BY VALERIE LINZEY, DNP, APRN, FNP-C
Primary care practices are faced with many challenges when their patients are admitted or visit an outside facility or hospital. One of the major problems is a breakdown of communication when patients are discharged from the health facility or hospital and need to follow with primary care. Evidence suggests that improved communication to primary practices allows a higher continuity of care with fewer admissions and subsequent cost reduction (Li et al., 2020).
Primary care offices that are private or in smaller groups are missing out on a key intervention to obtain records and knowledge of a patient’s hospitalization. Data and support to medical practices was needed to ensure patients are receiving appropriate, timely care after hospitalization. We Our team, including Ursuline College staff, CliniSync and a local medical practice researched a strategy to obtain records and consequently ensure patients are followed up with upon discharge.
A process was implemented using CliniSync© to ensure primary care providers are notified of their patients’ hospitalization or emergency department (ED) visit to include a complete discharge summary with imaging or labs, and medication changes. CliniSync is a health information exchange tool that helps primary care providers stay informed of status changes with patients. We conducted a 6-week study using CliniSync in a primary care practice to compare before and after follow-up care coordination with ClinciSync.
The overall needs and goals of this project were to see a reduction in hospitalization and ED utilization, an increase in notification to primary care providers, improve communication with outside institutions and improve patient and provider satisfaction. CliniSync allows providers access to patients’ health information in a secure, trusted environment that’s run by a nonprofit company. Through CliniSync, providers can connect with hospitals, practices, behavioral health, long-term and post-acute care facilities and other health professionals involved in a patient’s care across Ohio.
CliniSync, a health information exchange (HIE), is a secure computer network that connects electronic health record systems used by different healthcare providers. The exchange allows those providers to share clinical and demographic information about patients they have in common quickly and securely to improve care coordination and efficiency. Providers receive an alert when one of their patients arrives to the ED, is admitted and discharged from the hospital. The practitioners can only view patient records if the patients have a treatment relationship with them.
Hospital readmissions are very costly for institutions. Across all expected payers in 2018, there were 3.8 million readmissions, of which Medicare accounted for 60.3% (2.3 million) and Medicaid accounted for 19.0% (721,300). The overall readmission rate was 14.0 per 100 index admissions, with Medicare stays having the highest readmission rate (16.9%) and privately insured stays having the lowest readmission rate (8.7%). The average readmission cost was $15,200, ranging from $10,900 for self-pay/no charge stays to $16,400 for privately insured stays (Research Agency for Healthcare and Quality, 2020). In addition, primary care offices are not reimbursed for transition of care if the patient is not seen within a certain time frame. Poorly executed transition in care is associated with increased vulnerability to adverse medication events, hospital readmissions and excess healthcare costs (Farrell et al., 2015).
Our practice setting consists of five physicians and one nurse practitioner, located in Northeast Ohio. We accept all payer sources and average 360 patient visits per month.
Inclusion participants were patients: 18 years and older of any gender/race/ethnicity experiencing a hospital admission or discharge. All payers were accepted, and all participants were active patients in the practice.
Exclusion criteria: patients under the age of 18, long-term care facility and skilled nursing facility discharges; also excluded are patients who opt out of CliniSync, and new patients establishing care.
Prior to implementation of CliniSync, the practice completed 50 Transitional Care Management (TCM) visits for 2021. Included in the results, during the data collection period of 6 weeks, the CliniSync system has surpassed the 2021 TCM visits with a total of 73 TCM notifications. This allows for a greater reimbursement and financial gain to the practice. This also allows a practice to take better care of their patients and improve continuity of care.
The data that CliniSync provided allowed the practice to improve outcomes and track progress outcomes. Notifications allow the practice to contact the patient and get them into to office more efficiently. New to the practice was notifications regarding ED visits. Although, unable to track data regarding ED visits prior to CliniSync, the outcome may be shown in the future as a decrease in ED utilization and hospitalizations. Notifications received on patients in the ED were 181 in the 6-week period. The average reimbursement for a level four visit is on average $125 per visit, according to the office billing team. Most transition of care visits and emergency department visit follow ups are a level four. These patients if brought into the office for a follow up ($125×181) would be a profit of $22,625. This is a potential game-changer for practice income and productivity.
We identified increased opportunity for improvements in care coordination in this study. Future improvements in ED follow-ups can offer a practice opportunity for improvement in care coordination, as well as the reimbursement for these services.
Agency for Healthcare Research and Quality. HCUP Clinical Classifications Software Refined (CCSR) for ICD-10-CM Diagnoses. Healthcare Cost and Utilization Project (HCUP). Agency for Healthcare Research and Quality. Updated November 2020. www.hcup-us.ahrq.gov/toolssoftware/ccsr/ccs_refined.jsp. Accessed January 22, 2021.
Farrell, T. W., Tomoaia-Cotisel, A., Scammon, D. L., Brunisholz, K., Kim, J., Day, J., Gren, L. H., Wallace, S., Gunning, K., Tabler, J., & Magill, M. K. (2015). Impact of an integrated transition management program in primary care on hospital readmissions. Journal for Healthcare Quality, 1, 81–92. https://doi.org/10.1097/01.jhq.0000460119.68190.98
Li, S. X., del Carmen, M. G., Thompson, R. W., Cafiero-Fonseca, E. T., Rockett, H., Ferris, T. G., Terry, D. F., Warner, A. S., Yu, A., & Wasfy, J. H. (2020). Evaluation of hospitalizations preventable with idealized outpatient care and continuity of care. Journal for Healthcare Quality, 3, 145–152. https://doi.org/10.1097/jhq.0000000000000259
Valerie Linzey, DNP, APRN, FNP-C, started her career as a registered nurse focusing on critical care treatment, level one trauma emergency department and the cardiovascular intensive care unit. Working in critical care informed Dr. Linzey to treat and educate patients on their illness and risks before they need critical care treatment. She is a family nurse practitioner and holds a doctor of nursing practice from Ursuline College. Dr. Linzey currently, works in a family practice and focuses on preventative medicine.