One of the biggest changes came in the hospital's treatment of patients with renal failure, many of whom lacked insurance and came to the Hopkins' emergency room for dialysis. According to Scheel, these patients were admitted to Hopkins for their routine dialysis, at a cost of tens of thousands of dollars, until their application for state Medicaid was approved and they became eligible for publicly funded dialysis in an outpatient setting. Before 2004, some patients waited in the hospital for as long as three months, and average stays lasted more than 20 days.
To bridge the gap between the emergency visit and receipt of state aid, Hopkins contracted with a community provider of outpatient dialysis services until the patients' Medicaid application was approved. At a cost of $120 per patient per treatment, or $360 per week, the community service was much cheaper than hospital care, and importantly, the move freed up beds for more acutely ill patients. Hopkins social workers experienced with Medicaid helped identify which patients were most likely to be accepted by Medicaid and which patients could be offered the community service. This augmented service immediately dropped Hopkins' Millman score for renal failure to 4.9 days, below the industry average of 5.4 days.
Within six months of the program's initial success, all other departments at JHH quickly followed suit by the end of 2003, establishing their own physician-review teams and with similarly dramatic results.
In Hopkins' surgical department, for example, better emphasis on discharge planning allowed it to achieve among the highest gains, with wait times and length of stay declining steadily from close to six days in 2002. Within the last two years, the
Contact: David March
Johns Hopkins Medical Institutions