Source: OrlandoSentinel.com - July 18, 2010
http://www.orlandosentinel.com/health/os-hospitals-surgery-coalition-20100718,0,2300821.storyFlorida hospitals join forces to cut readmissions
By Linda Shrieves, Orlando SentinelEighty-one hospitals in Florida are teaming up with one important goal: to reduce the number of infections and complications that occur after surgery.
For patients throughout the state, the coalition's work could cut their chances of being readmitted to the hospital after an operation. And for hospitals, fewer complications could reduce the sorts of costs that will come under increasing scrutiny with the new federal health-overhaul law.
Currently about one in five patients discharged from the hospital is readmitted for complications. These subsequent hospital stays add $11,000 or more to the average cost of a patient's care.
Starting this fall, hospitals ranging from 759-bed Winter Haven Hospital to the entire Florida Hospital network will study four types of hospital patients: those who developed urinary-tract infections, those with surgical-site infections, those who had colorectal surgery and those 65 or older 65 who had any type of surgery.
By analyzing the data and finding which hospitals have low rates of surgical complications, the hospitals and their partners — the Florida Hospital Association and the American College of Surgeons — hope to zero in on the methods that minimize infections and complications.
"If we have 100 hospitals in a collaborative [study] and 20 are doing outstanding, what are these 20 hospitals doing that the other 80 are not?" said Dr. Clifford Ko of the American College of Surgeons, which will oversee the study.
In Central Florida, 11 hospitals are participating in the two-year study: Orlando Regional Medical Center, Dr. P. Phillips Hospital, Halifax Health Medical Center in Daytona Beach and Florida Hospital's eight regional hospitals.
"I think this has the potential to substantially raise the level of care in Florida," said Dr. David Moorehead, chief medical officer for seven Florida Hospital locations."But as much as that, it has the potential for Florida's hospitals to work together to create a database of what things work and what things don't work."
To determine what types of infections and complications to study in the $1.6 million project, Ko asked for guidance from Medicare administrators.
In addition to common complications such as surgical-site infections and urinary-tract infections, the hospitals will study one of the most common operations performed in the United States: colon-resection surgeries, in which part of a diseased colon is removed.
The hospitals also will examine results from surgeries performed on all patients 65 and older, and compare results from one hospital to another. Elderly patients often have many other health issues, which can contribute to complications after surgery, Ko said.
Participating hospitals will plug information into a database developed by the American College of Surgeons. Blue Cross Blue Shield will pay $800,000 to fund the project, with the remaining half paid by the hospitals.
'You learn a lot'
Similar collaborative studies in other states have revealed how hospitals can reduce infections by washing patients a particular way or by using a certain antibiotic after surgery, Ko said.
"When you collect this amount of information on procedures, you learn a lot," said Dianne Cosgrove, Orlando Health's patient and safety-outcomes officer. "For instance, by looking at patients' history, we may ask, 'Do we need to treat people with diabetes a little differently?' Or if you're using a certain type of surgical product and getting good results, you may say, 'Hmm, this seems to be working particularly well.' "
By sharing notes, hospital administrators can learn from each other's experiences.
"When somebody comes up with a great idea, hospitals love to steal shamelessly," said Cosgrove. "That's the purpose of this kind of initiative: to get the word out when somebody has a good idea. The feedback is much quicker than waiting for a journal article to be published."
By preventing complications, hospitals can save $11,000 or more per patient, Ko said. Hospitals participating in similar projects in other states avoided 250 to 500 complications a year.
"If you take that number of complications and multiply it by $11,000, that adds up to millions of dollars in costs that are avoided," Ko said.
Federal incentives
Starting Oct. 1, 2012, Medicare payments to hospitals with high readmission rates will be reduced.
That's why hospitals across the country are examining their readmission rates — and the causes for readmissions, such as post-surgical infections.
As health-care reform phases in, the federal government is using financial incentives to encourage hospitals to reduce errors and save money, said Gerard Anderson, director of the Johns Hopkins Center for Hospital Finance and Management.
To help reduce those readmissions, the federal government will pay hospitals a lump sum for a surgical procedure — a sum that factors in some money for patients who return to the hospital with complications.
"If you're able to keep your readmissions down," Anderson said, "you're going to make a lot of money."
Linda Shrieves can be reached at lshrieves@orlandosentinel.com or 407-420-5433.Copyright © 2010, Orlando Sentinel
