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December 2005

Briggs National Quality Improvement and Hospitalization Reduction Project

Partnering with Agencies to Make a Difference

The Centers for Medicare and Medicaid Services (CMS) has stated that Pay for Performance (P4P) will shape the future of health care and home care. The testimony from Secretary of Health and Human Services Michael Leavitt states, “the incentives in our health care system are just wrong – wrong for providers, wrong for payers and wrong for patients. Providers get paid based on the quantity of care they provide, not the quality of outcomes. I am determined to see P4P become part of the way we compensate health care providers.” Quality patient care outcomes are a key factor in the success of agencies in a P4P program.

In home care, all measures of quality have improved over the years except
one – the percentage of patients having to be admitted to the hospital. According to CMS, for the 12 month period of January through December 2004, there were 3,695,620 Outcome-Based Quality Improvement (OBQI) episodes. Included in that same period, 27.98 percent of patients ended up being hospitalized while in home care. That means 1,034,034 people were hospitalized. Reducing hospitalizations may be the single most important quality challenge faced by agencies.

The challenge is learning what the agencies with a good Home Care Compare score in acute hospitalization are doing and how these best practices can be applied in other home care agencies. Earlier this year, Briggs Corporation, the National Association for Home Care and Hospice (NAHC) and Fazzi Associates joined together in a national effort to identify best practices used by agencies for reducing unplanned hospitalizations and to share the information with the field.

Preliminary results from the Briggs National Quality Improvement and Hospitalization Reduction Study were presented on October 27, 2005 in Seattle, Washington at the NAHC annual conference. The preliminary findings demonstrated that an agency with a vision, a passion to make things better and a leadership willing to drive change can utilize best practices resulting in lower
re-hospitalization rates.

The study identified 15 distinct strategies from the field. Most agencies studied used more than one strategy, with an average of 6.4 strategies per agency. Agencies that were successful were also found to be very intentional in their efforts to reduce hospitalizations.

The top five best practice strategies identified are:

  1. Fall prevention (83%);
  2. Front loading services (71%);
  3. Management culture and support (69%);
  4. Medication management (64%);
  5. 24 hour availability (63%)

To put this in to perspective, if home care agencies adopt these best practices to reduce the national hospitalization rate from the current 28 percent to 25 percent, each year 110,129 patients would not be hospitalized and $2,737,696,605 would be saved (NAHC 2005, Presentation by Fazzi Associates).

Let’s get started with a commitment by each home care agency to reduce hospitalizations by 1 percent in one year! More information about this study is available at www.BriggsCorp.com/HomeCare.

Cyndi Rohret RN, CRNI, CHPN
Clinical Consultant, Briggs Corporation

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