Test aims to cut hospital readmissions, costs

Photo/Matt Dodge Mira Denning, CEO and co-founder of the Patient Performance Institute, is positioning her company's patient screening test for a medical landscape where medical reimbursements focus on better outcomes and reduced costs.

Write a Comment

By Matt Dodge

A new patient screening tool aims to reduce readmissions at two Maine hospitals as a means of cutting health care costs and improving patient success rates.

Developed by the Portland-based Patient Performance Institute, the Patient Performance Enhancement Test (PET) helps detect personal circumstances and personality traits that might put patients at risk for readmission.

"The vision is to have a comprehensive and efficient way to get info on patients and figure out where they are vulnerable," says Mira Denning, CEO and co-founder of the Patient Performance Institute.

Portland's Mercy and Sanford's Goodall Hospital are now piloting the test, which capitalizes on an industry-wide effort to reduce hospital readmissions.

"We're living in changing age where patient outcome and costs are starting to be what payers reimburse for," says Denning.

In October, Medicare began levying fines against some 2,000 hospitals for high readmission rates, hoping to recoup over $300 million in the coming year as part of the Affordable Care Act's Hospital Readmissions Reduction Program.

Hospital inpatient costs accounted for a quarter of Medicare's $556 billion in spending this year and are projected to grow by over 4% annually in the next few years, according to the Congressional Budget Office.

"Through that lens, it made good sense to ask how we could look at patients case-by-case to understand what's going on for them," says Denning.

Developed by Denning and Walter Corey, PPI co-founder and chairman, the PET is loosely based on a similar test used by the U.S. Navy to gauge how emotional intelligence and personality issues can impact individual military success.

By combining Denning's background in health care law, policy and administration with Corey's focus on business development and interest in the military — he trains with the Maine National Guard and lectures at the Naval War College — the PPI team set out to tailor the PET to fit the needs of the modern health care industry.

"We did a lot of research and development — reading peer reviewed journals, talking with health leaders — about emotional and personal factors that impact a patient thriving or failing," says Denning.

The resulting 60-question, 15-minute test includes questions on everything from financial and socioeconomic status to health literacy, emotional intelligence/personality and family/social support, giving health care providers a detailed look into a lifestyle factors that wouldn't otherwise make it onto a patient's chart.

"We ask really simple, self-reporting questions and then have to say whether they agree or disagree," she says. "We're finding that patients are revealing information in surveys that they aren't revealing in interviews, so there is some real meaningful information coming back."

Denning shares an example from Mercy Hospital, where a patient assured nurses that his son would be able to help him recover once he was discharged. Upon administering the PET it was discovered that the man had special transportation needs: His son was disabled and couldn't drive. The hospital was able to connect the patient with Mercy's transportation program.

The PET has seen early success in its testing phase and has the potential to be an important tool in the fight against rising health care costs, according to Bonnie Deveau, Goodall Hospital's vice president of quality and risk management.

"There is a huge initiative on behalf of Medicare to look at reducing readmissions, and it's a major focus of hospitals that are Medicare recipients. The information we have been able to gain has been very beneficial," says Deveau, whose hospital is participating in the free trial.

Deveau agrees that the PET makes some patients seem more comfortable sharing details on certain aspects of their lives that might affect their recovery.

"Sometimes [patients] are sick enough that they don't even think of those things. This test allows us to hone in on what factors might be the causative agents of someone coming back so we can focus on education and setting up support systems," says Deveau.

Support systems include helping patients to secure transportation so they don't miss follow-up appointments or connecting them with a hospital's prescription assistance program. "Sometime you don't know about the issues they might run into until after someone leaves," she says.

Deveau says readmissions take not only a financial toll, but a physical one as well. "Readmittance is a big cost, but the ultimate reason why we want to take a harder look is to have the patient be successful at home and be able to recover in a home environment," she says.

Running the PET trial over the last few months, Deveau says somewhere around 30 patients have opted to take the test. The hospital hopes to gather at least 50 responses before ending the trial, and Deveau says there is a possibility that Goodall would sign on for the market-ready version of the test, "depending on the cost associated with it."

Mindful of the propensity of a patient to be less-than-honest on such a personal assessment, Denning says the PET is designed to root out subterfuge. "You can tell really easily whether someone is trying to game the test with perfectly happy answers because we are seeing risk factors pop up that are different in almost every test," says Denning. "We are finding that patients are really taking ownership of the process."

Denning says that the company has not yet been able to determine the exact cost savings associated with use of the PET but will have a better idea once readmission data is compiled in the coming weeks.

The company is currently in talks to sell the test to hospitals throughout the Northeast and mid-Atlantic, including two large, 600-plus bed facilities in New York City. Denning says PPI plans to license out the test on a contractual basis that includes continuing assistance, training and support, including uploading results to a hospital's electronic records system.

"There is definitely tremendous energy around commercial products in this area, and a lot of energy at hospitals themselves as people rededicate themselves to figuring out solutions," she says.