Pittsburgh Regional Health Initiative Kicks off Primary Care Resource Center (PCRC) Project

Six independent hospitals in medium-to-small markets, spanning six different counties in two states, have been recruited by the Pittsburgh Regional Health Initiative (PRHI) to participate in the Primary Care Resource Center (PCRC) Project, funded by a Health Care Innovation Award from the Center for Medicare and Medicaid Innovation (CMMI) announced by PRHI in May 2012.

The six hospital partners in the PCRC Project are Butler Memorial Hospital (Butler, Pennsylvania), Conemaugh Memorial Medical Center (Johnstown, Pennsylvania), Indiana Regional Medical Center (Indiana, Pennsylvania), Sharon Regional Health System Main Hospital (Sharon, Pennsylvania), Uniontown Hospital (Uniontown, Pennsylvania), and Wheeling Hospital (Wheeling, West Virginia).

Under the Patient Protection and Affordable Care Act, effective October 1, 2012, Medicare payments that would otherwise be made to hospitals will be reduced by specified percentages to account for excess preventable hospitals admissions. This is of particular concern to the regional community hospitals in western Pennsylvania and West Virginia, which serve an unusually high density of Medicare recipients. Additionally, most community hospitals are the principle healthcare facility for their county, as well as the leading employer in their communities, making their economic vitality of paramount importance.

For community hospitals to remain viable, they now have to play a key role in reducing demand for acute care services, which requires a tremendous shift in thinking and behavior. The PCRC Project will help these institutions experiment with a new model of care.

The PCRC Project – under the direction of Keith T. Kanel, MD – principal investigator for the project and PRHI’s Chief Medical Officer – will bring state-of-the-art primary care support for reducing preventable admissions and readmissions to these six community hospitals serving local, small physician practices.

The overarching goal of the PCRC Project is to slow, stop, or reverse chronic disease progression for patients with chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF), or coronary artery disease (CAD), shifting the locus of care from inpatient to outpatient and home settings. Better care will result in both better health and in lower costs – an estimated $40 million+ to the Medicare program alone – over the term of the grant.

The prototype of the PCRC model was established at Monongahela Valley Hospital (MVH) during 2011-12. All protocols, pathways, electronic health record (EHR) configurations, job functions, training strategies, and data collection methods to be used in the PCRC Project were piloted within the prototype. The MVH PCRC opened to clinical activity on July 1, 2012, with an initial focus on COPD admissions. Initial outcomes are dramatic: by the second quarter of operations (4th Quarter 2012), MVH had 47% fewer 30-day all-cause readmissions than in the comparable quarter in 2011.

Through collaboration of host hospital communities and PRHI experts, pathways and protocols piloted within MVH will be customized for each hospital partner using Lean quality improvement methods, disseminated via a hospital-wide educational plan, then shared between hospitals in the partnership.