Please stand by for realtime captions.
Good morning everyone and welcome to today's teleconference before handing the
microphone over to the moderator, I would like to remind everyone that your line is in
the us and only mode. If you should need assistance during the call, you can press the
start zero under to -- touch tone phone. To reach an operator.
At this time, I will go ahead and turn it over to your moderator, Joyce read.
Thank you so much Rochelle and good morning everyone. We have exciting program
today. You asked for some information on medication management. And how can we
make the transition from home from the hospital to home. And how folks are really
looking at different programs. And it is my pleasure to introduce several different
practices that are being implanted and dashed into of our hospitals and in partnership
with grades positions program. So our objectives for today is to discuss the purpose of
the Walgreens will transition to Graham, as well as to claim the role of the clinical
AIDS on fusion nurse and the role in the bedside education vacation reconciliation.
And then we're going to ask actually list -- it jacking will tell us how they are using
the Walgreens medication distribution program. And some of what they have found in
the implementation of this program and the impacted his hat on the admission. And
then Edna -- she had given just a brief little introduction to what they are doing with
their pharmacist in discharge planning. So she and her pharmacist is actually going to
talk a little bit about how they are looking at the navigation reconciliation with the
role with a pharmacist and how the pharmacist is actually coming in and discussing
with the patient their medication.
So we would hear a little bit about what they have learned from their program. And
again, what we have heard from you all is that you want to know the how of will we
are doing. And we are actually after talking with -- and discussing medication
management -- that we want to take a look at some of what is happening with our
data. Because data does drive. And we will go over that.
The other thing that we will actually talk a little bit about also is [ Indiscernible ]
charts and we are coming down to our last month in the CMS challenge of reducing
readmission by December -- I 10%.
So we have a lot going on. And so I want to first of all just think our individual -individuals for speaking -- who got on board and said yes we will be more than happy
to share what we're doing. So thank you so much to Brandy, to Jackie and to Edna.
And I would like to have her shell -- if you could please bring up the slides -- from
Brandy. And while she's doing that -- I just want to make sure that everyone is aware
that we do have -- we are benders of the care product. But we are not going to be
discussing the care products during this session.
So Brandy -- I will turn this over to you.
Thank you Mr. a. And for so want to thank the Georgia Hospital Association for this
wonderful opportunity. As a healthcare provider and Excel -- healthcare providers we
all know [ Indiscernible ] readmission and the readmission rates floor. And also
focusing on these hierarchies and how we can get cetacean at home, and not remitted
with 30 days.
Walgreens has developed a tradition program. And our goal is to assist increasing
hospital readmissions and also to increase patient medication reconciliation. And
compliance.
We will sit down and we sit at roundtables and we discussed what can we do to
improve, we all can come up with a common analogy about cost. We have to look at
cost and how it is affecting everyone but
This chart challenges facing healthcare practices today. We're spending about $5
billion annually. In preventable hospital readmissions cost. About 40% of
readmissions were nearly 1,000,000, are avoidable and this is something that
Walgreens is aware of and we want to partner up with the organization to make sure
that we are doing our heart in decreasing readmission and help lower these costs.
Medication adherence challenges of course cost us $100 billion a year talk with this,
Walgreens has developed the will transition program now so the bedside delivery
program. To give you a little bit more numbers -- reading from medication appearance
-- to give you more numbers at percentages, reasons for medication not inherent -number one reason is forgetfulness. As healthcare providers we have to recognize
when a patient is going through for stations -- stages of dementia or they have a
diagnosed psychosis [ Indiscernible ] -- something that is causing a different
medication -- think this is an important fact. Side effects of the medication -- getting
the patient from the family to -- and the families to understand that the side effects
versus the benefits of the medication -- and if they feel that the side effects are too
much for them to communicate with physician or healthcare providers.
Also we have to recognize that cost of healthcare and medications for some patients is
very expensive and they typically cannot afford it.
The benefits of the medication for the -- I'm sorry -- the belief of the medication -some patients -- depending on their culture -- may believe that herbal medications are
better. They may want to try the herbal way versus a traditional way.
And the complex via Regiment.
The complexity of the Regiment is very important. Especially for newly diagnosed
heart patients. You know they go from maybe not taking any medication on Monday,
and then upon this chart on Wednesday, they are asked to take for five different
medications. And understanding how each dedication needs to be taken at what time.
Whether it is a bit of block or H. inhibitor -- the Q8 hours -- you go from being a
regular citizen with no medical background to saying that you have 12 medications -looking at your space and you have to understand not only the mechanism of the
medication, when to take the medication and what type to take the medication and
even as a healthcare provider for me it would be difficult -- so as a patient we need to
understand that sometimes the Regiment is just too complex to them.
Lack of access is very important -- that is about 10% of the reason for not adherence.
Unfortunately everybody does not have a Walgreens card with a CVS across the street
and maybe efforts diagonal but every -- some people actually don't have access to a
pharmacy. And we have to take that into consideration. Location of the patient. Do
they have a family member that would take ownership of the medication to make sure
that they are getting their resale in a appropriate manner -- refill.
And of course other -- there are other reasons that we can all think of that may lead to
medication nonappearance. Some of the ones that I thought of is some patients just
don't want to. They are newly diagnosed with a chronic illness and they just
absolutely don't want to cut the fact. And they do not want to take the medication.
Another reason that I thought about as well is some patients might -- like to try the
natural approach. According to -- it could be religion, it could be called sure but the
regions -- reasons may lead them to decide that they want to take the natural approach
that I have to find the natural approach -- they I realized that they have to go to
medications that their physicians ordered.
So I am going to get into a little bit about the bedside delivery -- medication program.
Bedside medication delivery -- offers a pharmacist of the patient to patient. And this
will include the caregiver. It also offers EBD it thought of therapy.
Once the patient is ready for discharge, the discharge prescriptions can be faxed to the
local Walgreens pharmacy or some hospital that has the on-site pharmacy that backs
up to the on-site Percy. The pharmacist technician will deliver the medication upon
discharge to the patient prior to leaving the hospital.
I think this is very important because as a nurse, I have seen in several cases -- the
patients are either too thick to stop by the pharmacy, sometimes they just want to get
home. And they don't realize the importance of getting this medications in the hands
prior to getting home.
I have had certain patients tell me that once they got home, they were home alone it
did not have a right to the nearest pharmacy. So getting that medication in their hands
prior to discharge is a key factor.
If we can actually go to slide seven please.
And I want to talk a little bit about the will transition program and the importance of
this program. It address three key hospital system needs. With the one single
integration program.
Number one is -- it will improve patient outcome. Number two -- it will reduce
penalties for a portable readmissions. And also it will improve the H. Score and the
joint commission accreditation score.
Which we all know are very important.
Will transition takes patients from the health system to the home. And also joint
outcome reporting qualifies the value of Walgreens will transition program.
So let's get into the details of the will transition program. Well transitions and how it
works. After the patient in Lex the program, the start of the program will begin.
Is like the medication reconciliation. The Walgreens pharmacist will access the patient
vacation history. Be a -- via a national crime database. Overview -- the pharmacist
will then activate the medication list which is then shared with the hospital staff.
From there we go to the patient Woelfel -- Walgreen. The Walgreens pharmacist -technology -- technology centers the patient's room, indicates the transitions -- and
indicated that time -- she will collect different -- -- additional information if needed
such as insurance information or updated our two list. Demographic. Demographics is
very important because on file -- the patient may have their leg -- local address
however he or she may be living with her daughter, his mom.
So think of that and make sure that -- it is very important in Walgreens has taken the
initiative to step up to the plate and make sure everybody's on the same plane with
that.
Medication validation -- hospital staff reviews the active medication list with patients
to verify access to medication. This list them becomes the BAM -- which is the
validated activated -- activated medical us.
Hospital staff will e-mail back to the pharmacy where Walgreens will update the
CAM and allocate all the medication information.
Next we were going to therapy planning.
Prior to discharge -- and I cannot stress this enough -- prior to discharge the hospital
staff was in the prescriptions to the Walgreens pharmacy.
Medications are filled, and synchronized for refills. 30 days post discharge.
So this time the pharmacist is already planning for the resale of the medication within
30 days but
The pharmacist performs a discharge medication reconciliation. The pharmacist will
then update the BAM. And print out patient copy.
And then here we go for the bedside delivery.
The pharmacy technician will deliver the medication. And a copy of the be -- BAM to
the patient's room.
You will also obtain the patient's signature. And technicians at the time will offer
counseling for the patient and the patient's daily member.
Some muscles have a Walgreens on site location -- some hospitals have a Walgreens
location and some patients are able to go to bedside and do counseling at the bedside.
If not a pharmacist is always available via phone. Neck therapy review.
Approximately 48 hours post discharge the Walgreens pharmacist will contact the
patient to review the medication to therapy.
And took a on the adherence and answer any medical related questions. Medicated
relation -- related questions.
The pharmacist will also verify that the patient has appointments with appropriate
healthcare providers. For continuation of care. And this is very important. Most
patients or some patients go home and they don't follow-up with their color -cardiologist or enter all or just or pharmacologist in a timely manner. They are just
writing it on the discharge sheet -- follow-up in one week. They are asked to not -- to
make employment -- sometimes they don't get to cardiologist in a timely manner.
Also with this -- the patient will have a copy of their VAM but once they actually go
to the physician and they have that follow-up appointment, they will have a copy of
the VAM with them. Which is important because it is not the patients hand written
medication list where they have the dosages confused -- they may have switched from
one data block to another beta blocker and did not realize it is the same drug
mechanism.
This actually comes from the pharmacist and is updated upon discharge.
And then we have the community integration but a pot -- approximately tarmac the
Walgreen pharmacist will call the patient, for review the medication therapy. And
asked the patient for his or her pharmacy of choice.
And from there the resales will be initiated.
So that is the overview of the will transition program and how it works and how
Walgreens will implement the program.
From well transitions we will get into home infusion services in the benefits. The
benefits of home infusion services includes the fact that patients have an increased
risk of contracting to -- additional infections for longer they are hospitalized. Our goal
is to get the patient out of the hospital as soon as possible. To prevent additional
infections.
Being at home is an added protection against the risk of serious [ Indiscernible ]
infection.
Pathogens come in the hospital [ Indiscernible ] the end of Eddie's [ Indiscernible ]
been in the home.
And their the 82% were line infection rates for patients receiving infusions at home.
I'm sorry -- which slide number is that exNumber 12.
Sorry about that.
Now here we go to the big word again -- cost. The average cost per day of home
fusion is around $150 $150-$200 a day.
The average cost per day at the hospitalization is around 1600 $1600. To $2500 per
day.
So at home infusion programs -- our goal is to help assist you get the patients out of
the hospital and their infusion to continue at home.
The role of the clinical liaison with the Walgreens home infusion program.
Introduction to the Walgreens home infusion team in a relationship with the
Walgreens retail pharmacy.
This is very important because we don't want patients to take their patient -- basic
Walgreens home infusion perception and drop it off at the Walgreens retail store. So
make sure that they understand the difference between the two -- however we are one
company that works together.
Bedside education in assisting the patient and family members with understanding
discharge instructions as it relates to home ID medications. And many cases, patients
have not had home ID medications before or a family member that has had ID
medications and what they are -- are aware of the process. So we make sure that we
educate them thoroughly on the importance of of underlying care. To do that
appropriately.
We also want determined that they will have a nurse -- whether it be from the infusion
team or a home health agency but we -- that they can contact if they have any
problems that
Providing them with needed contact information. 24/7 access to specially trained
nurses and dietitians and infusion pharmacist. And most important -- the clinical
liaison is the bridge between the hospital, the patient, and the Walgreens home
infusion local branch.
Home in fusion services in the benefits also provide personalized they should care.
We understand that every patient is different but every situation is different. And to
have that clinical liaison -- at the bedside to introduce himself or herself to the patient,
and to get to the patient and their circumstance, makes it very personable.
Also the clinical liaison -- their importance of reviewing the patient discharge
instruction -- discharge medication -- erring physician information, primary care
physician information, and any specialty position that is involved in patient care.
We realize sometimes that physicians are very busy and they may not communicate
with each other. So we tried to make sure that everyone is on the same page,
especially upon discharge. If the ordering physician is in total medicine physician -however the patient they have an ID position on console or cardiologist on Consul.
We make sure that everyone is aware and that everyone is on the same page.
We have an understanding of who is actually going to be following the patient upon
discharge and following the patient through throughout -- the infusion service.
Walgreens also provides for beyond infusion services but we have a 24/7
English/Spanish bilingual support program.
We also we have home management on infusion and the retail level. So not only does
the infusion services provide core management for retail [ Indiscernible ] as well and
some of those here seen -- HIV, heart failure, nutritional support, and anti-effective
therapy.
Publication services in the benefits continue with -- we are a proven partner in the
fight against infection. And those include cellulitis, I sue my latest bacteria.
Complicated respiratory infection such as cystic fibrosis. Post operative infections,
and compensated urinary tract infections.
And most important, 98% overall patient satisfaction. With home IV infusion but we
all want to make sure our patients are taking care of in quality, not in quantity. So
Walgreens has initiated all these programs to help the national and local facilities in
ink -- decreasing readmission and medication inherits and compliance. Thank you.
Thank you so much brandy. And I think what would like to do now is have Jackie
from [ Indiscernible ] talk about what you all have put into place in regards to
medication management. And how working with the [ Indiscernible ] and having the
medication by the bedside has helped in reducing your it readmissions. Or Jackie I
will turn it over to you.
Thank you but -- thank you.
And is Michelle setting up the presentation -- there we go.
Okay we can advance to the next slide. I am Jackie Paynter I am the Executive
Director of care management for the cab medical Center. And we have to -- if you
care hospitals -- the hill and dale campus and [ Indiscernible ]. The [ Indiscernible ]
facility has 407 beds, and the hill and dale that -- facility has 100 beds but we will talk
a little bit more about some of the specifics of those two hospitals shortly.
First of all the burden of remission. First of all -- we all know that the burden of
remission at the hospitals -- the top 15 drivers of readmissions are the ones that
probably most hospitals the -- which are heart failure, read a file -- failure psychosis -pneumonia, respiratory failure. Red blood cell disorders and facility represents sicklecell -- primarily and [ Indiscernible ] UBI diabetes. In the top 50 DRGs represent 33%
of our it readmissions on the campus. And 40% of the readmissions on our hill and
dale campus.
With the average admission rates for the top 15 being 15 average admission rates for
the top 15 being 15.5%. Our overall readmission rate is around seven Our overall
readmission rate is around 7% -- when you take all discharges into account.
So this diagnosis really is the driver of remission.
We design these around Coleman transition models -- to talk about -- we will talk
about that shortly but those are the elements that you see there -- assessment,
caregiver education family education. And over communication between writers -discharge planning and community connection are the drivers of our models.
And we all know where we stand with the CMS pay-for-performance around
readmissions. Of course we are all in the second round of that -- actually the third
round of the measurement time talk
Right now.
This is the federally fiscal year 13 performance for our hospitals on the readmissions
for CMS Medicare, AMI heart failure, pneumonia. And you can see that North
Decatur facility -- if you look to the far right, that accessed readmission ratio was the
measure that is used to determine whether the impact is by penalty for your remission
rates.
So the -- there is a predicted risk with hospital rates -- those are readmission rate for
our facilities -- compared to the national expected risk adjustment rate. And when you
compare those infected -- and factor them -- the accessed readmission rate shows how
you can stack up against the expected.
So the for the North to cater camp as you can see that we did well on heart failure and
required pneumonia comparably. But then on am I week see the expected slightly.
On our hill and dale campus, we perform well on AMI and heart tell your
comparatively, but our [ Indiscernible ] required pneumonia rate was 14% higher than
expected.
So we were penalized at the hospital for our performance one. Thirty-day
readmission.
We have some intervention that we put in place for managing readmissions over the
past -- I would say starting in 2010 and going forward -- at its developed our
readmission program.
So we had a heart failure focus care Corporation initiative. We learned a lot about
heart failure -- readmissions with that and one of the key drivers of it readmissions for
heart failure patients has to do with medication management. We are finding that
many of the heart failure patients come back to the hospitals with dehydration after
being diarrhea that can -- for the congestive heart failure on initial mission. That was
pretty interesting. So we put the focus intervention around that -- the post to start
classes.
The next one is in the location of risk assessment tool. We can go back to the slide.
Processes to identify patients in the E. and to target our residents of greater flyers. We
expanded our social work coverage. And we implement the bedside delivery which
we focus on my discussion today. We implanted post discharge phone calls, and we
also I lamented heart failure education with the red, green and yellow heart failure
ventilators for the patient.
This is our pepper report for the nurse Decatur -- North Decatur hospital. And you
could see the readmission for the same hospital -- are slightly below the national
jurisdictional and Georgia State rate.
We run about 15% on thirty-day readmissions to Medicare to our own hospitals.
Our readmission rate or all hospitals ones in the 25 -- 20% range. Again we are right
in line with other hospitals around the country. On this measure.
Our hill and they'll hospital is seeing an increase in the readmission rates for our
patients there. And one of the things that pepper hospital has a really dramatic growth
in volume in the case making nation population.
And here you have with you see -- you look it readmissions to all hospitals when we
are exceeding the performance of other hospitals nationally and locally.
So the section -- I will focus on the bedside delivery solicitations.
Before I do that, going back to the characterizations model but that we have
implemented. This slide shows the five pillars that are part of our model and the types
of interventions that we have developed for each of the Ellers. So you can see that -in the patient family education, we have the bedside delivery, the zone education and
the home health provider signed up with the -- to coordinator they should family
education.
And again, if you look in the discharge planning section -- again we have bedside
delivery along with that -- as long as -- as well as their medication and hand over to
the post discharge providers. But you will see that through this -- throughout this
model, there is vacation management falls much in each of the pillars on the mission
assessment reconciliation -- with patient family education -- again and over to the
patient to make sure that we are given a post discharge writers the right information
about the patient's medications. Plan. Again and discharge planning medication
management comes into play. And then following the patient into the community -what we call patients would find out a post discharge phone calls that a percentage of
the patients do not fill the prescriptions -- patients over the prescriptions within 48
hours of discharge.
So we implemented the Walgreen's bedside delivery. And what drove us to look at
this model had to do with a lot of literature that points to medication management L.
yours as an important driver of readmission but
And then also in terms of patient says action and patient compliance -- want to make
sure that that patient leaves the hospital with their medication.
On our North Decatur campus the bedside delivery -- [ Indiscernible ] at 11 -- and in
Hallandale and jittery 2012 -- the North Decatur campus has been on site satellite
Walgreen's pharmacy. And Helen L. campus -- we is a retail pharmacy -- Walgreens
retail pharmacy that is about half a mile from the hospital.
So the way the program functions is that -- we provide the patient with a little flyer in
their mission packet that tells them that the program is available -- it should have
included a picture of it -- but a little flyer that says the bedside delivery program
delivers the medications before you leave the hospital and has the phone number on
their. And the way that we identify patients is that we track our discharge orders. So
whenever we have a discharge order we are able to trigger a list of patients to target.
For bedside delivery. And we provide that list to the Walgreens coordinator tech.
Then Walgreens pharmacy provides a tech on site at our hospital to assist the patients
with the medication -- offering the program to them in coordinating the fill in the
prescriptions.
So the other element of this is that everyday we have a huddle and we identify the
discharges in the patients with actual discharge orders. So we also use that forum to
queue up patients for bedside delivery.
When the pharmacy tech receives the list four rounds on the units are goes to hell and
comes up with their list of patients to introduce the program, they will go through the
patient, and speak to them about the program on the program. Contain a push version
from the chart once the physician has written a discharge orders and are by the
prescriptions. Take the prescriptions back to the pharmacy. Or fax them to the
pharmacy. And then the pharmacy will fill those descriptions.
And what are the benefits of having this program on site -- where the prescriptions are
filled, is that we sometimes identified when the patient -- where their plan does not
cover medication or if the co-pay is too high and the patient cannot afford the
medication. And so we have been able to catch some issues that would be too failures
in the community that we never would have known about until the patient is back in
the hospital.
So that's an advantage and when that happens, the pharmacist -- the Walgreens
pharmacist will contact the physician. And discuss with them therapeutic interchanges
that might work for the patient. That may be more affordable. Because thing about
that is -- even if we provided the patient with medication assistance the first time
around, they're very likely not to be able to afford to continue that medication for the
refills. And we would not have known about it until we have a failed discharge and
readmission.
So from there, patients are very satisfied of the program. The caregivers can be
included in the education consult. Once the first version is filled, the tech brings
dedication back to the patient's bedside. And asks the patient if they need more
information or if they would like to speak to the pharmacist about their medication.
If the patient wants a consultation with a pharmacist, the perps -- pharmacist comes to
the bedside or will speak to the patient on the phone to go over the medication.
The program does turn around the prescriptions -- basically within 30 minutes. So
from the time that they received them, and the patient is able to refill the productions
at any pharmacy -- they can either stay with Walgreens, or they can return to their
own pharmacy if they would like to. So the patient bedside program does not really
love them into -- to stay with Walgreens although Walgreens would like to have them
as a customer. But the real focus of the program is to make sure that the patients leave
the hospital with their medications.
The other elements to the program is that the pharmacist -- a clinical pharmacist does
follow-up with the patient within 72 hours. To see if they are having any troubles with
adherence or if they have any questions about the medications.
So how well did we do? At this point in our program, we have an 18.7% of our
patients for discharge from the -- I'm sorry -- those numbers are transposed. The first
column is Allendale's -- 100 bed hospital in the second column should be North
Decatur. I mixed them up. So the hospital with 400 Decatur. I mixed them up. So the
hospital with 455 discharges is Hill and Dale.
And 85 patients received bedside delivery. This is data from September 2012.
So we have an 18.7% penetration rate on providing bedside delivery for our discharge
patients at Hill and Dale.
And at North Decatur we had 1810 just charges -- 307 patients received bedside
delivery in September. And therefore we had a 70% penetration with providing
bedside delivery at North Decatur.
So we actually are performing a research study on the impact of bedside delivery. So
we took the program to the IRB. And we did a retrospective analysis of the
population. All discharges, all pairs. And we -- this control which I will show you
shortly on -- patients before bedside delivery at both hospitals occupations at the same
time as the tide delivery at both hospitals. And the patient to receive the bedside
deliveries for the comparison.
So on this flight you see the variables that that we measure. And so we measured the
top line -- this data was from January 2011 always through June always through June
2012.
We had -- patients who were discharged from each of the hospitals. We had the
readmission rates. H. >5 -- average age -- age -- patients who have heart failure.
Patients who have Medicaid talk raised other -- black-and-white and will talk about
that -- and we you can see the readmission rates for each of those patient populations.
I just want to focus on the thirty-day readmission rate for the historic hill and dale.
But that was before bedside delivery. 7.5%. Contemporary hill and dale is the
readmission rate at a hotel at the same time -- that we provided bedside delivery.
Historic North Decatur -- Decatur was before bedside delivery. And that was [
Indiscernible ] percent -- 11.5%. And that was for the North Decatur hospital at the
same time that we were providing bedside delivery. And those patients on the far right
are the patients who received bedside delivery.
See can see that the readmission rates for patients who received bedside delivery
during this time was 5.6%. In comparison to 11 11.5% at the same hospital. During
the same time.
And then the other control groups show that the readmission rates were also pretty
consistent.
And higher than those -- for those patients who received bedside delivery.
The one of the things that we have to think about and maybe like control for by doing
a risk stratification -- [ Indiscernible ] -- [ Indiscernible - background noise ] -- It -- [
Indiscernible - background noise ] Except delivery. [ Indiscernible - background noise
]
So we saw that the readmission rates were considerably lower for patients who
received bedside delivery. And so we did a regression analysis and control for those
other factors that we were able to measure in the patient population. And so if you
look at the columns that says oh are -- that says odds ratio -- whether or not the same
as that access risk ratio that we looked at the readmission rates before. So it shows
whether or not -- [ Indiscernible - background noise ] Are higher or statistically
significantly higher in this patient populations.
So this data controls for all the other variables that are on this chart, so that each one
is independent control for the other ones.
So patients being mailed -- does not have a higher risk ratio for readmission. Patients
greater than 55 have a 1.3 higher likelihood of readmission in comparison to patients
that are less than 65. And that [ Indiscernible ] -- whenever [ Indiscernible ] is listed -.05 -- I mean the -- significantly significant. So all of those points there is her once
means that those are significantly -- statistically [ Indiscernible ] certificate.
So the ones listed other that are not.
Patient Medicaid have a 1.4 times likelihood of being remitted significantly. Patients
brace -- black -- 1.2 times more likely to be remitted in a significant.
The month of the year -- has a slightly higher risk ratio -- that is significant. Again
slide -- risk of being remitted higher.
Heart failure has a 1.5
Heart failure has a 1.55 times likelihood of being remitted and that is statistically
significant.
Am I interestingly does not have a higher likelihood of being remitted.
And the let's go down to the bedside delivery part of this. To the control here is
whether you have bedside delivery. And so this populations that did not have bedside
delivery -- which is historic hill and dale -- [ Indiscernible ] Allendale -- historic
North Decatur and contemporary [ Indiscernible ] compared to patients who have
bedside delivery. Or anywhere from 1.6. Or anywhere from 1.62. Or anywhere from
1.622 times more likely to be reinvented and they are all statistically significant oxo
on the bottom line -- it shows that the patients are much more likely to be reinvented - sometimes almost double -- two times more likely to be read minute when they do
not have bedside delivery.
So in conclusion -- so really what this shows is the kind next up that we have
identified. And many of these had medication management -- making sure that we are
coordinated with the providers making sure that we have good medication history
Brigadier filiation . Make sure that we have effective medication of the patients
around the medication. And handing the education information over to the providers.
Implementing case management is one of the ways that the -- if you're looking to find
ways to identify patients at education. Patient population.
And then if you have identify the needs to provide traditional clinic post is charge for
the clinic -- so we're able to [ Indiscernible ] with their hospital stay -- we also found
that 6% of the hospitals -- patients who leave the hospital don't coordinate with her
provider.
And finally working with post-providers -- in other community providers like
Walgreens on post is charge medication management. In the area that we have
identified the need to continued intervention in focus.
And that is all I have.
Thank you so much Jackie. Wow. And we are just thankful that you are able to share
what the impact has I am providing medication management. And we will go directly
into redness presentation and then we will open up for questions.
Edna.
Hello Joyce and everyone there. This is really -- this is a project that our heart failure
team has taken on. And Don Tang -- he is actually our quality director -- he is taking a
lead along with the pharmacist and the nursing staff. So while if you have my name
on the title slide -- I'm not really the one who has done the work and the pilot. We are
in the initial phases. We do have advanced certification from the joint submission -commission in the heart failure. And we were talking about the projects and
opportunities that we have, we are doing all the things for readmission that we can.
We are doing the post a charge to -- discharge phone calls and making apartment for
patients within seven days of the discharge. And we are trying to follow-up the
readmission that way but one of the tools that we have is information for the for -Gore manager. And where we have fallouts and where we have inconsistent
processes. And in that population, heart failure discharge instructions for one of the
areas where sometimes we did really well. And sometimes we would fallout. And of
course by really well -- our hospital goal is to always be in the 90 percentile at EMS.
So I will let John King take the lead. He is our quality director. And we also have a
nurse to rector Anita Jackson where the pilot is occurring. We have pharmacist and
we have Lee Bolton and we have Marty [ Indiscernible ]. And so we don't have a lot
of results to resent because we are still in initial stages. And I will let John take the
lead.
Good morning everyone. Happy to be here. I will tell you a little about the pharmacy [
Indiscernible ].
Besides that we have up on the screen is our last two quarters. And prior to that, I
December or the are 2010 or 2011 are very good heart failure once course. But we
discovered that our documentation is allowing us to hide our results a little bit. And
wanted to correct that processes -- we change the documentation methodology and
this course drop-down box the conceded 2011 score -- we actually scored as an outlier
for this particular one measure. And at that point we pulled the multidisciplinary
group together and started an action item to figure out what on earth we could do to -now that we have identified our needs to get our scores back up and treat the patient
appropriately.
The first major thing that we did -- the little things all along -- would institute a
doublecheck. Which is basically a post inspection task. And while there are issues
with doing inspections after the fact, because her fill your medications or so -- or
medication reconciliation is so important, we felt that it was worth the effort and for
the staff to do a doublecheck after-the-fact. And the nurse training the patient who had
most of the care during the patients performed their regular medication reconciliation
and call it additional nurse off the unit to do a doublecheck and make sure that we
were not missing anything all along.
We instituted that for heart failure patients doing that as a pilot to see if that actually
made a difference. This goes without further.
And we were kind of surprised by this as we went along.
So we did a doublecheck her heart failure patients only. But because the nursing staff
were not doing it on all patients, we did not have it really hardwired in. And
sometimes they did not do it -- we did not do a doublecheck -- but it just was not well
hardwired on our end.
What we did do right third quarter is [ Indiscernible ] the meta-tag is the application
software. And our mad reconciliation screens were printed in portrait. And our
nursing staff was having to take a very long time to do their [ Indiscernible ] because - [ Indiscernible - muffled speaker ] On the screen. We pull the ITN and change the
screen to landscape. Going from third quarter -- 11 to recruit or probably at two
290.4%.
We also instituted doing a doublecheck on all discharge patients. Just a standardize
process and make it well hardwired in. And also implement it a [ Indiscernible ]
reminder to make sure that we covered all of the heart failure one discharge
information that we had to get across.
And so we were very pleased with the scores going up. And third-quarter this year -we also started the pharmacy pilot project which is an initiation for the divisional
pharmacy. Office.
And to go to the next screen, this is actually our flow. So far in our pharmacy title we
wanted to make sure that we have the process right. Because this is a brand-new
process for us. Oregon the multidisciplinary team has been working on making sure
that the process is right. So that the results [ Indiscernible ] will measure will give us
good results and we don't have to stop and correct the process again. As you can see
this is their fourth generation of the flow. And very happily, this is basically turned
out to be a linear process. More [ Indiscernible ] that you put in the more complex -completed the processes. So we were very happy to see that this was basically a
straight line process. So that we don't have a lot of decisions to make.
And there are only two handoffs once -- one for the nurse giving hand out information
to the pharmacist and the pharmacist comes up on the floor and then the pharmacist
and activities with the patient back to the original nurse again.
Running through this -- running through this our coordinator the heart failure charts
are identified and the nursing staff is the normal procedures for the [ Indiscernible ]
procedure. At the time to give the pharmacy a call and say that the patient is ready for
the doublecheck. Pharmacist comes up to the floor. And has to get the chart from the
nurse. So when you hardwire it in, the nurse pharmacist -- and [ Indiscernible ].
And at that point then the pharmacist asks any questions that she needs to bring
herself up to speed. Examines the medications chart. And if there are any questions
they asked the first question to the nurse. And if there are still some conclusions than
the pharmacist will reach out to the position.
As well. Back and then the pharmacist completes the medication reinstallation and
goes into the patient's room and the patient pharmacy dedication [ Indiscernible ]
education at the side quick
And so we're able to get a pharmacist into the room, talk with the patient and making
sure that the patient is that clear on the medication as absolutely possible. When the
pharmacist complete set task than cheap -- he or she brings the chart back out and
discuss is that information than with the patient's nurse. And we finish out the
process.
So our team has met just yesterday as a matter fact to figure out from this process.
Because we feel like we have a very strong process that works now. We don't have to
worry about the process itself. What the measures can do but we have got some longterm goals that we expected this process is going to help with the a Scores for the
medications. And as well as the transition over all.
We also are looking at the workload on nursing, on pharmacy and on chart
instructors.
And since our heart fill your coordinator's follow-up phone calls in three days, we are
going to include major collections information on that phone call as well.
So expect this -- is going to take us 6 to 8 weeks before -- for the staff to measure to
make it into print. Think this is going to be a good long-term solution for us.
One of the things -- some of things that are pharmacist are able to help address is the
patient is getting a good review by a pharmacist of all the medications that are being
sent on home with -- so they can look from drug to drug interactions. And when they
provide the medication education and they are expect -- discussing side effects or they
can have a discussion or they can have a time to discuss maybe there are some
alternatives that the pharmacist could recommend to the position. The same with -- the
thing with costs -- sometimes at the patient indicates that the cost is an issue, the
pharmacist may know of something that is a little lower cost or cheaper alternative but
and so the pharmacist can mutate that with Dr. mutate that with Dr.
And the final thing also is sometimes they should have very complex regiments, and
there are other drugs that may become nation's -- and maybe a way to simplify. And
so they are able to look at that.
I think that is all we have for you that if you have any questions about the pilot -- we
will be glad to take them.
Thank you so much at the and John for that introduction to what you're doing. And [
Indiscernible ] the flowchart and how you really had thought about what is taking
place from the pharmacist perspective involving them in the patient's care.
I look forward to you all coming back and letting us know and I think one thing that
you did mention was that age Scores -- the H. Cap scores and what you guys are doing
with the divisions in the pharmacist -- I think all of us will see some impact of not
only their emissions, but also the patient's perspective -- perception of care. So I am
looking forward to hearing more about that at this time before we take questions I will
quickly have Cheryl take [ Indiscernible ] to our actual agenda. And we want to talk
quickly about the data. And if you can scroll down Cheryl to the bottom. We do have
you all presenting [ Indiscernible ] with the measures to continue [ Indiscernible ].
And at the end of the agenda, you will see -- keep going down.
All the way to what we look like now in September.
You will see that -- with the added kit process. We have been increasing the number
of hospitals providing us with a received information on how MS would like us to
look at participation and you provide us with outcomes for the Georgia outcome
systems -- but the this is will really drive the effort as far as showing that whether or
not encompass -- what you're putting in place is actually working. The process
measures are more for you all. But we do like for you to submit your results. So thank
you to those who will actually help. And then if you can go up Cheryl -- Jennifer
Hodge will talk a little bit about the quality next opportunity that you can actually get
reports on quality net.
Hello there -- can you all hear me ask
Right.
This month -- -- [ Indiscernible - background noise ] Diana Smith -- you would have
received -- or someone in your -- at your hospital would have received a report. I want
to say seven pages long -- [ Interference on phone line ] That would give you some
data -- the
Bulova -- can you take yourself off speak or ask
Hello there. Can you hear me now ask
Much better -[ Indiscernible - background noise ] [ Interference on phone line ] So earlier this
month, well maybe not this month. Late last month -- you would have received
something -- [ Interference on phone line ] Connect inbox or someone at your hospital
would have received a -- in your do next inbox, a report on your hospital from Diana
Smith that gave you information both historical and current. And when I say current, I
am talking about Medicare claims -- so the most recent data available to us is January
-- well first-quarter.
Of 2012.
This information would be very useful for you to look at your all caused remission
rates. And the number of live discharges, and then the number of revisions to the same
hospitals -- as well as hospitals to another hospital. And the total readmissions.
And then in addition to just that raw data -- but you will see is a graphic depiction of
each of those that plots your hospital -- again at a statewide parameter.
So you will be able to see those things -- and -- [ Interference on phone line ] And I
would love feedback from anyone who has already had the opportunity to look at that.
We have had many providers -- e-mail us or call us and ask for patience specific data.
And at this time we are not able to provide that.
So I think that it will provide us with a report that we looked at and hospitals that I
talk to have found it very very helpful. So it will help us look at our outcome. So we
appreciate everything that you all are doing from the quality improvement artist nation
and the great relationship that we have been able to have in working on readmissions.
It is just been a great partnership and thank you for providing those reports to the
hospital.
At this time of like to open up -- we are going to use our open chat at the time to
answer or ask any questions. So if we could please open up lines, and as for shows
doing that but I just want to make sure that you all submit your sign in sheet as well as
we would like one evaluation at each of hospitals.
And also just has a disclosure, [ Indiscernible ] is a vendor and she and Brandi has
provided us with the information that we need so that you all can receive your
continuing education if you would like to receive the education, please ensure that you
provide us any evaluation as well.
So Joyce at this time -- all of the lines are open please keep in mind everyone -- if you
are not asking a question or making a comment, to please leave your microphones on
mute. So that we do not have background noise interfering with the call
This is Heidi Nelson -- University Hospital. I just want to ask John and Edna about
the program. This year's [ Indiscernible - background noise ] Program coordinator also
to education in terms of medication. It seems to me if a pharmacist intervenes the day
of discharge, the patient is ready to go. And what do they retain ask
We do start education on day one. We have an education pathway that we use that so
had it where it was day one, day to accommodate three. But then we kind of made it [
Indiscernible ] with all the different proponents for heart failure education proponents.
Because that is just one component. So really when the pharmacist goes in, the patient
should have already heard all of that information but there is a prompt for when a
patient is given a new medication in our hospital to make sure that the nurse -- it pops
up as the nurse scans it. It refreshes the nurses memory about the side effects. So they
can provide information to patients about side effects and information on medication.
And so that is provided as well. And then the pharmacist part is just really that final
check. That we are using.
That is right. And that sound like a good plan.
This is Teresa from Jefferson Hospital. And I would like to know how the rates -- [
Indiscernible ] -- those opposed by CMS and I'm trying to find out [ Indiscernible ].
This is Jennifer. I can certainly address that. Information that you saw hospital reports
is based on Medicare claims. And a readmission -- and then a visit to the hospital -whether they are to your hospital or not from the hospital -- [ Indiscernible background noise ] -- [ Interference on phone line ] Would be redistributed to your
hospital. And that will be the number that you see that I apologize for the phone
writing.
And information you were sent -- or someone at your hospital sent, you will see the
information is very similar to what you will see all your Report you will see the
number total readmissions for another hospital.
Remember this is all the Medicare data. So the data that you are seeing is probably all
there. And all slide. And this is very specific. That it is all the Medicare patients.
So today counted -- the secondary diagnosis. The primary diagnosis.
Well if it is in the top four talk or I believe -Well I think Medicare has said. The top 10 diagnoses. It is either for 10. But in the top
list of billable DRGs -- [ Interference on phone line ] It is going to show up there now
what is interesting about this report, is that we have included all Medicare patients.
Discharged from the hospital. So it is in all cause report. It is not specific for a
particular TRD.
Are we going to be penalized now for all call readmissions?
Yes.
Going forward -- I certainly think that Medicare is going to involve the penalties that
of our event established to include all costs.
Remember they are concentrating now -- all cause for your A- CHF and ammonia
patients.
Right. And what we can do also is -- if this is something that you would like more
information on, we can put our heads together and see -- I know that Dr. Rath has
provided information during the session that she had in September and October. But
maybe we can maybe expand on that a little bit more Jennifer.
I am happy to do that. There also are fairly good resources on the web@CMS.gov on
the web@CMS.gov. That you can search -- [ Interference on phone line ] That will
answer some more of your questions and certainly very specific question about
calculations. I am not prepared to answer right now.
Just because of Collations or so. And hospitals -- [ Interference on phone line ]
-- Topamax the Mac thank you.
What are the questions for Brandi or Jackie or Edna or John -- [ Interference on phone
line ] .
Has this been helpful ask
Very.
In talking to the About -- what was the bedside delivery rights of [ Indiscernible ] for
Helen Dale ask
-- Ask
We are still measuring. We in demented Hill and Dale -- we have is the particular data
set.
So the program has just gotten off the ground of the time we were doing that but and
this did not include that in the measure.
And Walgreens -- I looked on the website -- this is a national program -- how do they
work in terms of building relationships with hospitals in cities and towns?
We have an account executive for this region. And so that account executive -executive reaches out to our hospitals -- Nick Otello. And introduces various or grams
including bedside delivery as well as other programs like care physicians like Randy - I am talking about. And products that were great has to offer.
In addition to that, we put a satellite are missing on site here at [ Indiscernible ] in the
professional office building. And so that was another driver of hospitals looking into
the bedside delivery program initially last year.
So if it is helpful -- we can have Nick put up as information. I think you have the flyer
that you can share with you all. If you find that helpful but we will posted to the site.
What is the region that he covers -- [ Indiscernible - low volume ]
Choice -- on the phone right now -- [ Indiscernible - multiple speakers ]
The reason that I cover right now is Georgia -- the region I carry -- cover right now is
Georgia as well as the Carolinas and Alabama. And what I can tell you about our
bedside delivery program, is that we certainly have to be sure that we can be criteria
such as how close we are to I hospital to make sure that we can provide services up
really. And not delay the discharge. That is one of the factors we consider we talked
hospitals. But if it is something that your staff would like or your team would like
more information about -- a need that can be provided, I can certainly make sure that
we give them the proper contact information.
Great. And neck -- is it okay if we share that one page flyer ask
Absolutely but these do it. And if I were member correctly Joyce -- the one page talks
about not only the bedside delivery program, but it talks also more about the will
transition program that we are really focusing on. Because that program from Randy's
point is really trying to impact early readmission and H. Caps together.
Thank you. One thing that this discussion today has really got out is the importance of
breaking together [ Indiscernible ] -- and I don't know if these people are so the line
from visiting nurses Association -- but I know that some -- from health perspective
also -- and what we're all trying to do his work so we can give that patient what they
need. So that they don't have to feel like they can come back into emergency rooms
and the Reed minute or I think this is -- this program has just been one innovative idea
that has -- and I think you so much Jackie -- because we have not even publish the
information yet -- for sharing with us the impact that it seems to have had on the
readmission.
We are very excited about it.
Are there any other questions -- I just have a couple of announcements.
November 5 is going to be a learning leverage of where we will invite all of the
learning elaborate is that will be our last one or 2013. We have Denise and Kathy and
Lorna and Lynn -- all providing updates to what has happened over this past year.
Within the different learning collaborative and the communities. And so we are just
excited to be able to celebrate all the hard work that you have done. And we really do
appreciate what you have provided this year and making sure that we do decrease
readmissions by 20% as well as other hospital conditions by our 40% by 2013. Snack
into all have come on board and have really just been just so energetic and very
innovative in how you have had the time and the energy that we have been putting
into this hard work. Of decreasing readmissions in-hospital. So we hope you can all
share and celebrate with us on December 5. The time will be from 11 until 12:30.
The other thing I like to just mention -- that if you do know someone that would like [
Indiscernible ] the GHA staff is working at -- looking at decreasing hospital
conditions, we do have an opening. And please contact Kathy Cowin at 770 770249
77024945 770-249-4519. Or Kathy McGowan at GHA. Org.
And that is K. the gallon at GHA that Governor. So what -- GHA. Governor -GHA.Org.
This is Terry Invesco at University Hospital in Georgia.
[ Interference on phone line ] I just wanted to find out if there has been any mention of
providing the patients with weighing scales if they don't have a means to do that -- has
anybody found a way to do that -- [ Interference on phone line ] -- Any way to do that
besides donations -- any companies besides Walgreens perhaps.
All I have heard -- this is Joyce -- all I have heard is that the hospitals have been
donating them.
And then we do have some folks that have actually contracted with -- outside agencies
to actually do tell a monitoring.
Any efforts -- with coordination with the outside facilities as far as [ Indiscernible ] [
Interference on phone line ] Concerning home health agencies as well as [
Indiscernible ] homes for follow-up phone calls with the patients with the survey ask
--?
Anybody out there that is than anything innovative?
Choice -- this is Priscilla would have a chance -- in relation to heart failure patients -we sent a letter to the manager of Kmart. And they have actually done skills for us to [
Indiscernible ] the patients.
Great. Wonderful. Thank you.
Say that again.
I was just saying thank you but
Choice -- this is neck.
And I know whether it is the bedside delivery program -- or our CHF programs with
the infusion teams -- we have certainly sat down with the hospitals and come up with
some specific grams region with details -- [ Indiscernible - low volume ]
Thank you.
Any other thoughts? Any other comments ask and again -- I just want to thank you all
for -- [ Indiscernible ]
[ Audio cutting out ]
Our story -- and I will share that with you all. And again -- thank you so much.
Withers -- there are no further comment