3-minute case study: Hospitalists reduce unnecessary admissions

| May 9, 2017

What innovations drive success in healthcare? Here's a tactic from a high performer on the athenahealth network.

The problem

Summit Medical Group, a 500-physician multi-specialty group in New Jersey, does not own any hospitals. But Summit's patients are treated in the emergency departments of hospitals across the state. Summit's leaders need to prevent avoidable admissions and readmissions, eliminate duplicate testing, and reduce costs without sacrificing quality of care — all in settings they do not control.

The solution

Since 2007, Summit has worked to build a robust hospitalist program that embeds its own physicians at six hospitals in the region. While most hospitalists focus on inpatient care, Summit's hospitalists are also deployed to prevent avoidable admissions from the emergency department, redirecting patients when appropriate to outpatient resources, whether a primary care doctor, a high-risk clinic, or a skilled nursing facility.

In busy emergency departments, their hospitalists watch the board and work with staff doctors to identify patients who can be treated as outpatients — those who might otherwise be admitted for observation. Using their direct access to Summit patients' electronic health record, hospitalists can prevent duplicate testing, ensure timely handoffs of clinical information, and schedule patients to be seen in Summit's chronic care center as soon as the next day.

For patients for whom skilled nursing care is more appropriate than hospitalization, the hospitalists work with nursing facilities to ease the transition. For Next Generation ACO patients, Summit has taken advantage of the Centers for Medicare and Medicaid Services waiver program to skip the mandatory 3-day hospital admission and refer patients directly to skilled nursing facilities.

“We make sure that the patient gets everything that they need and will not get admitted," says Jamie Reedy, M.D., Summit's senior vice president of population health and quality.

The outcome

Summit, a high performer on key quality metrics across the athenahealth network, consistently has among the lowest admission and readmission rates in the nation across its seven ACO contracts.

Summit saw its days-per-thousand rate — the number of hospital days used in a year for each thousand covered lives — decline dramatically in 2016. And Summit reduced costly hospital stays without increasing days spent by patients in other facilities.

According to Reedy, “We have everything we need with our own hospitalist team. The workflows are so tight that patients never fall through the cracks. We don't need hospitals to help us with that."

Lia Novotny is a contributing writer for athenaInsight.


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Excellent article! As a previous ED case manager I had spent many attempts to encorage hospitalist and ED physicians to see the light in regards to decreasing admissions on patients that could just as easily be treated in an outcare setting. Especially thoses that show up in the ED often and receiving repeat test, sometimes, over and over again, which of course drives the healthcare cost through the roof! I am very happy to see this is being looked at and Summit is working to make a difference.
Jennifer Simpson
Nothing new here. New West Physicians in Denver has been doing exactly this for 25 years. Makes perfect business sense when the physician group takes full risk for all professional costs and shares risk for hospital costs. New West goes further upstream to ID such patients and intervene before they even show up in the ED. New West also controls and staffs their own SNF to help reduce readmissions. New West's readmission rate now less than 5%.
Thomas Culhane

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3-minute case study: Hospitalists reduce unnecessary admissions