In anticipation of changes in medical care due to the Affordable Care Act, the City of Eden Prairie along with St. Louis Park are in the process of developing a “Post Discharge Visit” program. The Affordable Care Act was designed to provide a number of new tools and resources to help improve health care and lower costs for Americans. One component of this is “bundling payments” which combines the payment for services that patients receive during one single care episode such as a heart surgery or knee replacement. In simpler terms, if a patient is discharged after a heart surgery, and has to come back to the hospital in five days for something related to that surgery, the patient will not be charged for this visit.
The “Post Discharge Program” program is a joint effort between metro-area fire departments and hospitals, in hopes to provide better care to the patients and reduce the number of “return visits” for one care episode. In certain circumstances, when hospital patients are discharged, metro-area firefighters are assigned to check-in on them in their home. Typically, patients are being told important information in regards to what medications to take and how to care for themselves at time of hospital discharge. Sometimes, due to the overwhelming nature of a hospital stay, this information can be overlooked, and can be the cause of a return visit to the emergency room days after being discharged. With the ”Post Discharge Visit” program, firefighters/EMTs from metro-area cities are responsible for checking on the patients in their homes within 24 hours of their hospital discharge. They can answer questions the patients may have. The goal of this is to ultimately reduce the amount of patients that are readmitted to the hospitals.
The program developed from conversations between St. Louis Park Fire Department and Park Nicollet Hospital in St. Louis Park about how to limit patient return visits to the hospital. The timing was perfect for a pilot as the hospital was already having these conversations. Using lean sigma, Park Nicollet along with area fire departments created the new process for the pilot, launched on May 12, 2014.
During the pilot, St. Louis Park, Minneapolis and Minnetonka have engaged doctors and nurses, in order to help them understand and increase their level of comfort with the program. After learning about the program, patients could opt-in to the pilot. Currently the pilot is being run in these three cities with the idea of adding cities later. If patients within these three cities opt in the fire department receives access to a subset of their medical data. After their release from the hospital, the patient and the fire department schedule an appointment. During the visit, staff asks the patient whether they understand how to take their medication; if they find they do not, they ensure they know who to call for assistance. In these conversations, the fire department can also determine whether there are any needs for additional care or assistance needed. In addition, fire staff can also do an assessment of the home, scoring for physical safety. Staff can also determine that all fire needs are being met. Based on that score, they can determine whether additional resources are needed such as social services or medical and then pass that information on to the appropriate party. The goal of these practices is for the patient to maintain control of their medical process by understanding expectations. According to St. Louis Park Fire Chief, Steve Koering, in the past when a patient had difficulty with their discharge instructions they would call 911, be picked up by an ambulance and sent to the hospital. Now, the patient’s questions can be addressed in advance. At the end of the process, we provide all patients with a survey which helps the fire department and Park Nicollet measure the success of the visit. In total, the cities have completed 14 home visits to patients.
The pilot is raising questions that will need answers before the project can become implemented on a wider-scale. How can the communities measure the effectiveness and what are the meaningful outcomes? How can they determine funding for the future? To answer these questions, they need to first understand the demand for the service. Once these are answered, a sustainable program which allows for the expansion to more communities could be possible. In addition to the discharge information discussion and the safety assessment it was determined that food and access to food was a key component of security and healing. The program now asks the question about the patients’ ability to get food and has partnered with local organizations to solve the problem if it exists.
For Eden Prairie, they are currently helping assist St. Louis Park and the other participating cities during the pilot stage of this program, helping to analyze the success of the program and looking at various partnership opportunities with hospitals around the area. The goal is to analyze the success of the pilot program by fall, and if successful, to implement a full ”Post Discharge Visit” program shortly after in Eden Prairie.