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Advocates for SHM’s Project BOOST (Better Outcomes for Older Adults through Safe Transitions) presented a standing-room-only policy briefing June 8 on Capitol Hill to explain an innovative quality-improvement (QI) initiative and new collaboration with Blue Cross Blue Shield of Michigan (BCBSM) to increase patient safety and reduce preventable hospital readmissions.

“The room was packed,” says David Share, MD, BCBSM’s executive medical director for healthcare quality. About 60 people were in attendance, mostly House and Senate legislative aides, along with a few representatives of third-party health organizations. Dr. Share, one of the presenters, says many of the staffers were well aware of the challenges of hospital-based practice. “I would say the crowd was remarkably attentive during our presentation,” he says.

SHM past president Scott Flanders (left) discusses Michigan’s 15-hospital Project BOOST initiative in Washington.

SHM developed BOOST in 2008 to help hospitals and hospitalists systematically improve discharge processes through evidence-based interventions, management tools and resources, and expert mentoring. In January, BOOST was implemented in 15 Michigan hospitals with financial support from BCBSM. A 20-hospital partnership with the California HealthCare Foundation was announced in April, and more than 60 hospitals in 24 states now participate.

“These legislative staffers, who are responsible for crafting health-reform legislation, were given an in-depth understanding of how the provider community can take ownership of the challenges of transforming systems of care,” Dr. Share says. “I hope what they learned was that when payors … establish incentives for providers to transform healthcare systems, providers can do that very creatively and effectively in ways that affect patient care, patient well-being, and patient outcomes—both in terms of quality and cost.”

Hospitalist Scott Flanders, MD, SFHM, professor of medicine and director of the inpatient program at the University of Michigan in Ann Arbor, also spoke at the briefing. “I think our Michigan collaborative is a nice example of a local, provider-based, payor-supported quality initiative that will tackle an important problem and lead to a lot of collaboration and learning,” says Dr. Flanders, SHM’s immediate past president.

Also speaking at the briefing were Project BOOST principal investigator Mark Williams, MD, FHM, chief of the division of hospital medicine at Northwestern University’s Feinberg School of Medicine in Chicago, and representatives of the national Blue Cross/Blue Shield Association and the American Hospital Association, who discussed other initiatives that have successfully targeted the hospital readmission problem. “Not all readmissions are preventable. Some are necessary and important,” Dr. Flanders says, adding that the challenge is to distinguish between the necessary and the avoidable.

While there are no current legislative proposals involving Project BOOST, the initiative is aligned with a number of provisions aimed at reducing readmissions and improving care transitions, which are contained in the Patient Protection and Affordable Care Act passed in March. “Given the costs of readmissions, directly supporting demonstration projects like this would be a wise investment in improving healthcare quality,” says Dr. Flanders, adding that he heard suggestions at the briefing that the Centers for Medicare & Medicaid Services’ (CMS) Center for Innovation should consider supporting initiatives like BOOST.

Dr. Share, who calls payor support for the BOOST collaboration an example of its incentive programs with physician groups, says hospitalists are essential to partnerships with other providers, including PCPs, and the systems improvements necessary in the hospital setting.

“We’re actually bridging the gap between the hospital and the medical office,” he says. TH

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