Dr. Khungar can be seen discussing her pilot study and the Innovation Acceleration Program award on YouTube.
A study at Penn Gastroenterology is seeking to avoid readmissions within 30 days of hospitalization in the cirrhotic and post liver transplant populations.
In 2012, the Centers for Medicaid and Medicare Services Affordable Care Act established the Hospital Readmission Reduction Program (HRRP) to withhold up to 3% of total Medicare reimbursements for hospitals reporting higher than expected risk-standardized 30-day readmission rates for a collection of pre-determined conditions and procedures. To date, cirrhosis and liver transplantation (a complex, resource-intensive surgery) are not reported to HRRP, but many expert observers of the ACT expect their addition in the years ahead.
To address this eventuality, Vandana Khungar, MD, MSc, is conducting a study at Penn Gastroenterology to reduce readmissions in cirrhotic and post-liver transplant patients through a program known as Live Better, developed with a grant award from the Innovation Accelerator Program (IAP) at Penn’s
Center for Health Care Innovation.
“We know a great deal statistically about the readmission population,” Dr. Khungar says. “We know, for example, that patients with cirrhosis and those having liver transplants have about a one-third chance of being readmitted to the hospital within 30 days of discharge.” Because these patients are by definition very ill, avoiding re-hospitalization is particularly challenging. The estimated three-month mortality for critically ill cirrhotic patients is greater than 50%, Dr. Khungar notes.
Encouraged by the IAP and prompted by the $21.6 million annual cost to Penn Medicine for readmissions following treatment for cirrhosis and liver transplantation, Dr. Khungar collected a team of investigators and began seeking a solution.
“We found the idea of telehealth very appealing because it’s been used with great success in the heart failure population,” Dr. Khungar said recently. Together with her team, she developed the hypothesis that 30 day readmissions could be reduced for both the cirrhosis and liver transplant populations by remotely monitoring their weight, mental function, medication adherence and temperature––functions closely aligned with the symptomatology of cirrhosis and the post-transplant period.
At the initiation of the year-long pilot study that followed, a group of 21 patients received Bluetooth tracking devices and 4G tablets and trained to detect and report the signs and symptoms identified with hospital readmission. Follow-up was provided by trained RNs.
The result? The monitoring system reduced 30-day readmissions by 43% and produced a 75% reduction in potentially preventable readmissions. Using these figures as a point of reference, Dr. Khungar estimated that implementation of the monitoring program would reduce costs at Penn by approximately $9 million annually, and would approximately halve readmissions for both cirrhosis and liver transplant patients.
In the next phase of work, the team plans to refine the intervention and expand the pilot to all liver transplant and cirrhosis patients at Penn Medicine as a standard of care for the post-discharge period.