Usefulness of a Rounding Cardiologist in a Skilled Nursing Facility to Reduce Hospital Readmissions and Costs

Usefulness of a Rounding Cardiologist in a Skilled Nursing Facility to Reduce Hospital Readmissions and Costs

Accepted Manuscript Title: Usefulness of a Rounding Cardiologist in a Skilled Nursing Facility to Reduce Hospital Readmissions and Costs Author: Grego...

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Accepted Manuscript Title: Usefulness of a Rounding Cardiologist in a Skilled Nursing Facility to Reduce Hospital Readmissions and Costs Author: Gregory A. Panza, Ronald Pariser, Paul D. Thompson PII: DOI: Reference:

S0002-9149(17)31675-2 https://doi.org/doi:10.1016/j.amjcard.2017.10.019 AJC 22962

To appear in:

The American Journal of Cardiology

Please cite this article as: Gregory A. Panza, Ronald Pariser, Paul D. Thompson, Usefulness of a Rounding Cardiologist in a Skilled Nursing Facility to Reduce Hospital Readmissions and Costs, The American Journal of Cardiology (2017), https://doi.org/doi:10.1016/j.amjcard.2017.10.019. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

Usefulness of a Rounding Cardiologist in a Skilled Nursing Facility to Reduce Hospital Readmissions and Costs The Affordable Care Act established the Hospital Readmissions Reduction Program, effective October 1, 2012, which requires payments to hospitals be reduced up to 3% under Social Security for certain (e.g., heart failure {HF}, pneumonia) excess readmissions.1 Readmissions are defined as “an admission to a subsection (d) hospital within 30 days of a discharge from the same or another subsection (d) hospital.”1 Hospital readmissions are associated with poor outcomes and quality of care, and lead to increases in hospital costs. HF is responsible for 24.8% of 30-day readmission,2 and the total direct medical cost for HF is expected to increase from $20.9 B in 2012 to $53.1 B by 2030, with most of the costs due to hospitalization.3 Interventions are needed to decrease this high readmission rate. We examined if a cardiologist rounding approximately 7 hours per week (over 2-3 days) in a skilled nursing facility (SNF) reduced 30-day readmission rates. We retrospectively examined hospital readmissions one-year prior (May, 2013 through April, 2014), and during the cardiologist’s first year (May, 2014 through April, 2015) of rounding. We reviewed 1,032 patient records including 498 records before (125 men, 373 women aged 85.2±9.5yr) and 534 records (148 men, 386 women aged 85.3±9.2yr) during the intervention. Total 30-day hospital readmission rates for the SNF patients decreased by 3% (11% to 8%) resulting in a 27.3% improvement in the year after the cardiologist. Hospital 30-day readmission rates for HF patients decreased by 6% (14% to 8%) resulting in a 42.9% improvement. Estimated costs were reduced for both readmission cost of care (-$150,000.00) and penalties (-$731.70) for readmissions (Table 1).

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This project is ongoing but these preliminary findings suggest that a part-time cardiologist treating patients in a SNF decreases 30-day hospital readmissions, hospitalization cost of care and potential hospital financial penalties by Medicare.

Gregory A. Panza, MS Hartford Hospital, Hartford, CT University of Connecticut, Storrs, CT

Ronald Pariser, MD Hartford HealthCare Medical Group, Hartford, CT

Paul D. Thompson, MD, FACC Chief of Cardiology, Hartford Hospital Co-Physician-In-Chief Hartford HealthCare Heart & Vascular Institute Professor of Medicine, University of Connecticut School of Medicine

Acknowledgements: The current project is funded by Jefferson House grant #136120.

1. Patient Protection and Affordable Care Act. Pub L No. 111-148 2. Dharmarajan K, Hsieh AF, Lin Z, Bueno H, Ross JS, Horwitz LI, Barreto-Filho JA, Kim N, Bernheim SM, Suter LG, Drye EE, Krumholz HM. Diagnoses and Timing of 30-Day

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Readmissions After Hospitalization for Heart Failure, Acute Myocardial Infarction, or Pneumonia. JAMA 2013;309:355–363. 3. Heidenreich PA, Albert NM, Allen LA, Bluemke DA, Butler J, Fonarow GC, Ikonomidis JS, Khavjou O, Konstam MA, Maddox TM, Nichol G. Forecasting the impact of heart failure in the United States. Circ Heart Fail 2013 1;6:606-19. 4. Kaiser Health News and the U.S. Centers for Medicare and Medicaid Services. Medicare Readmission Penalties by Hospital, Year 5. 2016: 1-67. 5. Grisham, Sarah. "Medscape Cardiologist Compensation Report 2017." 2017.

Table 1. Readmission rates and estimated hospital financial savings year before and year of cardiology service. One year

One year

Before

during

Rounding

rounding

a

Cardiologist

cardiologist

cost saving for

Variables

(n=498)

(n=534)

fiscal year

Total 30-day readmissions

53

41

--

Total 30-day heart failure

17 / 124

13 / 154

--

$550,000.00

$400,000.00

+$150,000.00

$2,682.90

$1951.20

+$731.70

Estimated

readmissions/total heart failure patients b

Estimated additional cost of care/yr

due to readmissions c

Estimated additional penalties costs/yr

due to readmissions

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d

$0.00

$71,750.00

-$71,750.00

Total

$552,682.90

$473,701.20

+$78,981.70

Cardiologist salary for 7 hr∙wk/yr

Costs are estimated for 500 patients to correct for unequal sample sizes. a

Calculated for 1-year before and during cardiology service.

b

Direct cost per stay (AV= 4.82 days) was $6,775, plus 40% indirect costs, totaling ~$10,000 per

readmission stay. Calculated by 500 patients x % readmission rate x $10,000. c

Based on Medicare billable costs ($6,775). Calculated by 500 patients x % readmission rate x

$6,775 x average reimbursement penalty (0.72%).4 d

Estimated based on 17.5% (~7 hr∙wk) of average cardiology salary ($410,000)5

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