Reducing unnecessary hospitalizations is no longer just an option. In this new environment of health care reform, it is a mandate, a minimal survival mechanism for home health agencies. It is also the foundation for partnering in new health care initiatives.

 

If home care is to survive in the coming environment of ACOs, Medical Homes, Bundling and other health reform payment initiatives, agencies’ minimal criteria will be a rehospitalization rate that is at least as good, if not better than the national rate of 26% (17% based on the recent Medicare-only Home Health Compare data.)  One out of every four home health patients is hospitalized during a home health episode of care. The human impact of keeping those patients at home and the resultant effect on their family and loved ones is even greater than the financial impact! 

The pre-cursor to the SafeSide Rehospitalization Reduction project, called the “Ohio Move To Improve” study was conducted in collaboration with the Ohio Council of Home Care and Fazzi Associates and included 78 agencies who completed the 11 month program.  Those agencies realized an average of 6% reduction in their rehospitalization rates. 

Fazzi Associates has made refinements to the early Ohio study and continues to do so as we wrap up the current Phase II SafeSide study ending in February 2013.  We are ready to begin a 2013 program in order to replicate the success that we have seen around the country.

Project Goal

To provide participating agencies with the skills and tools of this high accountability, outcome oriented model in order to measurably reduce their hospitalization rates.   Participating agencies will either lower their hospitalization rates by 25% or be in the top (best) 25% of agencies in the country.

The SafeSide Model

The SafeSide model can be established in a home care agency in a short period of time. SafeSide uses existing agency resources and solid management principles, including goal setting and the complexity theory. It includes the capacity to provide real time tracking, trending and improvement efforts. And, it provides a highly accountable “foundation” and the ability for agencies to choose agency-specific best practice strategies.

In developing the model, we looked at contemporary management theory and practice, including goal setting, leadership, complexity theory, overload theory, data-driven decision-making and accountability. Rather than dictating WHAT interventions your agency uses to lower rehospitalizations, this model is focused on assisting you to establish a process that can be used in a wide variety of your agency’s initiatives.

Five Components

The model includes five components.  A leader is assigned to each component with the overall project having a senior level project leader.

Accountable Leadership

The Project Leader owns the program.  Project leader oversees the leads of other components, tracks progress and functioning of the program, Chairs the SafeSide Panning and Improvement Meetings, drives the initiation of data-driven process improvements, new practices, staff training/competency improvement initiatives, and the identification and implementation of new hospitalization reduction strategies.   

Project Lead:  Ideally, the Project Leader is a senior leader.  If not a senior manager, the leader must be a mid-manager who is highly respected and is able to ensure that senior managers are involved and actively (not passively) supportive of the efforts that need to be initiated.

SafeSide Hospitalization Dashboard

This is a real time tracking, trending and goal oriented dashboard.  Using hospitalization data from OASIS assessments, the dashboard provides real-time results and trending of hospitalizations.  It provides the foundation for auditing, tracking, and trending key strategies related to current hospitalizations. 

Dashboard Lead: Quality Improvement or Performance Improvement Manager or an equivalent position. 

SafeSide Real-Time Audits

Using the SafeSide Audit Tool, a targeted audit is completed within two business days of the hospitalization.  The Team Supervisor assigned to each patient is responsible for conducting the actual audit.  Audit Leader collects all audits and forwards the completed audit tools to Fazzi where on-going tracking and trending reports are developed and provided to the agency. 

Audit Lead: Senior clinical leader (Clinical Director) who ensures that Team Supervisors complete audits in a timely and accurate manner or person assigned and given authority by agency leadership.

SafeSide Planning and Improvement Meetings

These are not update meetings; they are planning meetings.  The meeting is chaired by the Project Lead and includes the Audit Lead, the Dashboard Lead.  The meeting can also include the Educator, if the agency has this position and other clinicians.  The meeting can also include other staff, particularly those who might be named leads for improving targeted strategies.  Planning and improvement meetings should be held whenever there are ten hospitalizations, or at least once per month. The goal of the meeting is to review all data and insights generated from the data-tracking component and the audit component and make data informed improvement decisions based on trends and insights generated. 

Planning and Improvement Meeting Lead:  Project Leader. 

Targeted Outcomes

Once the SafeSide Model is in place and fully operational, the program calls for a two-pronged approach for improvement strategies. The first phase entails a systematic review of existing strategies to ensure that they achieve maximum impact.  Once the existing strategies have been reviewed, the SafeSide Model calls for testing and implementing new processes, practices or trainings geared toward reducing unplanned hospitalizations.  Specific activities will be determined based on information generated from the Dashboard and audits discussed at the Planning and Improvement Meetings.  Each activity has a lead person assigned.

Additionally, each agency is assigned a senior level consultant who will support and work with the agency to succeed.  1:1 monthly consulting call will be scheduled throughout the program.

Expected Outcomes

By the end of the study, agencies are expected to see the following results:

1. Your unplanned hospitalization percentage will be reduced by 25% or your scores will be in the top 25% of most successful agencies in the country.
2. You will have established a state-of-the-art accountability structure that will ensure the success of the program and can be utilized in other sectors of your agency.
3. You will receive and learn to use a real-time hospitalization reduction dashboard for improvement.
4. You will have a reporting system and graphic reports essential for improving your ability to market your services to new referral sources and new emerging health programs.

Participating Agency Commitment

Time Commitment

The SafeSide Program is a year -long project starting in February 2013. The SafeSide model requires no additional staff and once the system is established, there should be minimal impact on staff time. There will be a new system established for ensuring increased accountability and some staff may have a limited number of new or modified responsibilities. There will also be trainings and consultation calls throughout the project.

Commitment to Project Requirements

The first two months of the project includes:

• Uploading six months of OASIS data to Fazzi Associates to create a baseline for your agency
• Providing eight recent hospitalization records for Fazzi to audit

The second month of the project includes:

• Attendance/Participation in SafeSide Model training program
• Identifying lead roles for various project components
• Working with assigned Fazzi consultant to be sure your agency is ready to begin goal setting , audits and improvement meetings

Third Month of the Project:

• Begin auditing all hospitalizations using the SafeSide audit tool
• Send audits in batches to Fazzi Associates
• Conduct first SafeSide improvement meeting

Fourth through Twelfth Month:

• Continue in house audits
• Continue OASIS submissions
• Continue SafeSide improvement meetings that will include reviewing SafeSide Dashboard report and Audit Summary Reports
• Determine and execute plans for new interventions/practices based on trending reports
• Conference call with Fazzi SafeSide consultant
• Celebrate successes along the way!

Cost

The cost for this year-long program is $4,900 per provider. The cost includes eight hospitalization audits* with a report on the findings, the SafeSide Dashboard, training, a record audit tool, a monthly accountability planning agenda, monthly phone consultations, targeted trainings, job descriptions, report charts, and best practice guidelines for all strategies implemented.

If your average agency census is greater than 200, you may want to have more than eight records audited to increase the statistical accuracy.  If so, audits over the 8 included will cost $100.00 per record.

Registrations will be accepted through February 8, 2013.  For questions, please email Jean Ellis, Director of SafeSide Phase III at jellis@fazzi.com