HIMSS: Massachusetts pilot could IMPACT transitions of care
NEW ORLEANS—“Currently, our payments in the U.S. are incredibly siloed, even though our patients aren’t in siloes, as they move from hospitals to outpatient facilities to nursing homes to home health. Therefore, we need to re-orient the payment to match the patient cycle,” said Craig D. Schneider, PhD, in a March 6 session at the Health Information and Management Systems Society (HIMSS) annual convention. The IMPACT program in Massachusetts has attempted just that.
Post-acute care costs are rising faster than acute care costs, reaching $45.1 billion in 2007, said Schneider, senior health researcher at Mathematica Policy Research. Fifteen percent of emergency department admissions and $8 billion are wasted annually from adverse drug events that could be avoided if the outpatient information was known. Also, there are 1.5 million preventable adverse events annually in the U.S. because discharge treatment plans are not followed. Finally, 20 percent of patients are readmitted within 30 days, and $577 million is spent on preventable readmissions in Massachusetts alone and $25 billion is spent annually across the U.S.
To address this problem Schneider, along with his colleagues at the Massachusetts Health Data Consortium, received a $1.7 million grant from the U.S. Department of Health and Human Services and the Office of the National Coordinator for Health for IMPACT: Improving Massachusetts Post-Acute Care Transfers (IMPACT) in February 2011.
The group thought one of its founding principles would be “controversial with the providers,” according to Schneider. The principle states that “accountability for care during transition remains with sending providers until receiving providers acknowledge responsibility.”
“We thought we would get a lot of push back on this, but instead, the provider community confirmed that this was the right way to address transitions of care,” he said.
IMPACT’s objectives and strategies seek to:
- Facilitate developing a national standard of data elements for transitions across the continuum of care;
- Develop software tools to acquire/view/edit/send these data elements (LAND & SEE);
- Develop software to transform summaries into a consumer-friendly format;
- Integrate and validate tools into Worcester County using Learning Collaborative methodology—building on cross-continuum teams (STAAR); and
- Measure outcomes.
This program was piloted with the Reliant Medical Group, formerly known as Fallon Clinic, has more than 300 provider multi-specialty group practices with 30 specialties and 23 sites in central Massachusetts. They serve 200,000 patients with more than 1 million visits per year.
Traditionally, for datasets for care transitions, Schneider said the sender sends what he or she thinks is important to the receiver, but in the future, the sender needs to take in account what the receiver says they need. Also, “we have learned that many transitions of care do not need all data, and it creates unnecessary sender work."
After large-scale, in-state surveys, IMPACT identified five types of transitions/datasets:
- Report from outpatient testing: Treatment or procedure;
- Referral to outpatient testing: Treatment or procedure (including transportation);
- Shared care encounter summary: (office visit, consultation summary, return from the ED to the referring facility);
- Consultation request clinical summary: (referral to a consultant or the ED); and
- Permanent or long-term transfer of care to a different facility or care team or home health agency.
Currently, the IMPACT learning collaborative is testing the care transitions datasets across 16 organizations, with 40 participants and several hundred patient transfers. The organizers are polling users and discovering what else needs to be improved and how varied providers can share tools that allows for improved transitions of care.