This week, Vero Beach’s Indian River Medical Center will officially become one of only 35 hospitals in the nation – and the only hospital in the state of Florida – to participate in the American College of Cardiology’s(ACC) “Patient Navigator Program:” the first cardiology program of its kind in the country.
The ACC, a 47,000-member medical society based in Washington, D.C. was founded in 1949 and the nonprofit group’s self-professed mission is to transform cardiovascular care and to improve heart health.
Dr. Ty Gluckman says the new program will live up to those goals.
“As part of the navigator program, the Indian River Medical Center will serve as a model for other hospitals seeking to help heart patients safely return home after a hospital stay,” says Gluckman, medical director at Oregon’s Providence Heart and Vascular Institute and ACC’s patient navigator quality improvement specialist.
Jason Nance, IRMC’s director of cardiovascular services, says the hospital has already put much of the program into effect but the official kickoff will be at a ceremony on Thursday, Feb. 12.
What exactly is this patient navigator program? Nance quickly explains it is not some kind of marketing ploy designed to “steer” patients to IRMC. “Don’t be fooled by that meaning of the word navigator.”
Instead, Nance says, the program addresses key issues that heart attack and heart failure patients face both before and after discharge from the hospital when they are at their most vulnerable, with the overall aim of reducing heart patient readmissions.
According to the ACC, nearly one in five patients who suffer a heart attack or heart failure and receive treatment return to the hospital within 30 days of discharge. Those re-admissions, the college’s research shows, can often be associated with stress, fragility, lack of understanding of discharge instructions or the inability of the patient to carry out those discharge instructions.
It was to deal with those issues that ACC developed its patient navigator program: a personalized, patient-centered “team” approach created by ACC caregivers from a variety of disciplines. In a nutshell, the concept is to better prepare patients for discharge ahead of time and follow up with them on a regular basis in the days and weeks after they leave the hospital.
The program grew out of the ACC’s “Hospital to Home” initiative, says Dr. Mary Norine Walsh, medical director of the Heart Failure and Cardiology Transplant Program at the Saint Vincent Heart Center in Indianapolis, IN. “Out of that,” explains Walsh, “came more information about what works and what doesn’t.” She added that in expanding the concept’s application, “We wanted to select hospitals with a clear interest in quality improvement.”
According to Nance, the IRMC patient navigator team has already been formed and consists of between eight and 12 multi-disciplinary members. In addition to an administrator there are experts in pharmacology, nurse educators, heart failure/acute myocardial infarction experts, physicians and discharge planning staffers – all working together to implement what he calls, “an over-arching plan based on evidence-based information.”
IRMC cardiologist Dr. Richard Moore, who joined the hospital in 2002, serves as the team’s “physician champion,” or the one designated take the lead in promoting and implementing any changes to the program that will benefit patients.
Partial funding for the program is provided by a $10 million grant from the global pharmaceutical giant AstraZeneca, which is administrated by the American College of Cardiology. According to Nance, the ACC will help fund the program for just the next two years, but he adds that he expects the hospital will keep it going well beyond that.
AstraZeneca’s $10 million aside, there is an even more powerful financial reason for hospitals to continuously strive to decrease readmission rates.
In October of 2014, Kaiser Health News reported that under Medicare’s new cost-control protocols, three-quarters of U.S. hospitals would be subject to its “Hospital Readmissions Reduction Program.” In other words, those hospitals with “excessive” coronary readmissions will receive lower payments for every Medicare patient they treat, not just on those patients who are readmitted.
Last year Medicare withheld hospital payments totaling some $280 nationwide. For 2015, Medicare projects that figure will climb to $428 million.
Partly for that reason, IRMC and the other 34 hospitals in heart patient navigator program want to cut cardiac readmission rates – even though IRMC’s readmission rates are already among the lowest in the country.
Last year the ACC named the Vero Beach hospital as a “top-ten” cardiac care provider based on readmission rates. Two years before that IRMC had already instituted its own outpatient clinic for heart patients and in December of 2014, IRMC was one of the first hospitals in the country to be chosen to implant the St. Jude’s Medical heart monitoring device, CardioMEMS™ – in no small part because of its extremely low cardiac readmission rates.
Nationwide that is definitely not always the case. In New Jersey, for example, every hospital in the state except one will be penalized for “excessive” readmissions this year. So will the vast majority of hospitals in 28 other states including Florida, California, Georgia, Illinois, Massachusetts, New York, Ohio, Pennsylvania and Texas according to a Kaiser Health News analysis.
Closer to home, the Tallahassee Democrat reported in mid-October that while no Florida hospital was hit with the maximum 3 percent Medicare withholding penalty, IRMC’s neighbor to the south, the St. Lucie Medical Center in Port St. Lucie, was fined 2.4 percent.
That’s a fate IRMC plans to avoid. According to the ACC’s Gluckman, “IRMC will use the tools and support system established by the ACC to create a customized team-based program to help schedule follow-up appointments soon after hospital discharge, meet other patient needs and ensure the patient has appropriate support to return home safely.”
Since, as Gluckman points out, “Heart disease is the leading cause of death in Florida,” IRMC’s continued efforts improve on an already laudable record by further reducing hospital readmittances seems, as Nance says, “a great example of combining sound medical practice with sound financial practice.”
