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READMISSIONS: What is a transitional care bundle?

Kaiser Permanente Northwest (Portland, Ore.) developed a transitional care bundle in 2009 intended to assist patients on discharge from hospital to home.  The initial results of implementation of this approach are reported in this study.  Hospital inpatients are assigned a risk level – high, medium, or low – and then receive different level of support services.  The services include:

  • Telephone hotline number
  • Same-day standardized discharge summaries and discharge instructions
  • Post-hospital follow-up – 5 days for high risk and longer for lower risk patients
  • Medication reconciliation

In the 269-bed hospital that was studied, about half of all patients discharged from hospital to home were judged to be high risk.  In the 5 years studied, the readmission rate was cut from 12.1 percent to 10.6 percent.

Source: Rice, Y.B., and others. (2016, Feb.). Tackling 30-day, all-cause readmissions with a patient-centered transitional care bundle. Population Health Management, 19(1), 56-62.  Click here: http://online.liebertpub.com/doi/pdf/10.1089/pop.2014.0163

Related news item: Erich, J. (2015, July 1). Kaiser Permanente’s plan to prevent readmissions. IH Executive. Click here: http://www.ihexecutive.com/patient-care/clinical-pathways/article/12076292/kaiser-permanentes-plan-to-prevent-readmissions  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

HIP REPLACEMENT: You might have to go to school first

Total joint replacement procedures – hips and knees – are commonly performed on Medicare patients, costing an estimated $7 billion annually for the hospital care alone.  The Centers for Medicare & Medicaid Services (CMS) has developed a bundled payment pilot initiative with mandatory participation for 67 selected health care markets nationwide.  One cost-reduction approach that is being tried by several providers is the idea of having elective hip and knee patients go to an “academy,” or otherwise receive patient education, before surgery to remove or lessen risk factors that might complicate their recovery.  Among the hospitals and health systems trying this out are: DCH Regional Health System (Tuscaloosa, Ala.), Catholic Health Initiatives (Englewood, Colo.), and BayCare Health (Clearwater, Fla.).

For more information about the CMS initiative, click here: https://innovation.cms.gov/initiatives/cjr

Source: Evans, M. (2016, Mar. 28). Ready or not, the bundled-payment challenge is about to start. Modern Healthcare, 46(13), 8-9.  Click here for publisher’s website: http://www.modernhealthcare.com/article/20160326/MAGAZINE/303269996  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

FORECASTING: Hospital payer mix 2014 and 2024, U.S.

What are the projections for U.S. hospitals’ Medicare margins over the next 10 years?  This brief article by a staff specialist at the Healthcare Financial Management Association takes a look at data from the Congressional Budget Office and the Medicare Payment Advisory Commission to address this issue.  I especially like the inclusion of payer mix statistics for the two endpoint years.  Here they are:


  • 37.8 percent  Commercial
  • 35.1 percent Medicare
  • 18.2 percent Medicaid
  •   5.8 percent Other governmental
  •   3.1 percent Self-pay


  • 40.0 percent Medicare
  • 33.0 percent Commercial
  • 18.4 percent Medicaid
  •   5.7 percent Other governmental
  •   2.9 percent Self-pay

Source: Mulvany, C. (2016, Apr.). Margins under pressure. HFM. Healthcare Financial Management, 70(4), 30-33. Click here: https://www.hfma.org/Content.aspx?id=47230 Posted by AHA Resource Center (312) 422-2050, rc@aha.org

Top 10 Patient Safety Concerns for Healthcare Organizations for 2016

The ECRI Institute has released its annual ranking of the top patient safety concerns for healthcare organizations. Based on a review of its patient safety organization [PSO] database of reported safety events, its PSO members’ root cause analyses and research requests, and a vote by an expert panel, these are currently the top issues:

  1. Health IT configurations and organizational workflow that do not support each other
  2. Patient identification errors
  3. Inadequate management of behavioral health issues in non-behavioral-health settings
  4. Inadequate cleaning and disinfection of flexible endoscopes
  5. Inadequate test-result reporting and follow-up
  6. Inadequate monitoring for respiratory depression in patients prescribed opioids
  7. Medication errors related to pounds and kilograms
  8. Unintentionally retained objects despite correct count
  9. Inadequate antimicrobial stewardship
  10. Failure to embrace a culture of safety

Source: Top 10 patient safety concerns for healthcare organizations 2016: executive brief. ECRI Institute, April 2016. www.ecri.org/patientsafetytop10 [free registration required]

Posted by AHA Resource Center (312) 422-2050 rc@aha.org

Accountable Care Organizations in 2016: Private and Public-Sector Growth and Dispersion

There were 838 active accountable care organizations as of January 2016, and they have service areas in every state. That’s all according to a new analysis by Levitt Partners  and the Accountable Care Learning Collaborative. The count of ACOs has grown from 64 in early 2011, and has increased 12.6% just over the past year. The number of accountable care contracts is now at 1,217, and an estimated 28.3 million people are covered by an accountable care arrangement.

The report also charts:

  • ACOs over time
  • ACOs by state
  • ACOs by hospital referral region
  • ACO lives over time
  • ACO lives per payer type
  • ACO penetration by state
  • ACO penetration by hospital referral region

ACO contract renewals and dropouts, policy drivers, ACO challenges, and the future of accountable care are all discussed briefly.

Source: Muhlestein D; McClellan M. Accountable care organizations in 2016: private and public-sector growth and dispersion. Health Affairs Blog, April 21, 2016. http://healthaffairs.org/blog/2016/04/21/accountable-care-organizations-in-2016-private-and-public-sector-growth-and-dispersion/

Posted by AHA Resource Center (312) 422-2050 rc@aha.org

TURNOVER: How to improve exit interviews

Exit interviews may provide less than useful information because departing employees may not be candid about interpersonal factors that contributed to their decision to leave.  Moreover, the authors contend that an exit interview program is often used “as an excuse not to have meaningful retention conversations with existing employees.”

Results of a cross-industry survey of 210 organizations yielded data about who conducts exit interviews (I rounded the following percentages off):

  • 71 percent done by HR department
  • 19 percent done by departing employee’s direct supervisor
  •   9 percent done by direct supervisor’s manager
  •   1 percent done by consultant

Pragmatic tips on how to structure a strategic exit interview program are discussed.

Source: Spain, E., and Groysberg, B. (206, Apr.). Making exit interviews count. Harvard Business Review. 94(4), 88-95.  Click here for publisher’s website: https://hbr.org/2016/04/making-exit-interviews-count  Posted by AHA Resource Center (312) 422-2050 rc@aha.org

CANCER: Top 10 most frequently diagnosed types of cancer

For many years, the American Cancer Society has produced estimates of new cancer cases and cancer deaths for the nation and by state.  Here are some of the most current numbers.

Estimated New Cancer Cases, US 2016

  • 249,260 breast
  • 224,390 lung & bronchus
  • 180,890 prostate
  •   95,270 colon
  •   83,510 skin
  •   82,330 uterine (cervix plus corpus)
  •   81,080 lymphoma
  •   76,960 bladder
  •   64,300 thyroid
  •   62,700 kidney

Source: (2016) Cancer Facts & Figures 2016. Atlanta: American Cancer Society, Table 1.  Click here: http://www.cancer.org/acs/groups/content/@research/documents/document/acspc-047079.pdf   If you’d like to review trend data, older editions can be accessed here: http://www.cancer.org/research/cancerfactsstatistics/allcancerfactsfigures/index Posted by AHA Resource Center (312) 422-2050, rc@aha.org


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