F2F FOLLOW UP WITHIN 7 DAYS
OF AN MENTAL HEALTH
INPATIENT DISCHARGE
Greg McCutcheon, MA
Executive Director
MH GOAL 1
argeted Case managers will meet face-to-face with
individuals within seven days after an inpatient
discharge inc...
WHAT ARE THE FINDINGS?
andom sampling of 49 adult hospitalizations showed 90% compliance
with F2F follow-up with 7 days
ri...
YOU DON’T KNOW JENCKS…
tephen F. Jencks, M.D., whose April, 2009 article in the New England
Journal of Medicine set the to...
WHAT DID JENCKS FIND?
ne stunning finding from Jencks was that little more than half
of patients readmitted to the hospita...
HOSPITAL READMISSION WITHIN 30
DAYS OF DISCHARGE A MAJOR ISSUE
MS focused on reducing readmissions for heart attacks, hear...
READMISSIONS INCREASE COST
OF CARE
nrelenting rises in health care costs has created a renewed and
more urgent push for “b...
WHAT CAUSES READMISSIONS?
eadmissions in the immediate post-hospital discharge
period are more likely to be related to car...
TRANSITIONS
he movement of patients from one care setting to another offers many
opportunities for quality improvement.
os...
WHY IS FOLLOW-UP
IMPORTANT?
he gap between the percentage of readmissions and the percentage of
potentially avoidable read...
OPPORTUNITIES FOR REAL
IMPACT
ront-loading the number of home visits immediately after discharge
mproving patient transiti...
AN OUNCE OF PREVENTION
oing things correctly day-in and day-out
reventing the initial admission helps to reduce readmissio...
UESTIONS?
hank you for your time and attention
reg McCutcheon, MA
xecutive Director
MU (Case Management Unit)
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F2F Follow Up Within 7 Days of an Mental Health Inpatient Discharge

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Re-admissions related to mental health and addictions are high cost items for CMS and likely to get further attention. Preventing avoidable hospital re-admissions is considered by many to be the most important opportunity for reducing waste in health care. The transition from the inpatient to the outpatient setting is a critical point along the care continuum in which there is a real opportunity to prevent re-admissions. Targeted Case managers will required to meet face-to-face with individuals within seven days after an mental health inpatient discharge. Targeted case management support in the days following hospital discharges are an effective deterrent in preventing some avoidable hospitalizations. Analysis indicates that targeted case management face-to-face follow-up in the 90% to 94% range for the time frames tested.

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F2F Follow Up Within 7 Days of an Mental Health Inpatient Discharge

  1. 1. F2F FOLLOW UP WITHIN 7 DAYS OF AN MENTAL HEALTH INPATIENT DISCHARGE Greg McCutcheon, MA Executive Director
  2. 2. MH GOAL 1 argeted Case managers will meet face-to-face with individuals within seven days after an inpatient discharge including all acute IP psychiatric, any state mental hospital, and Philhaven extended acute care.
  3. 3. WHAT ARE THE FINDINGS? andom sampling of 49 adult hospitalizations showed 90% compliance with F2F follow-up with 7 days rimary reason for not meeting the criteria was the inability to locate the individual after the hospitalization BHNP found that 94% of individuals received CMU TCM service within 7 days.
  4. 4. YOU DON’T KNOW JENCKS… tephen F. Jencks, M.D., whose April, 2009 article in the New England Journal of Medicine set the tone for today's readmission prevention energy. is review found that nearly 21%, or one in five, were re-hospitalized within 30 days and 34% were readmitted within 90 days.
  5. 5. WHAT DID JENCKS FIND? ne stunning finding from Jencks was that little more than half of patients readmitted to the hospital within 30 days of discharge had no evidence of a follow-up visit of any kind between discharge and readmission
  6. 6. HOSPITAL READMISSION WITHIN 30 DAYS OF DISCHARGE A MAJOR ISSUE MS focused on reducing readmissions for heart attacks, heart failure and pneumonia he Medicare Payment Advisory Commission recommended a payment strategy to penalize hospitals with high readmission rates that was included in the Affordable Care Act (ACA) eadmissions related to mental health and addictions are high cost items for
  7. 7. READMISSIONS INCREASE COST OF CARE nrelenting rises in health care costs has created a renewed and more urgent push for “bending” the cost curve npatient services are generally the largest expense reventing avoidable hospital readmissions is considered by many to be the most important opportunity for reducing waste in health care
  8. 8. WHAT CAUSES READMISSIONS? eadmissions in the immediate post-hospital discharge period are more likely to be related to care during the hospitalization hey may also be due to failures in the transition of care between the hospital and outpatient setting
  9. 9. TRANSITIONS he movement of patients from one care setting to another offers many opportunities for quality improvement. ospital discharges are a critical transition point in care that leaves many patients vulnerable to lack of support, resources and readmission. hese “transition” points contribute to unnecessarily high rates inpatient use and healthcare spending and expose some individuals to lapses in
  10. 10. WHY IS FOLLOW-UP IMPORTANT? he gap between the percentage of readmissions and the percentage of potentially avoidable readmissions widens as the number of days increase his suggests that efforts to prevent avoidable readmissions should target discharge planning and the time immediately following discharge. he transition from the inpatient to the outpatient setting is a critical point along the care continuum in which there is a real opportunity to prevent readmissions
  11. 11. OPPORTUNITIES FOR REAL IMPACT ront-loading the number of home visits immediately after discharge mproving patient transitions between care settings he term “discharge” has a bad connotation Transition” infers a sense of accountability between both the giving and receiving parties
  12. 12. AN OUNCE OF PREVENTION oing things correctly day-in and day-out reventing the initial admission helps to reduce readmission rates. he most effective way to prevent readmission is to prevent
  13. 13. UESTIONS? hank you for your time and attention reg McCutcheon, MA xecutive Director MU (Case Management Unit)
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