Mid-Atlantic States Hospital Patient Day Rate Reduction


Farzaneh Sabi, MD; Pam Galley, MAOL; Claire Pagano, MHA; Blair Van-Horn


Abstracts from the Kaiser Permanente 2019 National Quality Conference

From Northwest Permanente

Background: Between 2015 and 2017, the Kaiser Permanente Mid-Atlantic States (KPMAS) patient day rate (PDR) rose by 18.25% (251.5 in 2015 to 307.5 in 2017). The increase in the PDR was multifactorial, including variables of increased membership, changes in member mix (Medicaid, Affordable Care Act), in the setting of ongoing capacity restraints in their partnering hospitals. KPMAS does not own or operate any Kaiser Foundation Hospitals in their Region.
Methods: KPMAS reduced avoidable hospital days by improving care coordination in the ambulatory and acute settings. This included proactive outreach and enrollment of high-risk populations into case management (CM), an investment in the CM workforce, and efficiencies through standardization of workflows and documentation. Rounding and care coordination in the acute setting was standardized across the Region with pairing of hospitalists and patient care coordinators, twice daily huddles, bedside multidisciplinary rounds, utilization management reviews, and standardized handoffs from the acute teams to the ambulatory teams. Appropriate surgical procedures were internalized to Ambulatory Surgery Centers (ASC). Investments were made in the pharmacy team to support members’ medication reconciliation.
Results: A 4.4% decrease in overall PDR was achieved in 2018. The major driver of the reduction in PDR was a 6.6% decrease in the admission rate. This is a result of the work done by improving care coordination in the ambulatory setting through the KPMAS complex care program, proactive care management programs, case management, and access to urgent care and clinical decision units. Internalization of appropriate surgical procedures to the ASC lead to a 19.7% decrease in the surgical admission rate. The rate of medication reconciliation by transitional pharmacists for all members discharged from the hospital doubled in 2018. In addition to the support of the transitional pharmacists in the inpatient setting, transitional pharmacists provided medication reconciliation and support for members in the clinical decision units and skilled nursing facilities.
Discussion: Hospital utilization rates are multifactorial and impacted by membership mix, management of chronic conditions in the ambulatory setting, access to care in the ambulatory setting, care coordination, and engagement of members with their health care teams. KPMAS has been on a journey of investments in the ambulatory infrastructure, which improves quality, access, and member satisfaction while driving down avoidable outside medical services utilization.

Abstracts from the Kaiser Permanente 2019 National Quality Conference


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