- Implementing a patient nutrition care program at four Chicago-area hospitals helped Advocate Health Care accrue more than $4.8 million dollars in savings by reducing hospital readmissions and shortening inpatient stays, according to a new article published in American Health & Drug Benefits.
The program, which addresses growing instances of patient malnutrition, leveraged a data-driven population health management approach to reduce 30-day readmission rates by 27 percent and the average length-of-stay per patient by close to two days.
"Value-based care means looking comprehensively at patient care to identify gaps and opportunities for improvement," said Lee Sacks, MD, executive vice president and chief medical officer of Advocate Health Care.
"The study's findings demonstrate that modest changes in the way we care for patients, such as ensuring patients are nourished during their hospital stay, can have a big impact in reducing costs and improving health outcomes."
Care for malnourished patients can cost twice as much as treating patients with adequate diets, the study says, due to the fact that improper nutrition tends to lead to longer hospital stays and more unplanned readmissions.
In an accountable care environment, these extra costs can make it difficult for organizations to reach quality benchmarks and control spending levels.
Many population health management and value-based care initiatives are starting to stress the importance of addressing the social determinants of health, such as access to healthy food choices, alongside clinical care.
Yet understanding patient challenges outside of the hospital or clinic – and ensuring that individuals are able, informed, and willing to make positive lifestyle choices on their own – is a continual struggle for providers who may not have access to adequate community-level data and risk assessment tools.
“The utility of medical nutrition as a driver of value-based medicine has largely remained overlooked and underappreciated as a means of improving cost-savings at the hospital level as well as the integrated delivery network,” the study points out.
In order to assess the effect of addressing patient nutrition in the hospital, the researchers used a web-based budget impact model to gauge the effect of adding malnutrition risk screenings, oral supplementation, patient education, and diet-related discharge planning to the standard patient care routine.
The project, which began in 2014, involved implementing a basic quality improvement program in two hospitals and an enhanced quality improvement initiative in two more. Each group included one teaching hospital and one community hospital, all located in the suburbs around Chicago.
The basic program included nurse-led malnutrition screenings, prompted by the electronic health record, and oral nutrition supplementation for those patients requiring extra help.
The enhanced program also included inpatient education, post-discharge dietary instructions, follow-up phone calls, and coupons for purchasing supplements in the community.
Using an average readmission cost of $11,200 for patients in 2013, the study found significant savings from both the basic program and the enhanced program. The basic program cut costs related to unplanned readmissions by 18 percent, while the more robust strategy produced a 22 percent drop in readmissions spending.
“The net savings from avoided readmissions per patient treated was $403 for the basic quality improvement program and $493 for the enhanced quality improvement program, respectively,” the study explains.
“For the combined program cohorts, the total cost-savings resulting from avoided readmissions was $556,461 and the patient net savings was $439 per patient treated.”
Source: Center for Applied Value Analysis
The effort produced even more savings from reduced length of stay. Net savings per patient in the basic program totaled $1062, while the hospitals saved $1239 per patient in the enhanced program.
Total savings related to length of stay for the combined quality improvement program cohorts was tallied at more than $4.1 million, or $3255 per patient.
“The clinical and economic outcomes of the quality improvement program thus provide the rationale for merging patient care and financial modeling to make the delivery of value-based medicine possible in the underserved malnourished patient population,” the authors stated.
While the team acknowledges that the study may be limited by its choice of financial boundaries and the fact that the entire study took place within one single health system, the potential for nutrition counseling to significantly reduce hospital spending should be explored by other organizations participating in value-based care arrangements.
"This research confirms that implementing nutrition-focused quality improvement programs, like the ones at Advocate Health Care, can help patients recover from their hospitalization faster while also removing some of the burden of financial pressures placed on health systems today," said lead author Suela Sulo, PhD, a health outcomes researcher at Abbott, which supported the study financially.
"As providers, administrators, and payers face added pressures from rising healthcare costs, value-based nutrition interventions should be considered in all hospitals across the US."