Produced by Becker’s ASC Review
Written by Sabrina Rodak | December 08, 2012
Readmissions are becoming a top concern of hospital leaders, not only because readmission rates reflect quality of care and population health, but also because they have significant financial implications for hospitals. Under the Patient Protection and Affordable Care Act, hospitals will lose a portion of their Medicare reimbursement for having higher readmission rates for heart attack, heart failure and pneumonia. An analysis by Kaiser Health News found that in October, more than 2,000 hospitals will lose a total of $280 million in Medicare funds due to high readmissions.
Hospitals need to employ a variety of strategies to decrease their readmission rates to improve quality and avoid cuts to Medicare funds.
Collaboration is essential for meaningful change
“Collaboration is really at the core of reducing readmissions,” says Thomas R. Ferry, president and CEO of healthcare patient-management software-as-a-service provider Curaspan Health Group. Patients most at risk for readmissions are typically those who need additional care after hospital discharge. Hospitals need to collaborate with post-acute care providers to ensure patients receive appropriate care and will not need to be readmitted.
“As hospitals strive to move [patients] outside their four walls, they’re going to send them to long-term acute care, skilled nursing facilities or rehab facilities, and so they have to measure the performance of those organizations,” Mr. Ferry says. “You have to ensure you’re sending a patient to the right level of care and to an organization that can handle that patient and has a track record of managing that patient population.”
Collaborating with post-acute care providers through technology and data sharing can help hospitals track patients’ progress and avoid readmissions. Mr. Ferry explains three steps hospitals should take to develop a working relationship with community providers to achieve the common goal of reducing readmissions.
1. Ensure the technology is usable and useful. “The tendency of most organizations is to think of the impact [of technology] within their four walls and the users of the technology within their organization,” Mr. Ferry says. “But if you’re thinking about driving collaboration and the relationship with your external partners, you also have to think about a technology platform that’s going to be useful to those organizations as well.”
Technology that can work across multiple systems will enable hospitals to more easily share data with post-acute care providers, which can support a strong relationship between the two groups.
In addition to functional concerns, hospitals should consider the benefits of technology for both their own organizations and the organizations they will partner with. “Make sure the technology has utility and provides benefits to your users so they adopt it and want to incorporate it into their everyday life,” Mr. Ferry says. The technology should be easy to use to increase the likelihood the post-acute care providers will use IT to share data with the hospital.
2. Collect and analyze data. When hospitals and post-acute care providers implement a shared technology platform, they can collect data on patients discharged from the hospital and their outcomes at the new care provider. For example, hospitals can track data on how many patients are readmitted from each post-acute care provider, and can drill down further to identify readmission rates for different populations of patients — such as cardiac patients — by post-acute care provider. To pinpoint the source of the problem, hospitals can also track the reason for the readmission from each post-acute care provider. A provider may have a high number of cardiac patients readmitted due to medication noncompliance, for example.
By collecting this data, hospitals can evaluate the appropriateness of different post-acute care providers for specific patient populations. “You can start to use that data to drive the right processes in those organizations that are managing your patients,” Mr. Ferry says. “Without that adoption of technology, you don’t have that data and can’t better manage that process for better outcomes.”
3. Meet with post-acute care providers. Once hospitals and post-acute care providers share data and identify trends, they should meet regularly to discuss strategies for improving care. If a hospital notices higher readmissions for patients who went to a certain post-acute care provider, the hospital and post-acute care provider should discuss what the organization’s internal processes are for managing patients. The hospital may identify a problem or an opportunity to improve processes so patients receive better care and avoid needing to be readmitted.
For example, Mr. Ferry says one hospital realized that a certain skilled nursing facility had a disproportionately high rate of congestive heart failure patients who were readmitted to the hospital. The hospital encouraged the nursing facility to start offering a congestive heart failure coordinator to more effectively manage those patients, and there was a subsequent drop in readmissions.
In addition, the post-acute care provider may realize that it does not have the capability to care for a certain patient population. By communicating this to the hospital, the hospital will learn not to send these patients to that facility and can avoid readmissions.
Mr. Ferry suggests hospitals meet with their post-acute care provider partners quarterly “to continue to cultivate relationships and reinforce proper behavior to best manage patients for the best clinical outcomes.”
These collaborative relationships between hospitals and community-based organizations, supported by technology, can help hospitals discharge patients to the most appropriate setting and avoid high readmission rates.
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