Abstract
Purpose of Study: In response to the U.S. Affordable Care Act, the Centers for Medicare & Medicaid Services proposed a change in reimbursement penalties for hospitals beginning October 1, 2012. Reducing the occurrence of unplanned readmissions has become a more urgently focused topic. As part of the health care system, care management aligns with physicians to significantly improve service, financial, and clinical care outcomes. To address the changing health care climate in 2008, care management services were restructured at an academic university medical center located in 1 of the 3 largest counties in California. Changing from a unit-based to a service-based care management model partnered care managers and social workers with physician services. We sought to assess the effect of this change on surrogates for patient experience and clinical quality of care.
Primary Practice Setting: Tertiary academic medical center in southern California.
Methodology and Sample: Retrospective data were collected from 2 databases for all hospital patient care services from November 2008 to January 2010 to determine whether clinical quality of care and experiential service improvements were realized. Primary outcomes included all-cause and related readmission rates. Secondary outcomes were Hospital Consumer Assessment of Healthcare Providers and Systems (H-CAHPS) scores. An interrupted time series analysis compared data from the single institution for the diffusion and postintervention periods.
Results: Comparing data from the diffusion and postintervention periods, the rate of disease-related readmissions decreased significantly (mean 5.43-4.58, p < .05), and all-cause readmissions also decreased, although the difference failed to achieve statistical significance (11.42-10.49, p = .056). H-CAHPS scores with the patient response of "recommend this hospital" was unchanged over the 2 time points (mean 78.9%-77.8%, p = .26731). Data also showed stable care management staffing rates whereas average daily census (ADC) increased over time (ADC 274-297).
Implications for Case Management Practice: With health reform driving value-driven care transformation, partnering care managers and social workers with physician services has the potential to impact the patient's experience as well as financial and clinical care outcomes. Care managers serve a significant role in improving the clinical quality of care by reinforcing a consistent and clear message by the health care team to the patient during the entire hospitalization, not just at the time of discharge. At one institution, partnering physicians with care managers through the acute care continuum (service-based care management) appeared to reduce readmissions without compromising patient satisfaction. Both readmission reduction and effective patient satisfaction scores impact the Centers for Medicare & Medicaid Services value-based purchasing reimbursement calculations.