5 Embedded Case Management Strategies for 30-Day Readmissions Success

Looking to ward off Medicare 30-day readmissions penalties, Caldwell Memorial Hospital managed to decrease rehospitalizations from over 19 percent to less than 10 percent, a metric that catapaulted their hospital’s readmission ranking into the top five nationwide, says Melanie Fox BSN, RN, director of embedded case management with Caldwell UNC Healthcare.

What was their secret? A well-performing team of physicians, administrative staff, and embedded case managers who communicate often.

I want to share with you our 30-day readmit success. We’re very proud of this at Caldwell Memorial Hospital. Back from April to June 2012, our total readmission rate was 19.16. Nationwide out of 89 hospitals, we were number 62.

From October to December of 2013, our total readmission rate dropped from 19.16—and it’s hard to say even for me—to 9.09. We also improved our ranking from 62nd place out of 89 hospitals nationwide to fourth. Within that time frame, our 30-day readmits dropped that much. The only thing we changed over that time was adding embedded case management, but of course that won’t give us all the glory.

We do have great case managers in the hospital that help us. We talk or e-mail every day about problem patients or 30-day readmissions. We have great doctors that try to get our patients in to be seen; they are usually seen within seven to 14 days. That has decreased our readmissions. And we have great administrative support. They see the advantage of case management in doing their practices as well as in the hospital.

We all work as a team and we’ve been able to drop our numbers and become a lot more successful working together to make this happen. This is a big thing. This year and moving forward, you will be penalized for those readmissions. That’s what we wanted to be able to do, and we strive to get better as we go along.

Source: Embedded Case Management in Primary Care and Work Sites: Referral, Stratification and Protocols (Webinar available for replay)


Embedded Case Management in Primary Care and Work Sites: Referral, Stratification and Protocols presents Melanie Fox, director of the Caldwell Physician Network Embedded Case Management program at Caldwell UNC Health Care, as she shares how embedded case managers in both primary care practices and work sites are improving the quality of care and reducing healthcare costs by increasing preventive care measures at the work sites and improving care gaps for patients managed by the primary care practice.

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