Mina Breuker, a speaker at the marcus evans Long-Term Care CXO Summit Fall 2013, on working with competitors to reduce a community’s rehospitalization rate. Interview with: Mina Breuker, Chief Operating Officer, Holland Home

1. Interview with: Mina Breuker, Chief
Operating Officer, Holland Home
To decrease rehospitalization in its local
community, Holland Home has joined
forces with five competitors in the area,
to standardize processes and share best
practices. “It is unique to work so
closely with the competition, but we all
felt it was the right thing to do, as it
would help us provide care at the right
time and right place,” explained Mina
Breuker, Chief Operating Officer,
Holland Home.
A speaker at the marcus evans Long-
Term Care CXO Summit Fall 2013 in
Palm Beach, Florida, July 25-26,
Breuker gives a brief overview of the
program that Holland Home was
involved in to better serve its
community.
How did the program to reduce
rehospitalization in the community
come about?
The catalyst was the fragmentation of
care and the fact that one of our area
hospitals wanted to prevent rehospi-
talizations, to avoid penalties. It
approached five long-term care (LTC)
providers and suggested we all meet
together.
At first, I did not consider it a good idea
to discuss our “dirty laundry” with each
other, but then we looked at the
opportunities and decided it was the
best thing for the community as a
whole.
It took some time to build trust and
work as a group, but we focused on
reviewing each and every rehospi-
talization from our facilities to the
hospital, and what we could learn from
them.
We identified processes that needed to
be fixed, and procedures and tools that
were needed. We avoided duplication of
work by working together, with
standardization as one of the outcomes.
For example, we developed a transfer
form for all five providers to use,
common guidelines for conducting
follow-up calls and a dashboard report
comparing our rehospitalization and
patient satisfaction rates.
What has this project achieved for
the community?
The hospital’s rehospitalization rate
dropped from 20 to four percent down.
Our rates are much less than other LTC
providers in town. When we started, all
of the skilled nursing facilities were
running a 24-25 percent rehospi-
talization rate, but now it is under ten
percent.
How did it impact your bottom line?
The hospital had the most to gain, as
they were able to avoid penalties.
However, we found that for the post-
acute providers it brought in additional
costs. Keeping people in longer meant
more diagnostics, X-rays, and so on,
instead of sending them back to the
hospital.
The conversation we are now having
with the hospital is about how we can
also gain financially. For example, with
a low rehospitalization rate, we could
become their preferred provider. There
are synergies we can share or the
hospital could provide some of the
transition care. At the moment, it is
lower cost to the community, the
hospital and Medicare, but a higher cost
to post-acute providers.
What culture change did this
require of each organization?
This was a major change. All of a
sudden we were sitting in a room
talking about what went wrong and why
someone was sent back to the hospital,
with our competitors! It took a while to
build the trust that this needed to have
such conversations, but we are now at
the point where we give each other
referrals. When one of the nursing
homes had to evacuate because of a
flood, we took in their residents.
It is a whole different culture now than
it was two years ago, but we are still
working on getting that culture
throughout our organization, to make
sure everyone understands why this is
best for the community we serve.
We looked
at the
opportunities
and decided it
was the best
thing for the
community
Reducing Rehospitalization in a Community

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To view the web version of this interview, please click here: www.longtermcaresummit.com/MinaBreuker