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OverviewMcKay-Dee Hospital Center in Ogden, Utah, part of the Intermountain Healthcare System, had readmission rates in the lowest 3 percent of hospitals across the nation for all three clinical areas reported to the Centers for Medicare and Medicaid Services (CMS) for the selection period, and its heart failure and pneumonia readmission rates were within the best 1 percent of hospitals reporting (Exhibit 1).
McKay-Dee’s success may be attributed to the following:
- comprehensive quality improvement strategies, supported by extensive, systemwide clinical research and training in evidence-based care;
- standardization of care through "care process models," or clinical protocols, and heavy use of hospitalists;
- information systems designed to monitor quality;
- interdisciplinary care coordination and discharge planning with individualized patient education and scheduling of follow-up appointments before discharge;
- comprehensive identification of heart disease patients for education, post-discharge phone calls, and referral to the outpatient heart failure clinic;
- integration with community providers, both within and outside of Intermountain's network, which provides a continuum of care and helps ensure patients are connected with a medical home; and
- Intermountain's role as a leader in health care delivery and payment innovations, exemplified in its involvement with pilots of bundled payment/accountable care arrangements.
The Intermountain Healthcare System is a highly integrated system with multiple hospitals, primary care practices and clinics, an outpatient heart clinic, home health service, and a renowned clinical research institute. Membership in this system provides clear advantages in terms of shared resources and expertise, and enhanced communication across care settings. Nevertheless, McKay-Dee's experiences provide lessons for other hospitals and systems—even less-integrated entities—that are striving to reduce readmission rates as well as improve outcomes and maximize systemwide efficiencies.
First, McKay-Dee Hospital Center and Intermountain Healthcare operate on the premise that lower readmission rates, better quality measure scores, and financial savings are not the primary focus of their efforts, but rather byproducts of caring for patients correctly. Second, alignment of hospital care with outpatient care improves transitions and health outcomes. Third, it is critical to select and nurture physician leaders who embrace a hospital's quality measurement and reporting philosophy. If other physicians do not respond through medical leadership and incentives, it may be necessary to hold them to a higher level of accountability to encourage their adherence to clinical protocols. Current payment policy that rewards volume rather than clinical outcomes conflicts with some of these desired practices. Over the long term, changes to the incentives in the health care system are needed to align goals across hospitals and other stakeholders.
This study was based on publicly available information and self-reported data provided by the case study institution(s). The aim of Commonwealth Fund–sponsored case studies of this type is to identify institutions that have achieved results indicating high performance in a particular area of interest, have undertaken innovations designed to reach higher performance, or exemplify attributes that can foster high performance. The studies are intended to enable other institutions to draw lessons from the studied institutions' experience that will be helpful in their own efforts to become high performers. Even the best-performing organizations may fall short in some areas or make mistakes—emphasizing the need for systematic approaches to improve quality and prevent harm to patients and staff. The Commonwealth Fund is not an accreditor of health care organizations or systems, and the inclusion of an institution in the Fund's case study series is not an endorsement by the Fund for receipt of health care from the institution.
S. Silow-Carroll and J. N. Edwards, Intermountain Healthcare's McKay-Dee Hospital Center: Driving Down Readmissions by Caring for Patients the "Right Way," The Commonwealth Fund, Feb. 2011.