Rutland sets example in heart-attack care
By Gordon Dritschilo
Staff Writer | October 18,2013
Albert J. Marro / Staff Photo
The Green Mountain Care Board is seen Thursday in Rutland, its third stop as it tours the state. Board members, from left, are Betty Rambur, chairman Al Gobeille, Dr. Allan Ramsay, Dr. Karen Hein and Con Hogan.
Rutland’s approach to cardiac patients could be a model for the state, health officials said Thursday.
The Green Mountain Care Board held its weekly meeting in Rutland, part of an ongoing effort to find out what local communities are doing and what they need.
The board, which is charged with regulating the state’s health care system as well as trying to make it more innovative, normally meets in Montpelier but it has taken to holding meetings on the road.
Rutland was GMCB’s third stop, with previous visits to Bennington and St. Albans.
Officials from Rutland Regional Medical Center described how they were able to reduce the number of patients with congestive heart failure who returned to the hospital within 30 days of discharge.
In previous years, roughly a quarter of the patients who suffered congestive heart failure were back in the hospital within a month — slightly below the national average.
This year, according to Darrent Childs, RRMC’s quality improvement director, the rate has been below 15 percent.
The drop in the readmission rate beat the hospital’s goal.
“We’ll never get it to zero,” Childs said. “That’s not a good target — it means patients aren’t coming to the hospital when they need to — but we brought it down quite a bit. I think this provides the foundation for further work.”
Childs said the model could apply to other conditions like chronic obstructive pulmonary disorder or COPD.
With congestive heart failure causing one million hospitalizations a year nationally, RRMC cardiology medical director Dr. Stan Shapiro said the problem had a large scope in the United States and was likely to become more prevalent locally due to the aging population.
“It stands to reason a well-intentioned community may be able to do something in preventing why people come back to the hospital,” he said.
The hospital tackled both how treatment is performed and how it is paid for.
As far as payment, RRMC looked at a model where a lump sum would cover all aspects of congestive heart failure treatment, giving providers an incentive to keep patients from returning to the hospital.
And in care, it worked on communication across the various organizations involved in caring for patients.
“We recognized that we didn’t know what the next provider down the line needed,” Childs said.
A case manager in the emergency department served as a liaison between the different groups, helping to determine whether a patient really needed to be hospitalized and cutting down unnecessary admissions.
Providers also got better information to patients about when to stay home and when to come to the hospital, and allowed them to monitor and self-report weight and blood pressure.
RRMC President Thomas Huebner said the cooperation between care organizations was vital to the program’s success and could prove the most difficult aspect to replicate in other communities.
While the payment model creates an incentive to work together, Huebner said breaking down walls between, and even within, organizations can take a lot of work.
“Rutland’s always really hard on itself,” he said. “It’s what we do ... but it’s a close place and in a lot of ways the relationships between the entities are really good.”
GMCB Chairman Al Gobeille praised the hospital’s program not just for its results, but for its approach.
“There are a lot of people who comment on the fragmented health care system,” he said. “Then there are people who are offended by the comments and try to defend the system. You didn’t care about either of those. You went out and did something.”
The meeting also saw presentations from Rutland Mental Health Services, the Rutland Area Visiting Nurse Association & Hospice and the West Ridge Center for Addiction Recovery.
The latter institution is the city’s soon-to-open drug treatment clinic, which will initially serve about 400 people, starting with established patients from the Rutland area who have been traveling to Burlington or New Hampshire for treatment.
West Ridge program director Jessi Farnsworth said the facility will differ from many other treatment centers in that it will offer both methadone and buprenorphine treatment. The program will include a biological, sociological and psychological assessment; daily dosing that assures clinical “eyes on” each day; and required counseling and “life-skill building.”
“My experience is, so many of these patients have been so involved in addiction for so long that they have lost a lot of life skills,” Farnsworth said. “They’re not sure how to have conversation. They’re not sure how to have job interviewing skills.”
Farnsworth also described the “hub-and-spoke” approach the center will take.
“West Ridge will be the place of treatment, stabilization, structure,” she said. “Then, as patients do well, we will send them off to spokes where doctors can treat the patients in ways that offer them more comfort in life.”
Farnsworth said similar treatment programs have led to reductions in illegal drug use, associated criminal activity and associated health problems.