Dartmouth-Hitchcock among best nationally in readmission rates

Beginning in October, more than 2,200 hospitals across the country will begin paying penalties for having poor readmission rates with their Medicare patients as part of the government’s overall effort through health care reform to improve quality and lower costs of care.

Mary Hitchcock Memorial Hospital, part of Dartmouth-Hitchcock’s (D-H) academic health system, will not be one of those hospitals. In fact, D-H achieved excellent performance on this quality measure (low readmission rates), ranking in the top one percent of hospitals in the country in its care of heart failure and acute myocardial infarction (heart attack) patients, and in the top 15 percent for pneumonia patients.

The results – which are based on discharges from July, 2008 through June, 2011 – are even more impressive considering that D-H is a major “safety-net” hospital in New Hampshire, providing services to patients who are unable to pay for their care. On average, safety-net hospitals (mostly academic medical centers) had higher readmission rates than their counterparts.

“Had we been in the penalty category, it would have meant about a $1 million payout for us,” says George Blike, MD, Chief Quality and Value Officer at D-H. “Our performance in this area reflects the exemplary work done by Alan Kono, MD, and the cardiology care management team, as well as Darlene Saler, RN, and the care management team, who are real experts in coordinating follow-up care for patients so they can recover successfully once they’ve left the hospital. After all, that’s what reducing readmissions is all about – improving the care we provide to our patients.”

While significant, the Medicare penalty (and future reward) initiatives are but one example of how D-H is working with partners regionally and nationally to help lead the shift from a volume-based (fee for service) to a value-based health care reimbursement system. In the coming year, the organization will be engaged in a number of governmental and commercial (insurer) incentive programs – all aimed at making care more effective and efficient for selected populations of patients.

These programs will have a total financial impact of about $40 million (about $25 million in potential reward and $15 million in potential penalties) that will include more than 80,000 patients, says Gregg Meyer, MD, MSc, Chief Clinical Officer and Executive Vice President for Population Health at D-H. Meyer notes, “We are off to a good start, but the number of metrics for which we are at risk and the rising bar for performance mean that there is much work to do.” 

The impressive progress D-H has made in recent years, in advancing its quality and safety programs, is providing a solid foundation for this new model of health care. As its most recent milestone, the organization created the Value Institute in 2011, which is using proven process improvement methodologies from industry – what Blike calls “the science of high reliability” – to provide the education, coaching, and infrastructure needed to improve quality and reduce costs throughout its health system.

“This clearly identifies some of the strengths of Dartmouth-Hitchcock,” he says. “While we’re not going to be able to excel in all areas, we have a number of key advantages that I think position us well to be successful in the future. They include: having excellent commitment and leadership ‘on the front lines,’ where care is provided by dedicated, talented people who care deeply about the patients and families they serve; a strong accountability system with clear goals and the tools needed for measurement; and a reorganized quality and safety infrastructure that can support sustained improvement work across our institution.”

“You know, we don’t have a national health care system that is financially sustainable at this point,” adds Blike. “We’ve got to create it, and part of creating it is going to be executing change and using value as our guide.”

ABOUT DARTMOUTH-HITCHCOCK:

 Dartmouth-Hitchcock is a national leader in patient-centered health care and building a sustainable health system. Founded in 1893, the system includes New Hampshire’s only Level 1 trauma center and its only air ambulance service, as well as the Norris Cotton Cancer Center, one of only 40 National Cancer Institute-designated Comprehensive Cancer Centers in the nation, and the Children’s Hospital at Dartmouth-Hitchcock, the state’s only Children’s Hospital Association-approved, comprehensive, full-service children's hospital. As an academic medical center, Dartmouth-Hitchcock provides access to nearly 1,000 primary care doctors and specialists in almost every area of medicine, as well as world-class research at the Audrey and Theodor Geisel School of Medicine at Dartmouth.