risk of heart disease or heart attack. However, it is important to discuss with patients the risks and benefits before beginning an aspirin regimen. D. Review E. If Cathy had been on an aspirin regimen after her first AMI, she may not have had a recurrence. Section 4: Vaccines for Prevention of Communicable Infections A. Pneumonia is a common illness among immunocompromised and elderly patients. According to the CDC, Pneumonia accounts for more deaths each year than any other vaccine-preventable disease. Pneumonia is a very taxing condition to older adults, however it is also easily preventable, and the vaccine is both safe and effective. B. The quality measure used to address vaccinations uses survey data to assess the percentage of Medicare members 65 years of age and older (as of January 1 of the measurement year) who have received a pneumococcal vaccination. This measure is consistent with recommendations from the Advisory Committee on Immunization Practices (ACIP) in that it recommends that all individuals over the age of 65 receive the Pneumonia vaccine. Many older adults may be unaware of the need for a Pneumonia vaccine, or they may be under the impression that the vaccine is not useful or safe. It is up to the primary care provider to address these concerns so that the patient may make an informed and safe decision. C. Similar to Pneumonia, an influenza vaccination is the most effective method for preventing an influenza infection. The quality measure for influenza vaccination is used to “assess the percentage of patients aged 6 months and older seen for a visit between October 1 and March 31 who received an influenza immunization OR who reported previous receipt of an influenza immunization.” D. Vaccinations are important not only because they can prevent infections, but also because they can help prevent the SPREAD of infection to those who are unable to receive vaccinations, those who are immunocompromised, or to those who are otherwise at an increased risk of infection. This is known as “heard immunity.” Even if an individual is at an increased risk of infection from a particular organism, if they are surrounded by those who are immune to that particular organism, the individual who is at an increased risk has a significantly less chance of contracting the illness from their peers or environment. E. Review F. If Cathy had a vaccine, she would not have contracted pneumonia from the hospital
Lisa Hohlbein, RN, CDP brings over 25 years of healthcare experience and offers cutting-edge expertise in the areas of the RAI process and clinical reimbursement systems. Her experience includes performing and overseeing various reimbursement reviews for Medicaid and PPS in multi-state, skilled nursing facilities, long-term care, and sub-acute care assessment and operations. Lisa has presented workshops on a variety of topics at the facility, regional, state, national, and international (Canada) levels. She was a Master Teacher with AANAC, participated on their Expert Advisory Panel, and has presented at their annual conferences. Lisa has also been a contributor to MDS Alert, Provider Magazine, LT Living, and AANAC's LTC Leader. Lisa is also a Certified INTERACT Educator, Certified Dementia Care Practitioner, and was previously a Certified Alzheimer's Disease and Dementia Care Trainer. Disclosure: Lisa Hohlbein, RN, CDP has declared that no conflict of interest, Relevant Financial Relationship or Relevant Non-Financial Relationship exists.