LRHC Chronic Care Management Team helps patients save thousands in hospital bills

LRHC Director of Transitional Care, Brittany Hueftle, presented the team approach and two case studies to the LHRC board of directors on Tuesday, Feb. 25.

Hueftle said some of the biggest needs in the community surround obesity and diabetes.

Nationally obesity costs the United States $147 billion per year and affects one in three adults, 33 percent, which increases the risk of diabetes, heart disease and certain cancers.

Locally Dawson County has an incidence of 34.4 percent obesity, Hueftle said.

Patients with diabetes can be struggling with large healthcare costs, $13,000 a year compared to $2,500 for someone without diabetes. Over 30 million Americans have diabetes with 84 million having pre-diabetes.

Hueftle said 10 percent of the Dawson County population has diabetes.

While most patients know losing weight is healthy, some don’t know how to go about it and Hueftle said healthcare providers haven’t always given people the resources to help reduce their weight.

The LHRC chronic care team is asking patients what their goal for losing weight is and what their priorities are, to better serve them as they move through the process. Hueftle said it’s important to discover the underlying needs a patient has, but doing so takes time and an establishment of trust.

To provide more effective healthcare the chronic care team is shifting to evidence based practices, Hueftle said.

With the goal to prevent readmission of patients, the team has intervention methods which include post discharge phone calls, stratified risk assessment, improved medication reconciliation, coordination with clinics after discharge, multi-disciplinary teams and transition care visits at no cost.

On the subject of medication reconciliation, Hueftle, when working in home health, found it, “mind blowing,” how often patients didn’t disclose all the medicines they were using at home to their providers.

Hueftle noted the transitional care visits are a better time for healthcare education than when a patient is in the hospital recovering. Also having patient’s provider visit them in the home allows for the patient to, “buy in,” more, said Hueftle.

The chronic care team “takes a lot of work and manpower,” Hueftle said, but the LRHC team is highly benefited by the smaller location, allowing for conversations across the board.

The chronic care team also has their own practices they follow, such as, completing rounds with providers and meetings with the whole multi-disciplinary team, better coordination after care and follow up visits which include wellness screenings, development of patient centered medical home and the use of macro data to drive the implementation of new processes.

This type of care can lead to huge savings in medical bills for patients in the system.

Hueftle offered two case studies to the board, In the first, a patient struggled with obesity and multiple chronic conditions that affected their quality of life punctuated with multiple emergency room visits.

After an inpatient stay which only lasted five days, they were readmitted to the hospital only 13 days later. This is when the chronic care management stepped in.

A hospitalization period was followed by a swing-bed stay which then allowed the team to implement their practices, and the patient began receiving multiple layers of health care services. The patient was also allowed to set goals and LRHC assisted the patient through many services to meet the goals.

The patient was discharged on the diet protocol, with focused on mental health counseling, dietitian counseling and physical therapy.

Through this care the patient was able to stay out of the emergency room and was able to have a significant weight loss, and better manage their chronic conditions, which enabled them to greater freedom in their life

The medical cost savings is perhaps even more notable.

Before the implementation of the chronic care, from a one year period between 2017 and 2018, their healthcare costs were a little over $68,000. After the program, from 2018 to 2019 their costs were $9,897, a difference of around $59,000.

In a second case, an elderly individual had a history of different diseases, heart issues, hypertension and sleep apnea. Their health was in such a condition that they were looking at moving from an independent living situation to an assisted living situation, they were struggling to complete daily tasks.

After going through the chronic care program the individual was able to exercise five times a week, was able to cook meals for themselves and company and can complete daily living tasks without exhaustion. They were also able to remain living independently.

From 2017 to 2018 the patient had three emergency room visits, three inpatient hospitalizations and two swing bed hospitalizations. The costs during this period were around $81,000.

From 2018 to the present, after going through the program, the patient has gone through cardiac rehab, transitional care and had follow ups with their healthcare provider, the costs were $6,786.46, a difference of over $74,000.

Another aspect is when it comes to food. If food is scarce at home, then patients are less likely to be healthy or taking the necessary actions to ensure they are healthy.

Hueftle noted one case of a family who was walking nine miles in the winter to the nearest dollar store for food. LRHC is able to help food scarcity among their patients through their community garden outreach. In 2018 the garden produced over a ton of tomatoes, 400 pounds of cucumbers, 200 pounds of peppers and squash, 88 pounds of zucchini and 65 pounds of carrots.

“This program is a way the hospital can invest and give back to the community,” CEO Leslie Marsh said after the presentation.

During the rest of the meeting, the board heard reports starting with medical staff from Dr. Francisca Acosta-Carlson.

Acosta-Carlson said a new resident from the Lincoln program will be coming next week to the hospital and a physician’s assistant student from Colorado has been present.

Of the students from the University of Nebraska Medical College, Acosta-Carlson described them as “top notch.”

Chief Nursing Officer Nicole Thorell said the nursing staff was taking part in acute-neuro program training on Tuesday.

Beyond this Thorell spoke of the importance of a hospital’s culture and how it not only impacts patient satisfaction but also employee recruitment, Thorell said of their four recently hired nurses, all said they came here due to the culture of LRHC.

During the Service Excellence report, the board got a personal story from Chief Financial Officer Wade Echenbrenner.

Echenbrenner said his father had suffered a severe stroke at the end of last year and spent multiple days in the hospital in Lincoln. When it came to the discharge process, Echenbrenner’s family considered bringing his father to LRHC and decided to do so.

Echenbrenner said during the whole process he saw, “the full continuum of care,” and noted the “extraordinary care,” his father was provided while he was in the swing-bed program at LRHC.

He also noted that his parents were thankful that they haven’t had to face the financial burden that they might have had if they had chosen a Medicare advantage plan. Now due to his condition his healthcare needs will be significant going forward, and paying the out-of-pocket maximums of $7600 every year is not something they had planned for and are thankful their traditional Medicare plan with supplement has picked up their deductibles and coinsurance.

During the quality update, Thorell said with the emerging coronavirus, LRHC is reviewing their procedures and protocols when it comes to dealing with an infectious disease. Thorell said while they don’t expect to have to deal with the virus in the area, they are still ready to do so.

Director of Marketing and Public Relations Brenna Bartruff brought the board up to date on all the different activities going on with LRHC.

On Feb. 3 a provider meet and greet was held in Bertrand for the staff at the clinic in the community, Angela Howard - NP and Roger Wells - PA-C. Bartruff said the response to the event was great and it was beneficial to meet with members of the community who expressed gratitude they still had healthcare access in town.

February is American Heart Month and LRHC is hosting two events on Thursday, Feb. 27 which are related to heart health.

From 11-12 p.m. and 4-6 p.m. an open house will be held for the new cardiac rehabilitation, sleep lab, in patient physical and occupational therapy and diabetes education rooms.

In addition to the open house a “Heart Healthy Cooking Demo,” will be held from 12-1 p.m. in the board room where registered dietitian Lacey Zarek will show healthy cooking options, how to read food labels and what to look for when buying groceries.

Annual health screenings are coming up on Wednesday, March 4 and Thursday March 5 in the LRHC lobby from 6 a.m. - 9 p.m.. Tests cost $20 and will provide a blood count, lipid panel, and metabolic panel. Health Screenings will be offered on March 19 at the Orthman Community YMCA, April 7 at the Elwood clinic and for the first time ever in Bertrand on April 14.

Eschenbrenner presented the January financial saying the month was “solid,” in gross revenue as sickness going around has prompted more visits. In fact the past three months have been stronger for LRHC.

The outpatient procedures driving the most growth included radiology, laboratory, pharmacy, rehabilitation, surgery and the emergency room.

Around $13 million was noted in the cash reserves, Echenbrenner expects this increase throughout the year as their billing system issues are solved.

There was no charity care at the board level which needed to be approved, Echenbrenner said.

The next LRHC board meeting is Tuesday, March 31 at 12 p.m.