CASE STUDY

GETTING THE PERFECT FIT FOR A SKYSCRAPER

Client

Texas Children's Pediatric Houston, Texas

Demographics

48 practices 62,000 call center encounters annually

TeamHealth Partner Since

October 2005

Solutions

HL7 Demographic Feed Electronic Interface with EPIC

The Client’s Challenge

For nearly a decade, Texas Children’s Pediatrics (TCP) has entrusted TeamHealth Medical Call Center (THMCC) with providing quality after-hours triage and clinical advice to its patient base of nearly 500,000. During that time, THMCC has performed more than 500,000 encounters that were documented and communicated back to TCP via fax. Those generated documents required TCP personnel to manually retrieve, sort, prioritize, and ultimately file those documents within each patient’s medical record—creating numerous hours of work that in turn generated additional labor costs for TCP.

Our Solution

The revolving door of avoidable hospital re-admissions is slowing across the nation, including in Texas. The state posted a 5.8 percent decline in recent years, the federal Centers for Medicare and Medicaid Services reports.

Nationally, the average decline was 8 percent between 2010 and 2015, with every state except Vermont reporting reductions, a CMS blog post said. In Vermont the increase was statistically negligible.

The agency has gotten tough on the frequency and ultimately wasteful practice of patients with specific chronic conditions winding up back in the hospital 30 days after discharge. Potentially avoidable readmissions cost more than $17 billion each year in Medicare payments, it has said.

Under the Affordable Care Act, the Hospital Readmission Reduction Program can levy hospitals with penalties up to 3 percent of their Medicare reimbursements for all patients if the number of readmissions exceeds the national average for certain conditions: pneumonia, heart attack, heart failure, chronic obstructive pulmonary disease, hip and knee replacement and, for the first time this coming year, coronary artery bypass graft surgery.

Starting in October, CMS is expected to penalize roughly half the nation’s hospitals to the tune of more than half a billion dollars in withheld Medicare payments.

Still, the number of readmissions is dropping. CMS said they dropped nationwide by almost 104,000 in 2015 alone. Since 2010 it is estimated 565,000 readmissions have been avoided, officials said.

In 2010 the number of Texas hospital admissions statewide were 571,147, with a readmission rate of 17.1 percent. In 2015 overall hospital admissions in the state was lower, at 509,738, and the readmission rate had dropped to 16.1 percent, according to CMS calculations.

The federal program has long had mixed reviews as some have complained it is overly simplistic to measure quality of care and efficiency by readmission rates.

Our IMPACT

The electronic documentation generation and interface between THMCC and TCP’s EPIC system has sped up getting needed information to patients’ physicians faster so that patient care and safety are improved. An additional benefit of the TCP and THMCC collaboration effort has been a reduction in TCP’s costs associated with the time required for personnel to retrieve, sort, prioritize, and file printed documentation and the elimination of a cumbersome, paper-dependent process.