Since 2004, University of Arkansas for Medical Sciences’ (UAMS) ANGELS has operated a robust statewide telemedicine infrastructure with a 24/7 call center staffed with high-risk obstetrical registered nurses to provide guidance to rural, high-risk pregnant women seeking answers to questions, pregnancy advice, and triage. To provide telephone triage to a patient, the call center nurse utilizes computer software that requires the nurse to ask a series of algorithmic questions to uncover the patient’s symptoms and medical history, which will offer recommendations toward the most appropriate level of care.
Beginning in January 2013 ANGELS partnered with the UAMS Medical Center Congestive Heart Failure (CHF) Bundled Payment Committee to begin efforts towards incorporating the CHF patient population into the patients they serve. The Committee had been charged with reducing 30 day all cause readmissions in this population starting in July of 2012 when the Arkansas Bundled Payment Initiative officially began. At that time the 30-day all cause readmission rate was 24.99% compared to a national benchmark of 23.99%. Efforts of the interdisciplinary Committee resulted in reducing the 30-day all cause readmission rates to 18.69% (20/107) during the February-April 2013 timeframe compared to a national benchmark of 19.56%.
In May 2013 the ANGELS call center began contacting CHF patients on the day after their discharge and providing telephone triage using a CHF triage algorithm. During this time, ANGELS followed up with 80 post discharge phone calls, 11 triage calls and 1 informational call to 80/86 patients discharged with CHF from the May-July timeframe. During this time, no patients who were triaged were readmitted. After 3 months of implementation the 30-day all cause readmission rate decreased to 12.79% (11/86) compared to a national benchmark which remained steady at 19.17%.
The cost of a CHF admission to UAMS Medical Center from July 2012 to July 2013 averaged $12,000. Had the rates of 30 day all cause readmissions remained the same for the May-July 2013 timeframe, 16 patients would have been readmitted. Instead, 11 patients were readmitted which was a 31% decline representing a savings of $60,000 to the organization which would not have been reimbursed under the Arkansas Bundled Payment Initiative.
Donna J. Ussery RN, Project Manager, UAMS Centers for Distance Health; firstname.lastname@example.org Amy Hester BSN, RN, BC, UAMS Director of Clinical Informatics and Innovation; email@example.com