Study shows reduction in hospital readmissions, costs for medically complex patients seen in an outpatient critical care transition clinic

Fewer posthospital inpatient admissions and decreased costs were seen in a large group of patients with medically complex chronic conditions who were referred to and seen at an outpatient critical care transition clinic compared with those who were referred but did not attend the clinic, a recent study found.

“Reducing hospital admissions in patients with multiple complex chronic conditions is both a quality indicator and cost-effective to health care systems,” the study authors wrote in the September 2021 issue of The American Journal of Managed Care.

Healthy transition clinic goals

Common conditions of the patients in the study included congestive heart failure, chronic obstructive pulmonary disease, high blood pressure, diabetes mellitus and complications, acute myocardial infarction, substance abuse and renal and liver disease.

These patients were discharged from Ascension St. Vincent, an 822-bed tertiary/quaternary acute care hospital in Indianapolis, or its emergency department (ED) to the Ascension St. Vincent Medical Group Healthy Transitions Clinic (HTC) between March 1, 2015, and Feb. 29, 2016. The compared cohorts comprised patients who attended the HTC and those who did not.

According to the authors, the main goals of the HTC are to:

• Help high-risk patients better manage their chronic diseases
• Reduce encounters at EDs or hospital admissions
• Improve the cost effectiveness of healthcare services

“Transitional care services reduce ED encounters and inpatient stays,” the authors wrote, citing a previously published study.

“The benefits to patients, hospital systems, and payers from reduced hospital encounters include improved health, disease management, and financial savings,” the authors of the September study wrote. “As the U.S. health care system changes from fee for service to value based, efficiently managing medically complex chronic conditions is increasingly important.”

HFMA perspective

According to Shawn Stack, HFMA’s director of perspectives and analysis, programs like HTC “are designed around patient-centered care and effective case management — an approach that has repeatedly influenced healthier outcomes and long-term cost savings. Unfortunately, programs like HTC are still not the norm in the U.S., given that most healthcare continues to be delivered through fee-for-service models that do not reward health plans and providers for collaboratively managing and delivering better long-term health.”    

Shawn Stack, director of perspectives and analysis, HFMA, Washington, D.C.

Study outcomes

Among the outcomes of the study:

• HTC patients with chronic conditions had a 31% reduction in relative risk for inpatient admissions.
• The clinic reduced costs by more than $1 million.

A closer look at data revealed median cost reductions per patient encounter of:

• $2,612 among HTC patients compared with non-HTC patients at 30 days post-index period
• $1,537 among HTC patients compared with non-HTC patients at 6 months post-index period

“Applying the 30-day post-index period cost savings to the 409 non-HTC inpatient encounters results in potential savings of approximately $1,070,000,” the authors wrote, adding that there could be additional savings in ancillary services such as imaging and labs.

While additional study is needed on a longitudinal basis, they added, “We suggest that other health care systems could benefit from setting up similar programs to help these patients manage their medically complex chronic conditions and reduce health care costs nationwide.”

HFMA takeaway

“Programs like the HTC model further clarify the importance of HFMA’s commitment to promoting the importance of cost effectiveness of health,” said Stack. “Simply cutting costs and focusing on spend for specific programs is not an effective approach. Providing cost-effective care that delivers optimal health outcomes is key to driving impactful benefits to patients, payers, employers, providers and communities.”