Kissito Healthcare Facilities in Katy, Texas Selected As Two of Methodist Hospital System’s Preferred Providers

Kissito Post Acute Cane Island and Kissito Healthcare Katy, both located in Katy, Texas were selected by The Methodist Hospital System in Houston, Texas to participate in a pilot program aimed at enhancing the patient discharge process in preparation for healthcare reform. Under the proposed Bundled Payment legislation, hospitals will be penalized for readmissions within 30 days following the date of discharge thus motivating hospital systems to locate facilities able to aid in the reduction of readmissions.

Of the 75 facilities located in the Houston, Texas market, only 20 were selected for this program. The selection process was based heavily on the facility’s ability to manage various levels of acuity, expedited referral processes, and past survey history. Linda Collins, Director of Continuity of Care for The Methodist Hospital System, leads the efforts of selecting the facilities in the area able to meet the needs of their patients.

Linda and her team conducted on-site visits with both Kissito Healthcare Katy and Kissito Post Acute Cane Island during the selection process. At Kissito Healthcare Katy, her team found an extraordinary hybrid Skilled Nursing Facility/Long Term Care model able to cater to a high acuity nursing patient with a variety of diagnoses. Additionally, Kissito Healthcare Katy was recently awarded the AHCA Quality Award, a prestigious honor in the Long Term Care industry.

Upon their visit to Kissito Post Acute Cane Island , Linda and her team found a return-to-home program second to none. They were particularly impressed with the Collaborative Care Pathways, collaborative care rounds, and quality customer service focus.

Tom Clarke, President & CEO of Kissito Healthcare, headquartered in Roanoke, Virginia states, “We are very proud to have both of our Houston facilities selected by Methodist Hospital for their SNF Network of Preferred Providers. This recognition is the direct result of our staff’s daily focus on customer service and improved clinical outcomes. We believe the future of Healthcare will see more collaborations such as this, where the region’s high quality Acute and Post Acute providers work together to improve patient outcomes and minimize unnecessary patient transitions. We look forward to being a part of the Methodist TEAM!”

Based in Houston, Texas, The Methodist Hospital System is a non-profit organization comprised of a major academic medical center, three community hospitals, a physician organization and a research institute. Methodist Hospital is the only hospital in Houston, Texas to be named to the 2009-2010 US News & World Report’s “Best Hospitals” Honor Roll.

Collaborative Care Pathways – Patient Management Tool

Clinical Pathways, also referred as Integrated Care Pathways, Pathways of Care, Collaborative Care Pathways, are structured, multidisciplinary plans of care designed to support the implementation Read more

Who We Are

Kissito Post Acute is defining the next generation of short-term transitional healthcare through its innovative rehabilitation centers. Our Collaborative Post Acute Care Model^™ is physician driven and patient-centered and fosters an enhanced care environment and improved outcomes. This unique, industry-leading approach engages partners in a cohesive team, enabling patients to return to their lives and function at the highest level possible.

We have 9 facilities in Texas, Arizona and Virginia and are diligently studying and researching a single point of entry model to further enhance our Collaborative Post Acute Care Model^™ and our ability to improve outcomes and quality in the healthcare delivery system. We are currently developing more collaborative partnerships with Long Term Acute Care Hospitals and Home Health Agencies to provide a Total Post Acute Solution in several of our locations. All of our facilities provide speech, occupational, and physical therapy, long term care extensive nursing, and promote  aggressive return to home therapy programs based on systems and processes that help reduce hospital readmissions and mortality rates in both the acute and post acute setting.

Kissito Post Acute is a division of the Kissito Healthcare Family. This not-for-profit organization includes Kissito Post Acute, Kissito Long Term Care and Kissito International.

Model

The Collaborative Post Acute Model features a 5 phase approach to patients being able to achieve their goals and regain functional abilities to allow them to return home quickly, safely, and cost effectively. While at the same time we lower the chance of preventable hospital readmissions and mortality occurrences which happen far too often due to medical error, medication mismanagement, and failure to recognize red flags.

Phase 1

Joint Case Management & Pre- Admission Review (Pre-Admission)

Transition always presents risk. To eliminate the risk of re-hospitalization and medical error our model provides for a formalized system and HL7 compliant Electronic Medical Record, developed by physician staff to obtain specific information based on individual diagnoses pre-admission. This in turn allows Kissito Healthcare to provide a safe care transition that leaves minimal risk for hospital re-admission and medical error. As a bi-product of this system Kissito Healthcare is able to take a more medically complex patient earlier from the hospital.

Phase 2

Orientation & Assessment (First 24-48hrs)

ORIENTATION is conducted using a comprehensive easy to understand guidebook that helps to set the goals and expectations for both the patient and the family. Each patient and family is seen by their interdisciplinary team via what we call Collaborative Care Rounds. The interdisciplinary team is made up of therapists, nurse practitioners, social workers, nurses, and dietitians. The orientation process ensures that both the patient and family know they will be active participants in the rehabilitation process day one.

Phase 3

Treatment Phase (48hrs – 3 days prior to discharge)

TREATMENT planning is a crucial phase in the model. No one patient has the same treatment plan. A comprehensive tool called the Collaborative Care Pathway™ was developed to help guide the development and execution of purposeful treatment plans designed individually with the goal of returning the patient back to home. Based on 12 months of research and constant collaboration with healthcare providers, the Collaborative Care Pathway™ consists of staff competency and skills training, templated documentation, and use of industry best practices. This ensures that the staff and medical team are in tune with the patients every need and are equipped with the skills and knowledge to identify red flags and problems early enough to prevent hospital re-admissions.

Phase 4

Transition (3 days prior to discharge)

TRANSITION U is a program created for the patient and the family that allows the patient to start to takeover their care. Once this transition has begun the interdisciplinary team is able to step outside the box and really see where the patient’s progress really is and identify potential failures or areas that need to be addressed. Transition U not only prepares the patient to go home but it also includes processes like home safety evaluations and teaches medication management.

TRANSITION U introduces the patient and family to their Transition Coach. The Transition Coach becomes their key contact for preparing them to be able to not only go home, but remains their contact once they get home.

Phase 5

Home (Post Discharge): Home Phase is being implemented in early 2010

HOME but it’s not the end of the road. It’s the beginning of a new road, and not one that leads back to the hospital. Once the patient returns safely to home they are visited within 24-48 hours after discharge by their Transition Coach to ensure they are comfortable self administering and managing their medications, completing any exercises or therapy related items that were assigned, but most importantly to make sure they can function in the actual home.

Each patient is given the number to the Kissito Care line and the direct number to their Transition Coach. The Kissito Care line is simply a channel for the patient to ask questions related to their transition and care. No medical information or advice is given; however the care line attendant will refer them to a medical doctor should they ask for medical advice.

Services

Kissito Post Acute is primarily designed for patients transitioning to post acute care settings after being discharged from acute care settings/hospitals. Kissito Post Acute’s nursing and rehabilitative care comprise a holistic approach while ensuring residents’ safe return to home after a hospital stay. Kissito Post Acute care provides services that include Rehabilitation and Medically Complex Care while focusing on individuals’ functional ability and ensuring their previous level of functioning and return to home. After being discharged from hospitals and before going home or into other community- based settings, most patients need additional time to recuperate. Kissito’s Post Acute environment is tailored to address this need of patients by providing 24-hour skilled nursing care, specialized care, service programs and short term rehabilitation. Our interdisciplinary team participates in the rehabilitative process using clinical pathways which provide the framework for an interdisciplinary effort. The Kissito Post Acute Model provides each patient with a tailored approach to care to address individual needs.

Our clinical services include:

• Post Surgical Rehabilitation
• Post Stroke Rehabilitation
• Cardiac Care, including Post Heart Attack and Heart Failure Rehabilitation
• Respiratory/Pulmonary Rehabilitation (e.g., Pneumonia, COPD)
• Post Hip & Knee Replacement Rehabilitation
• Complex Wound Care Management
• Orthotic/Assistive Devices Management
• Diabetes Management and Education
• Pain Management and Education
• Re-stabilization of Chronic Medical Conditions like Renal Failure, Debilitating Arthritis or Other Chronic Orthopedic and Medical Conditions

In our Post Acute environment, we assist residents in achieving the highest level of independence after a hospital stay. Our large spacious private resident rooms along with our state-of-the-art rehabilitation facility offer an conducive environment for rehabilitation and this sets us apart from traditional skilled nursing facilities. Through rehabilitation, round-the-clock monitoring, and continued nursing care, we provide an appropriate setting to bridge the gap between acute hospital care and discharge to home or a community-based setting. Our highly qualified and skilled professional staff, consisting of registered nurses, licensed practical nurses and certified nurse aides, provides personal care to patients along with treatment and medication.

Rehabilitation

All of our facilities have well-equipped rehabilitation gyms to meet specific needs of our residents. Not only that, our rehabilitation program ensures high quality and provides for greater flexibility in our treatment times allowing the resident to heal more quickly and return to their previous level of functioning. We serve patients with a multitude of diagnoses. The most common rehabilitation diagnoses include stroke, orthopedic conditions like hip and knee replacement, arthritis, and spinal cord injuries. Most patients are admitted directly from a hospital’s medical/surgical unit, but patients can be admitted from any level of care, as well as home. We employ outstanding physical, occupational, and speech therapists and our rehab team works closely with our residents’ physicians, designing and implementing individualized rehabilitation programs.

Some of the features of our Rehab Program include:

• Individual Rehabilitation Care plan
• State-of-the-art rehabilitation gym
• In-house physical, occupational and speech therapies
• Restorative nursing services seven days a week
• Variety of activities for residents
• Provision of specialized dietary needs to support rehabilitation

The Rehabilitation Manager at each of our facilities coordinates rehabilitative care plans, ensures compliance with all insurance requirements, and ensures that each resident and/or family member is an active participant in all rehabilitation related decisions.

Medically Complex Care

Our facilities play an important role in providing quality healthcare to the communities we serve, admitting patients when they can no longer remain in the fast-paced hospital environment and need an affordable and comfortable setting where they can rehabilitate and return to home safely after a short-term stay. We offer advanced clinical care for the medically complex patients; our nursing staff is highly trained and can handle medically complex procedures.

Our skilled nursing staff work 24 hours a day, monitor complex medical conditions as well as medication regimen and ensure that diagnostic, nutrition and rehabilitation needs are met. Our medially complex care services include wound care, pain management, diabetic management, and a variety of discharge and diagnosis management education.

Discharge Process

Our team prepares, educates, and supports the patient and the caregiver/family in the critical discharge process. The team is trained in the University of Colorado’s Care Transitions Program℠ . The term “Care Transitions” refers to the movement patients make between health care practitioners and settings or a set of actions designed to ensure the coordination and continuity of health care as patients transfer between different locations or different levels of care within the same location. This program has been designed to encourage patients and their caregivers to assert a more active role during care transitions and has proven to reduce hospital readmissions.

Our Social Worker and Nursing Staff coordinate the following:

• Conduct home studies when appropriate to ensure the patient’s return to home
• Provide complete medication reconciliation upon patient’s discharge to help with self-administration of medications
• Support patient’s discharge needs including medical equipment and oxygen
• Contact the patient with follow-up calls at 2- days, 7-days, and 20- days

In addition our 24/7 CareLine is available 24X7 if the patient or caregiver has any questions or concerns.