Uniting Physical Therapy and Emergency Medicine to Reduce Admissions

From the 2021 HVPAA National Conference

Joshua Rosentel (Lehigh Valley Health Network), Gillian Beauchamp, Daniel Sawyer

Background

LVH has been a consistent high outlier for back pain admissions on CMS’s Program for Evaluation Payment Patterns Electronic Report (PEPPER) for more than 18 out of the last 20 quarters. The medical back pain metric from CMS was replicated using a custom comparison cohort of like hospitals. In FY 2019, out of 92 comprehensive academic medical centers, LVH had the third highest rate of admissions in MS-DRG 551 and 552 out of the total MDC 08 population.

Objective

A multi-disciplinary collaborative team approach is necessary to provide value-based care to patients; achieving high-quality care at the lowest possible cost. It is essential to reduce unnecessary admissions to the hospital whenever possible. Utilizing CMS reporting, cohort comparisons, and evidence-based care to develop a back-pain protocol allowing physical therapists (PT) to evaluate patients in the emergency department (ED) prior to admission.

Methods

Meetings between ED and PT personnel began in June 2019 and protocol development started for PT evaluations to occur in the ED. A dashboard was built to track data and analytics regarding back pain patients arriving to the ED, their disposition status, diagnostic testing, and PT evaluations. It also tracked how often each provider was utilizing PT in the ED for appropriate patients. The data showed that while patients who received PT care in the ED had positive results, the algorithm was underutilized.  Provider outreach and re-education was necessary but was interrupted by a second peak of COVID admission.

Results

On average, patients evaluated by PT in the ED using the algorithm wait 1 hour for the order to be placed and an additional 1.9 hours for the evaluation to occur compared to 14.5 hours and 25.5 hours respectively when evaluated on an inpatient or observation unit. LVH has also received positive satisfaction surveys for patients evaluated by PT in the ED. Patients evaluated by PT in the ED also exhibited a lower 7-day return rate of 5.88% compared to 10.63% for those evaluated by PT after admission. Currently, admission rates have remained relatively stable between FY 2020 and FY 2021-to-date at 34.8%.

Conclusion

Cohort comparisons show LVH as being amongst organizations with the highest admission rates for MS-DRG 551 and 552 compared to MDC 08 discharges. LVH recognizes the PT in the ED algorithm as another tool to reduce back pain admissions and will continue with data and analytics tracking and provider education, outreach and feedback to ensure expanded use of the algorithm.

Clinical Implications

Cohort comparisons found that the usage of PT evaluations in the emergency department remained low in both FY 2019 and FY 2020. While LVH has yet to fully achieve the desired results because of the COVID-19 pandemic, LVH remains confident that this evidence-based, uniquely innovative algorithm will provide patients with a faster and more efficient introduction to PT thus reducing admissions and cost while improving quality, pain management and patient satisfaction.