When Is 7.69 a Spectacular Number?

April 10, 2013
James L. “Larry” Holly, M.D., president and co-founder of Southeast Texas Medical Associates (SETMA), in Beaumont, Texas, has helped lead his colleagues towards a significant optimization of readmissions management for the at-risk patients being cared for by their group. What’s SETMA’s secret?

Even as one of several mandatory healthcare reform-related programs—the avoidable readmissions reduction program—gets underway, it is frankly discouraging to be aware that most hospital organizations nationwide have not yet begun the “heavy lifting” on analyzing their avoidable readmissions and on improving readmissions reduction performance. This is as reimbursement reductions for avoidable readmissions are set to begin in the fourth quarter of this year!

Indeed, as the figures that CSC's Erica Drazen provided to HCI exclusively this week show, mandates around the readmissions reduction program—just as for the healthcare-acquired conditions reduction and value-based purchasing program—are moving forward now, even as the Centers for Medicare and Medicaid Services (CMS) works on the definitions around “avoidable” readmissions.

Yet a small number of medical groups, hospitals, and health systems are moving ahead, and are already far ahead of everybody else. Among those pioneering patient care organizations is Southeast Texas Medical Associates (SETMA), in Beaumont, Texas, whose three dozen physicians have been speeding ahead in terms of care management, population health management, the use of dashboards and analytics, and readmissions reduction.

In fact, James L. “Larry” Holly, M.D., the group’s president and co-founder, has been documenting results for his group that really stand out, even among the pioneering organizations working on readmissions reduction. He told me today that, in January, “we discharged 12,000 patients from the hospital, including high-risk patients, and including 25 percent of the uninsured patients who are admitted to the hospital with which we’re affiliated” (Baptist Hospital of Southeast Texas, also in Beaumont). And, he noted, he and his colleague at SETMA achieved a 7.69 percent rate of readmissions within 30 days, for the organization’s high-risk patient population. That figure is quite astonishing, and very much worth noting.

Indeed, the leaders at most patient care organizations would be thrilled to get their avoidable readmissions rate down around 12 or 13 percent—which means that SETMA’s achievement is something to be celebrated and explored. And that’s exactly what will happen, when Dr. Holly participates on a discussion panel entitled “Readmissions and the Medical Home: Re-Visioning Care Management,” which will take place during the Healthcare Informatics Executive Summit, being held May 6-8 at the Marriott Orlando World Center in Orlando, Florida.

Dr. Holly—who prefers being addressed as Larry rather than as Dr. Holly, by the way—will join Dr. Ferdinand Velasco, CMIO at Texas Health Resources, and Tina Buop, CIO at Muir Medical Group IPA, our session on readmissions and the medical home. Like Larry Holly, Ferdinand Velasco and Tina Buop are working with their colleagues in the Dallas, Texas and San Francisco East Bay areas, respectively, to develop new approaches to managing care quality and cost for their patients and communities.

Like Larry Holly, Dr. Velasco and Tina Buop are also helping to lead their colleagues in the successful leveraging of clinical IT. Indeed, all three organizations are on the leading edge in many areas in that regard.

In the end, though, all the technology won’t get you there without the leadership, commitment, and vision. Here’s what it comes down to, Larry Holly says: “This is not rocket science. You have to pay attention and you have to be relentless.” Amen to that.

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