There's just two days left before the official launch of Hospital to Home, ACC's quality initiative to reduce 30-day all-cause, risk-adjusted readmission rates for heart failure or AMI by 20 percent nationally by 2012. Check out this video with Harlan Krumholz (following his blog post here). Also, don't forget to enroll in the initiative and register for Thursday's launch Webinar (1 p.m. EDT) at http://www.H2HQuality.org.

Today’s post comes to us from Harlan Krumholz, M.D., F.A.C.C., the Harold H. Hines, Jr., professor of medicine at the Yale University School of Medicine. Harlan is a well-known leader in advocating for improvements in cardiovascular quality. Not only did he lead ACC’s successful quality improvement program “D2B: An Alliance for Quality,” he currently serves as the co-chair of the Hospital to Home (H2H) steering committee. Outside of his work with the ACC, Harlan is also heavily involved in the Centers for Medicare and Medicaid Services’ efforts to develop national measures for public reporting of hospital performance.

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Over the last several decades, the cardiology community has led our profession in generating new knowledge and seeing it applied for the benefit of our patients. Recently, we dramatically improved door-to-balloon times – moving in rapid progression from an era where only one-in-three patients were treated within the guideline-recommended 90-minute timeframe to now, where almost 90 percent of our patients are treated within that benchmark. Remarkable.

Another chance to lead lies before us. On Oct. 22, the ACC, in partnership with the Institute for Healthcare Improvement, will launch a major quality improvement initiative called Hospital to Home (H2H)… this time focusing our quality efforts on readmission rates. Currently, about 20-25 percent of our patients hospitalized with an acute myocardial infarction (AMI) or heart failure are back in the hospital within 30 days. Many of these admissions are preventable through improvements in the transition from inpatient to outpatient status. Unfortunately, we have often neglected this vulnerable transition period for patients.

Gaps in Care
We have many obvious gaps in care – patients often leave without information about the hospitalization being transmitted to other caregivers in a timely way; without access to medications; without appointments being set; and without an emergency plan for if their condition suddenly worsens. Studies have shown since the 1990s that improving the handoff between the hospital and the “home” can lead to a reduction in readmissions by addressing these gaps. Our fragmented health care system places many barriers in front of health care providers in putting known methods into practice. To reduce readmission rates, we’ll need to make special efforts to focus on transitions and most importantly – to focus on the patient, specifically, making efforts to ensure that the patient is ready and knowledgeable enough to manage their care – and that the system is poised to provide the support they need.

H2H Goals – Just the Beginning
H2H will assist providers in overcoming the systemic barriers to improving readmission rates. The initiative is committed to reducing 30-day all-cause, risk-adjusted readmission rates for patients with a diagnosis of heart failure or AMI by 20 percent nationally by 2012. In HF, that would take the rate from about 25 percent to about 20 percent. This goal is ambitious – but we aspire to produce a substantial benefit for patients.

H2H will leverage other national initiatives contributing to a reduction in readmission rates and will harness the collective knowledge, creativity and energy of its key strategic partners -- Kaiser, the Veterans Administration, the American Hospital Association, The Joint Commission, PREMIER, HCA -- and others to reach this goal. In my opinion, the 20 percent reduction is just the beginning of what we can achieve through our collaborative efforts. The path is more challenging than ever because of our goal of actually affecting patient outcomes, but we are bringing together expertise, resources, tools and a mechanism for us to learn from each other to meet this goal.

For those of you who want to be part of this effort, you will not be alone. We already have more than 250 facilities (e.g., hospitals and medical practices) that have joined us. Teams will be anchored at hospitals but will stretch across the continuum of care. We will track progress and, ultimately, assess whether we decreased preventable readmissions through improved care. We want this effort to equip teams for success.

Join Us in Reducing Preventable Readmissions
For more information, visit: http://www.h2hquality.org/, or email hospital2home@acc.org. H2H officially launches Oct. 22 with a Webinar explaining the initiative in greater detail. To join the Webinar, please register in advance online. If you are unable to attend on Oct. 22, you will be able to access the Webinar archive through our Web site.

We want to again show the nation that the cardiovascular community knows how to get results for our patients. We hope you’ll join us for this exciting initiative.

* Dr. Krumholz's post is part of a monthly series of guest posts by ACC leadership. Check back next month to see which ACC leader is sharing his or her thoughts on health care reform!

Earlier today, CMS updated its Hospital Compare Web site to include data about 30-day hospital readmission rates for acute myocardial infarction, heart failure and pneumonia. The site already provides information about 30-day mortality measures for the same groups. The site is intended both as a resource to patients – who can search by hospital to find out how their hospital compares to other hospitals – and to hospitals looking to improve their performance.

Making this data publicly available is a positive first step toward improving quality, simply in that it lets hospitals know how they’re doing. The way our current health care system is structured, it’s completely possible that they have no idea – which means there is no incentive to improve. However, given the dire straights our health system is in, we all need to take part in reducing costs to make the system viable in the long-term. In the CV world, ACC data show that reducing high-cost heart failure readmissions by 20 percent could save $265 million. That kind of savings is nothing to laugh at.

What You Can Do
First, start by reviewing the data. Once you’ve done that, ACT. The ACC is encouraging hospitals to enroll in our new Hospital to Home (H2H) initiative, which aims to reduce cardiovascular readmissions by 20 percent by 2012 by improving the transition from hospital to “home.” This is a lofty goal, but by providing evidenced-based strategies for reducing readmissions along with technical assistance to implement the strategies, we can make the reduction a reality.

Other Considerations
Although we value the opportunity for improvement Hospital Compare offers, it’s equally important that the data used is both fair and valid – and that our response as a community always places the best interests of the patients in the forefront of our efforts. The ACC will work with CMS and others to use the release of this data to strengthen the Medicare program and help ensure that Medicare beneficiaries receive high-quality CV care. Because at the end of the day, high-quality CV care for patients is the most important goal.

Additional Coverage:

• Baylor hospital leads way to lower heart failure readmission rates. USA Today.
  
  
• 'Double failure' at USA's hospitals. USA Today. 

From the Senate perspective the SGRrrr elimination appears less likely this week. As you may recall, Mr. Baucus and the Senate Finance Committee last week proposed a $38 billion, three-year band-aid (a continuation of the past failed approach), but he told me last week at a breakfast meeting that he thinks they can muster together $150 – $200 billion from somewhere (cancellation of the war in Afghanistan?) to get closer to eliminating it. The Administration breakthrough decision to shift the $87 billion of injectable drug costs embedded in SGR from Part B to Part D of Medicare would make the total fix more likely.

The House (Pelosi, et al) still seems committed to look for the complete fix this year, but the Senate doesn’t see how it would be paid for (but hey! If SGRrr goes away, what formula would we use? Why not apply the Medicare Economic Index that the hospitals and the rest of the system use? This seems to provide annual increases that fairly closely approximate increases in the cost of doing business).

Keep in mind that even if Congress finds $280 Billion, physicians would not receive any pay increase over the next 10 years without additional funds. The SGR fix simply eliminates the overt pay cuts. Since business costs nonetheless continue to rise, new payment options for quality are also essential in this reform process. While Baucus insists the Physician Quality Reporting Initiative (PQRI) must continue, the quality improvement bonus attached in the current proposals are likely to be no more than 2 percent, hardly enough to motivate the extra work hours and workflow changes practices need to accomplish to effectively participate.

The ACC and IHI (Institute for Healthcare Improvement) Hospital-to-Home (H2H) project is generating great interest. This may be the kind of direction — one that unfortunately most of our members do not yet appreciate — that is the only pathway toward needed payment reform and payment increase that could keep pace with rising costs of business for practices. Given the rising tide to create reform this year, we will need some Patrick Henrys to ride through all of our chapters and states to let people know big change is coming -- and won’t be a tweak of the status quo. Reform doesn’t necessarily have to come out badly -- but need to make sure we stay at the table.

*** Image from Flickr (vtengr4047). ***

On Friday, the Centers for Medicare and Medicaid Services (CMS) released to all U.S. hospitals their performance on six key measures, in preparation for public announcement of these measures this summer.  The measures: 30-day mortality and 30-day readmissions for heart failure; acute myocardial infarction; and community-acquired pneumonia.

Hospital to Home
"Hospital to Home" -- a new partnership between the ACC and Institute for Healthcare Improvement -- is moving along swiftly, as a way to help our members reduce CV hospital readmissions. CV hospital readmissions are currently at 25% of discharges within 30 days. 

Though our Hospital to Home (H2H) project, we aim to reduce 30-day all-cause readmissions for heart failure and AMI by 20% nationally by December 2012.  The project will officially launch when the CMS measures are publicly released this summer.  Watch the video below for more info.