CV Team Sample Cases

Case 1: See You in 7: An Advanced Practice Provider Post PCI Clinic Improving Transition of Care

Background: A majority of elective PCI patients are being discharged same day resulting in a shift in clinical practice. This change has limited the patient exposure to the physician and healthcare team resulting in fragmented, uncoordinated care.

Case: A multidisciplinary team utilized lean principles to develop a patient centered transitional care program-See You in 7. This advanced practice provider (APP) run clinic ensured patients received appropriate coordinated services to manage their CAD post PCI. Pre and post implementation metrics selected included number of scheduled visits within 30 days of discharge, medication errors, and enrollment in cardiac rehab.

Decision-making: The retrospective review of 12 months of same day PCI data included 245 patients. The average time to follow up with a cardiology provider was 47 days and 9.5% of patients still had not been seen in cardiology clinic at 12 months. Only 21 % of patients were engaged in cardiac rehab within 30 days of discharge and 11% had medication errors. Following implementation of the APP transitional care program, the average time to follow up was 4 days. There were no medication errors and cardiac rehabilitation participation increased to 80%. An economic analysis of revenue demonstrates that this APP clinic is revenue generating for both the practice and hospital. E/M net revenue is estimated to be $11,799.00 annually for this population (245 patients) when utilizing APP follow-up. Based on salary costs derived from the Medaxiom 2016 CV Compensation Survey, there was a $35,600.00 loss with cardiologist provided follow-up visits. In this model, the ability of the cardiologist to generate new RVU potential was not considered. New revenue for cardiac rehab is estimated to be $374,976.00 based on 4.1 referrals/month using current billing guidelines.

Conclusion: This See You in 7 process improvement project aimed at standardizing the coordination and transition of the elective PCI patient from hospital to home has improved patient safety and patient outcomes following same day PCI. Additionally, this program is revenue generating for both the practice and hospital.

References/Resources: Medaxiom 2016 CV Provider Compensation Survey

Case 2: Patient Navigator Team Approach Successfully Reduces 30-Day Heart Failure Readmission Rate

Background: With increasing awareness to provide personalized care Montefiore Medical Center applied the American College of Cardiology (ACC) Patient Navigator Program (PNP) to improve transitions and outcomes among hospitalized heart failure (HF) patients. Utilizing a Navigator Team (NT) composed of a nurse and pharmacist, we delivered evidenced-based interventions and hypothesized this approach would reduce the all-cause 30-day readmission rate.

Methods: The NT followed primary HFrEF and HFpEF inpatients from June 2015 to January 2016. NT provided education, follow-up scheduled within 14 days and medical therapy recommendations. Interventions were tailored to the patient’s health literacy and social needs to increase adherence. The PNP was compared to internal analytics concurrently collected by the medical center’s quality improvement program.

Results: PNP enrolled 51 primary HF patients; mean EF was 36.5%, mean age was 69.7 years and 43.1% of patients were female. Results are shown in Table 1. There was a statistically significant difference in education and follow-up and a trend towards significance for medical therapy. NT interventions of education and follow-up resulted in an 81.3% decrease in the readmission rate.

Conclusion: The ACC PNP successfully reduced the readmission rate among primary HF inpatients by using a patient-tailored approach. Hospital programs can easily embed a NT into existing initiatives to further reduce the readmission rate.

  Navigator Program Medical Center p-value
Education, % 56.8 23.3 0.0002
14 day follow-up, % 68.6 39.5 0.0044
ACEi/ARB at discharge, % 85.2 68.4 0.17
Beta blocker at discharge, % 90.9 75.0 0.12
Readmission rate, % 4.8 25.6 0.0003