Post-CABG care program lowers readmissions, costs

Enrolling patients in a transitional care program after CABG operations greatly reduced the risk of readmission within 30 days of discharge and saved the hospital $41,000 in costs, according to a study published in the May issue of the Annals of Thoracic Surgery.

Michael H. Hall, MD, of North Shore University Hospital in Manhasset, N.Y., and colleagues designed and evaluated a pilot program called “Follow Your Heart” that focused on continuity of care between the inpatient and outpatient settings after CABG. The program assigns hospital nurse practitioners who know the patient from his or her index admission to conduct postdischarge home visits.

Recognizing that CABG is slated for a second wave on conditions to fall under Medicare’s readmission reduction program, Hall et al developed the program to reduce the rates of avoidable readmissions. Medicare already penalizes hospitals for what it considers excessive 30-day readmissions for heart failure, acute MI and pneumonia.

Follow Your Heart combines usual care with home visits by a cardiac surgery hospital nurse practitioner.  “The salient feature of this program was the intimate familiarity of the NP [nurse practitioner] with the specific patient’s hospital care and recovery,” Hall and colleagues wrote. “This provided for maximum continuity of care by allowing the home visit to be structured as an extension of hospital care.”

Researchers analyzed data from the New York Cardiac Surgery Reporting System and the Society of Thoracic Surgeons databases to study patients who underwent CABG at one hospital in New York between May 1, 2010, and Aug. 31, 2011. The study sample included 401 patients, with 169 assigned to the Follow Your Heart program and 232 to usual care. They used propensity score matching to compare the two groups.

Follow Your Heart was the only independently significant variable to affect 30-day readmission or death. Patients in the usual care group were three times more likely to be readmitted than patients in Follow Your Heart. The usual care patients had a higher rate of readmission or death, at 11.54 percent vs. 3.85 percent for the Follow Your Heart group.

In a financial analysis from the hospital’s perspective, Hall et al calculated that readmission direct costs for usual care patients were $86,187 vs. $27,147 with Follow Your Heart. Adding in the cost of nurse visits, Follow Your Heart cost $43,527. Overall, the Follow Your Heart program saved the hospital $41,078.   

“Given limited resources, identifying and engaging patients who are most likely to benefit, and most likely to achieve cost reduction, is becoming a priority,” they wrote. “Expanding NP staffing to achieve this goal may be financially justified from a hospital perspective.”

Since the pilot, they have expanded the program into three hospitals in their system and hired more nurse practitioners.