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GE Healthcare Camden Group Insights Blog

The Bottom Line Impact of Hospital Readmissions

Posted by Matthew Smith on Sep 18, 2015 10:03:14 AM

By Tawnya Bosko, DHA, MS, MHA, MSHL, Vice President and Tina Pike, RN, MSN, MBA, HCM, Senior Manager, The Camden Group

Hospital ReadmissionsYes, there is controversy surrounding the Hospital Readmissions Reduction Program (“HRRP”). Many hospitals feel that the costs to effectively manage readmissions are more than the penalty that is incurred, thus making readmission reduction efforts a net loss; and still others feel that the formula is flawed and disproportionately impacts certain facilities such as academic medical centers and those hospitals serving communities of lower socioeconomic status.

While either of these scenarios may be true, the reality is that reducing readmissions is in the best interest of all hospitals as an initial step in transitioning to a more population health-based delivery system. Potentially avoidable readmissions result in approximately $17 billion in excess spending by Medicare alone. Additionally, potentially avoidable readmissions are a reflection of the quality of care provided across the continuum. Understanding your hospital’s current performance, the performance of care providers in the delivery network, and identifying solutions to reduce readmissions are of significant importance. Acting now will prevent larger revenue impacts in the future and will position the hospital for success.

Although readmission rates have been declining overall, 75 percent of all hospitals eligible for the HRRP (i.e., 2,610 hospitals) are receiving a penalty this year, which is an increase of 433 hospitals receiving penalties over the previous year. The average penalty is .63 percent of their Medicare reimbursement for every Medicare stay, not just those readmitted. Overall, the hospitals receiving penalties will experience an estimated $428 million reduction in Medicare reimbursements, with the largest readmissions penalty to any hospital being approximately $13.3 million.

While the financial implications are important, hospitals need to be aware of the data collection and reporting periods that impact their penalty. This year brings the maximum penalty allowed by law (3 percent) as well as additional measures, but the data for this year’s penalty was collected July 1, 2010 through June 30, 2013. This means that hospitals cannot impact their penalty for 2016 at this point in time and have only four months remaining to make any impact for 2017, which will bring a new diagnosis (Coronary Artery Bypass Graft [“CABG”]). Of importance is taking action now to protect revenue in 2018 and beyond.

Readmissions_Table1-resized-600

If a hospital is subject to a penalty and/or attempting to improve current performance, a detailed analysis stratifying readmitted patients by payer, diagnosis, and source of the readmission should be completed in order to identify priority areas. From there, hospitals should assess the internal organizational processes related to care delivery and care management. This not only includes assuring high quality care during the hospitalization, but incorporates the preparation, planning, and communication needed for a successful transition of care to a post-acute or home-based setting. 

Paths_ReadmissionsDetermination of process effectiveness includes incorporating patient goals into discharge planning and instructions, including medication reconciliation with easy to use patient tools, as well as other tailored patient and caregiver education and programs focused on certain medical conditions. Coordination with community physicians for follow-up visits is imperative. Qualitative factors such as short patient or caregiver interviews at the time of readmission may also shed light on non-obvious reasons for readmission. Additionally, the hospitalist program should be assessed from a coordination perspective with care management, discharge planning, and primary care physicians. Paths for controlling readmissions include: pre-discharge processes internal to the hospital, performance of the post-acute network, and factors associated with discharge to home. Assessing and improving these pathways is recommended.

As the U.S. healthcare system continues its transition from volume to value, readmissions penalties appear to be here to stay. The penalties will impact each hospital in a different manner, and the costs and benefits of reduction efforts must be weighed. However, controlling and reducing avoidable readmissions is a solid first step toward delivering more accountable care. Hospitals should be aware of the penalties, the impact to their facility, and the drivers of potentially avoidable readmissions. Deploying proactive and effective strategies for improvement is necessary for success in today’s healthcare marketplace.

The Camden Group, Hospital Readmissions, Readmissions Reduction


Ms. Bosko is a vice president with The Camden Group and specializes in designing and implementing clinical integration, high growth medical service operations (“MSO”) and finance, physician hospital organization and MSO development, managed care strategy, and physician alignment. She may be reached at tbosko@thecamdengroup.com or 310-320-3990.

 

 

Ms. Pike is a senior manager with The Camden Group with over 25 years of clinical, business, and management experience in the healthcare industry. Ms. Pike’s areas of expertise include business development, strategic planning, operations management, Lean strategies, and performance and process improvement. She may be reached at tpike@thecamdengroup.com or 585-512-3900.

 

 

Topics: Hospital Readmissions, Tawnya Bosko, Readmissions Reduction, HRRP, Tina Pike, Hospital Readmissions Reduction Program

Leveraging Post-Acute Care to Address Acute Readmissions

Posted by Matthew Smith on May 13, 2015 2:22:40 PM

By Andy Edeburn, MA, Vice President, and Tina Pike, MBA, MSN, HCM, RN, Senior Manager, The Camden Group

hospital-readmissions-reduction-program.jpgFor most hospitals impacted by readmission penalties, post-acute care represents a key bulwark in improving readmission performance and reducing penalties under CMS’ Hospital Readmissions Reduction Program. Two out of every five Medicare fee-for-service acute hospital patients are discharged to post-acute care, and most of these to either a skilled nursing facility or home health agency. As we shift from volume to value, our relationships with post-acute organizations become critically important. However, collaborating with post-acute providers is unsure ground for many.

If you are thinking about confronting your readmission challenges, here are some key thoughts about selecting and engaging more directly with post-acute partners.

Post-Acute Provider Capabilities

All post-acute providers are not the same, and the typical hospital will historically refer to 20 or 30 different providers with little regard for quality or outcomes. Winnowing this list down is an important first step. Start with the “choice list” you most likely give to patients headed to post-acute care. You’ll want to sort through this accumulated collection of nursing homes and home health agencies and start strategically downsizing. Using publicly-available quality data, surveys, or even direct visits to providers, identify which providers show measureable quality and are clinically prepared to address your readmission challenges. Understand what kind of physician coverage they have (or will need), and discuss the disconnects that currently exist between your organization and them. Combine your findings and rank providers based on your organization’s needs. If the process of selecting quality providers seems daunting, seek assistance from someone with post-acute knowledge and experience. At the end of this process, you should have identified a list of key organizations that have the right skill sets (or the ability to learn) and can partner with you to address readmissions. This is the beginning of your network.

Redesigning Post-Acute Discharge and Transfer

With the beginning of a network in hand, you can get to the meat of leveraging post-acute to tackle readmissions. The bulk of post-acute discharged readmits typically bounce back in 48-72 hours or less, so re-thinking the acute to post-acute discharge and transfer process represents a key starting point for changing behavior. What happens just before acute discharge and right after post-acute admission often involves many steps, but here are three important areas that usually benefit from greater review and redesign:

  • Universal Transfer Documentation – The volume of information transferred from acute to post-acute (whether via paper or electronic means) is oftentimes chaotic and inconsistent. Practices can vary a lot: there can be wide variation among acute discharge planners about “what to send” and post-acute provider preferences for “what they want.” Standardizing the transfer is an important step towards consistency. Working in collaboration with your network, evaluate the current range of behaviors and re-design a universal process that everyone will use. Eliminate all of the unnecessary forms and data to focus on essential information that supports and informs the transfer. A standardized checklist as a dedicated cover sheet is often helpful and provides a tangible reference for both sides.
  • Readmission Risk Assessment – Stratifying discharges for their risk of readmission has been a results-oriented solution for many organizations, and acute and post-acute organizations can draw from a handful of simple scoring tools to help. One excellent example is the LACE index scoring tool. LACE evaluates four aspects of patient condition or behavior, including acute length-of-stay, if the acute admission occurred via the emergency department (“ED”), patient comorbidities, and ED visits in the preceding six months. The combination of these four results in a score ranging from one to 20, with higher scores indicating increasing likelihood of readmission. Patients who score at high risk (commonly 10 or greater) are noted appropriately at transfer and the readmission risk score is shared with the admitting post-acute provider.
  • Warm Hand-Offs – Direct communication among caregivers in a defined setting can be challenging enough, but interaction across settings is sometimes entirely non-existent. Improving (or daresay requiring) communication via warm hand-offs among physicians, nurses, and case managers is absolutely critical – even with a foolproof integrated electronic health record solution. Within 24 hours of patient transfer (either prior to or soon thereafter), an acute hospitalist should confer with the post-acute attending (commonly called a “SNFist”) or attending physician to review hospital care, discharge orders, and priority areas of concern that might lead to a readmission. Absent physician interaction, an acute RN case manager should connect with the post-acute intake nurse or case manager. Establishing a specific protocol about what should be communicated during the hand-off is helpful in reinforcing a change in behavior.

Understanding post-acute provider capabilities and redesigning practices around discharge and transfer represent mere opening steps in a longer journey of utilizing post-acute care to leverage readmission issues. In a future post, we’ll take a closer look at the role of care management in post-acute settings, reinforcing multi-disciplinary thinking across the continuum, and the post-acute to home discharge process.

The Camden Group, Hospital Readmissions, Readmissions Reduction


Andy_Edeburn.pngMr. Edeburn is a vice president with The Camden Group, with more than 20 years of healthcare consulting experience, specializing in acute, primary, post-acute, and senior care services. He is a nationally recognized expert on post-acute care. His areas of expertise include strategic planning, acute/post-acute integration, provider network development, and managed care. Mr. Edeburn is a frequent speaker on a range of topics including healthcare reform readiness, strategic planning, acute and post-acute integration, and change management. He may be reached at aedeburn@thecamdengroup.com or 312-753-7940.

 

pike_headshot.pngMs. Pike is a senior manager with The Camden Group with over 25 years of clinical, business, and management experience in the healthcare industry. Her areas of expertise include business development, strategic planning, operations management, Lean strategies, and performance and process improvement. She has a strong clinical background and has assisted organizations with patient throughput, physician and patient engagement strategies, transformational culture change, as well as, the development of care models which span across the continuum of care to help healthcare organizations transition to value-based care and population health. She may be reached at tpike@thecamdengroup.com or 585-512-3900.

 

Topics: Readmissions, Readmissions Reduction, Tina Pike, Hospital Readmissions Reduction Program, Post-Acute Care, Andy Edeburn, Acute-Care Readmissions

New White Paper Download: What is Your Plan for Avoiding Readmissions?

Posted by Matthew Smith on Mar 19, 2015 2:55:00 PM

Readmissions White Paper IconAs the U.S. healthcare system continues its transition from volume to value, readmissions penalties appear to be here to stay. The penalties will impact each hospital in a different manner, and the cost/benefit of reduction efforts must constantly be weighed. However, controlling and reducing avoidable readmissions is a solid first step toward delivering more accountable care.

The latest White Paper from The Camden Group, titled, What is Your Plan for Avoiding Readmissions? Understanding the Penalty and Solutions, examines:

  • Readmissions penalty history and trends
  • Distribution of HRRP penalties
  • Readmissions results vs. U.S. national rate
  • Readmissions measures and maximum penalty by fiscal year
  • States with the highest percentage of hospitals receiving penalties
  • Readmissions penalty calculations and projections (including CMS formula)
  • Solutions for controlling readmissions

To download the PDF White Paper, please click the button below:

The Camden Group, Hospital Readmissions, Readmissions Reduction

Topics: Readmissions, Hospital Readmissions, Readmissions Reduction, Hospital Readmissions Reduction Program

Hospital Readmissions: How Are They Impacting Your Bottom Line?

Posted by Matthew Smith on Mar 5, 2015 11:10:00 AM

By Tawnya Bosko, MHA, MSHL, MS, Senior Manager and Tina Pike, RN, MSN, MBA, HCM, Senior Manager, The Camden Group

Revolving DoorYes, there is controversy surrounding the Hospital Readmissions Reduction Program (“HRRP”). Many hospitals feel that the costs to effectively manage readmissions are more than the penalty that is incurred, thus making readmission reduction efforts a net loss; and still others feel that the formula is flawed and disproportionately impacts certain facilities such as academic medical centers and those hospitals serving communities of lower socioeconomic status.

While either of these scenarios may be true, the reality is that reducing readmissions is in the best interest of all hospitals as an initial step in transitioning to a more population health-based delivery system. Potentially avoidable readmissions result in approximately $17 billion in excess spending by Medicare alone. Additionally, potentially avoidable readmissions are a reflection of the quality of care provided across the continuum. Understanding your hospital’s current performance, the performance of care providers in the delivery network, and identifying solutions to reduce readmissions are of significant importance. Acting now will prevent larger revenue impacts in the future and will position the hospital for success.

Although readmission rates have been declining overall, 75 percent of all hospitals eligible for the HRRP (i.e., 2,610 hospitals) are receiving a penalty this year, which is an increase of 433 hospitals receiving penalties over the previous year. The average penalty is .63 percent of their Medicare reimbursement for every Medicare stay, not just those readmitted. Overall, the hospitals receiving penalties will experience an estimated $428 million reduction in Medicare reimbursements, with the largest readmissions penalty to any hospital being approximately $13.3 million.

While the financial implications are important, hospitals need to be aware of the data collection and reporting periods that impact their penalty. This year brings the maximum penalty allowed by law (3 percent) as well as additional measures, but the data for this year’s penalty was collected July 1, 2010 through June 30, 2013. This means that hospitals cannot impact their penalty for 2016 at this point in time and have only four months remaining to make any impact for 2017, which will bring a new diagnosis (Coronary Artery Bypass Graft [“CABG”]). Of importance is taking action now to protect revenue in 2018 and beyond.

Readmissions_Table1-resized-600If a hospital is subject to a penalty and/or attempting to improve current performance, a detailed analysis stratifying readmitted patients by payer, diagnosis, and source of the readmission should be completed in order to identify priority areas. From there, hospitals should assess the internal organizational processes related to care delivery and care management. This not only includes assuring high quality care during the hospitalization, but incorporates the preparation, planning, and communication needed for a successful transition of care to a post-acute or home-based setting. 

Determination of process effectiveness includes incorporating patient goals into discharge planning and instructions, including medication reconciliation with easy to use patient tools, as well as other tailored patient and caregiver education and programs focused on certain medical conditions. Coordination with Paths_Readmissionscommunity physicians for follow-up visits is imperative. Qualitative factors such as short patient or caregiver interviews at the time of readmission may also shed light on non-obvious reasons for readmission. Additionally, the hospitalist program should be assessed from a coordination perspective with care management, discharge planning, and primary care physicians. Paths for controlling readmissions include: pre-discharge processes internal to the hospital, performance of the post-acute network, and factors associated with discharge to home. Assessing and improving these pathways is recommended.

As the U.S. healthcare system continues its transition from volume to value, readmissions penalties appear to be here to stay. The penalties will impact each hospital in a different manner, and the costs and benefits of reduction efforts must be weighed. However, controlling and reducing avoidable readmissions is a solid first step toward delivering more accountable care. Hospitals should be aware of the penalties, the impact to their facility, and the drivers of potentially avoidable readmissions. Deploying proactive and effective strategies for improvement is necessary for success in today’s healthcare marketplace.

The Camden Group, Hospital Readmissions, Readmissions Reduction

bosko_headshotMs. Bosko is senior manager with The Camden Group and specializes in designing and implementing clinical integration, high growth medical service operations (“MSO”) and finance, physician hospital organization (“PHO”) and MSO development, managed care strategy, and physician alignment. She may be reached at tbosko@thecamdengroup.com or 310-320-3990.

 

 

 

pike_headshot

Ms. Pike is a senior manager with The Camden Group with over 25 years of clinical, business, and management experience in the healthcare industry. Ms. Pike’s areas of expertise include business development, strategic planning, operations management, Lean strategies, and performance and process improvement. She may be reached at tpike@thecamdengroup.com or 585-512-3900.

 

 

Topics: Hospital Readmissions, Tawnya Bosko, Readmissions Reduction, HRRP, Tina Pike, Hospital Readmissions Reduction Program

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