MelroseWakefield Healthcare is a coordinated system of hospitals, physician practices and community-based services providing care for communities throughout north suburban Boston.
At the start of 2016, a community health system in Melrose, Massachusetts named MelroseWakefield Healthcare (MWHC) put together a CV Performance Team to create a collaborative environment. The aim here was to foster positive change in Heart Failure Management.
The priorities of this team included Early Identification of Heart Failure Patients, Early Heart Failure consultation and diagnostic work-up, and a reduction in ‘same cause’ readmission rates for Heart Failure within 30 days. A reduction in the readmission rates was the selected top priority.
- Analyzed retrospective data, focusing on a primary diagnosis of heart failure
- Developed a process for real-time discussion with cardiologists
- Established review process between Physician Lead of team and HIM
- Physician leads collaborated with Dynafios’ team for identifying recent evidence-based order sets and clinical pathways
- 4-day pathway established; now moving towards the 3-day pathway
- Endeavored to improve EHR problems for HF
- Data query for the frequency of the term, ‘unspecified Heart Failure’ conducted
- Went from respective analysis of perspective one for clinical documentation
- Became conscious of the essential initiative, communication between clinicians and those who represent the patient in clinical terms
- Strove to establish response time to coding queries
At the beginning of the initiative, the 2016 same-cause HF readmission rate was a high 18.4%. The physician team had 21 physicians and 20 hospitalists. An HF Nurse Navigator joined the team during this initiative.
At the start of 2017, the readmission rates for the 30-day period were 18.4%. At the end of 2018, the readmission rates had successfully seen a 65% decline and were now at 6.5%.
For “Unspecified Heart Failure” Diagnosis Code found in Claims Data, the start of 2017 showed 1,263 instances. By the end of 2018, the team had successfully reduced the instances to 95, which is a 92% decline.
The Response time to coder queries within 24 hours was 82% at the start of 2017. The end of 2018 saw this statistic increased to 99%, which shows a 21% improvement.
The margins per case also saw an improvement in this period. At the starting of 2017, the margin per case of HF MS-DRG was $618, while the end of 2018 saw an increase of $390,600 with an average of $1,381 margin per case.
While the number of discharges from 2017 to 2018 remained similar, in-house mortality rates also declined in this period. There was a 55% decline from 33 to 15.