Local Project Among Initial Grant Awards
Dr. John Schnelle
In May, the Centers for Medicare and Medicaid (CMS) Innovation Center announced the first in a series funding grants to applicants working to implement the most compelling new ideas to deliver the right care at the right time in the right setting … every time.
Vanderbilt University Medical Center (VUMC) was among the first 26 recipients nationwide to win a portion of $122.6 million in the first round of Health Innovation Awards. Ultimately, CMS will fund up to $1 billion for sustainable projects impacting cost and quality for those enrolled in Medicare, Medicaid and Children’s Health Insurance Program (CHIP).
John Schnelle, PhD, director of the Vanderbilt Center for Quality Aging and a professor of Medicine at VUMC, is overseeing “Reducing Hospitalizations in Medicare Beneficiaries: A Collaboration between Acute and Post-Acute Care,” which is a project to improve discharge planning and follow-up as Medicare patients transition between acute and post-acute settings.
“The Innovation Awards have one major purpose — to improve quality and reduce cost,” said Schnelle. Vanderbilt was awarded just under $2.5 million for the three-year demonstration project, which is conservatively estimated to save the system $8.7 million during that time … a 3.5:1 return on investment.
Also known as INTERACT/IMPACT, the acronym stands for Interventions to Reduce Acute Care Transfers and Improved Post-Acute Care Transitions. Vanderbilt is partnering with National HealthCare Corporation (NHC) on the project and plans to train an estimated 30 healthcare workers to utilize evidence-based interventions to “IMPACT” the way patients are discharged from the hospital and “INTERACT” with NHC staff to enhance clinical responsiveness to avert readmissions within 30 days of discharge. Effective intervention strategies include standardized discharge protocols, patient education, follow-up by a transition counselor, improved advance care management, more effective condition management and proactive treatment to keep an issue from escalating to the point where acute care becomes necessary.
As the industry moves away from fee-for-service reimbursement towards Accountable Care Organizations, Schnelle said the emphasis is for providers in a variety of settings to become jointly responsible for patient outcomes. Transitions between settings have proven to be particularly risky for patients and costly to the overall system.
Currently, he said, “There has been no real focus (on transitions) because of the lack of financial incentives to prevent people from coming back to the hospital after discharge.” Similarly, he continued, “Post-acute care facilities have no financial incentive to not send people back to the hospital.”
This program aims to reduce inpatient readmissions by 17 percent and improve the patient experience for approximately 27,000 Medicare or Medicaid/Medicare dual eligible beneficiaries in 10 Tennessee counties. The catchment area includes rural and underserved areas in Middle Tennessee.
While Schnelle said the intervention’s premise is along the lines of how an ACO should work, he stressed that the financial incentive component is not in place at this point. However, he continued, such incentives … either in the form of penalties or of sharing in cost savings … are anticipated to begin in the near future. The project puts the systems in place to nimbly react to this shift in reimbursement.
“The actual grant will start July 1,” he said, adding, “There’s a major focus here in getting this up and running within six months.”
Previous research has looked at individual pieces of the intervention, but Schnelle said this is the first time all of the components have been brought together. “In previous work where just the INTERACT part alone was done, it resulted in reductions by about 17 percent. The same is true when just the IMPACT part is done so the assumption is an integrated intervention would have at least that much benefit,” he stressed.
Recent national statistics, Schnelle continued, show a little more than one-third of all Medicare beneficiaries discharged from the hospital go on to receive additional services with more than 40 percent of them being discharged to a skilled nursing facility for post-acute care. Of that group, 23.5 percent of the Medicare beneficiaries were re-hospitalized within 30 days of discharge at a cost to Medicare of $4.34 billion. Since each of these readmissions costs Medicare $10,000 or more per episode, Schnelle said it was easy to see how reducing readmissions nationwide should result in huge savings to the system.
Building on past success, Schnelle is hopeful the actual reduction in readmissions for the Tennessee project will exceed the stated 17 percent goal.