GE Healthcare Camden Group Insights Blog

Quality Outcome Achievement and the Impacts to Care Delivery

Posted by Matthew Smith on Apr 30, 2015 2:23:00 PM

The Affordable Care Act has changed the paradigm of our healthcare system moving from rewarding providers for the quantity of care they provide, to rewarding them for the quality of care provided. Frameworks such as the Triple Aim™ developed by the Institute for Healthcare Improvement and the National Quality Strategy from the Centers for Medicare and Medicaid (“CMS”) are two of the various models aimed at improving health system performance. While these approaches differ, each focuses on the accountability and improvement of care delivery across settings for all dimensions of health along with the associated costs. Through the use of quality measurement, CMS is driving healthcare transformation in collaboration with practitioners and patients.

Develop Patient-Centric Goals

As CMS and private payer reimbursement models move from volume-to-value payments and penalties, organizational leaders are recognizing the need to develop strategies which incorporate quality into all care delivery channels. First steps to approaching this landscape shift are through the development and implementation of proactive patient-centric goals. For example, engage patients as the stewards of their own care. This is a change from the “do as I say” approach of past generations. Truly listen to patients and their goals for their health. Discuss multiple options and assess the social determinants of health in terms of barriers to goal achievement. This is an approach which brings all disciplines together in the patient’s vision. Incorporate quality improvement strategies to support the long-term sustainability of an integrated care delivery model linked to outcome metrics. This will help drive a care delivery strategy and inform care redesign.

These organizational changes are of vital importance given the recent announcement by the Department of Health and Human Services (“HHS”) regarding the timeline for shifting Medicare payments toward alternative payment models such as Accountable Care Organizations or Bundled Payment Initiatives. Starting in 2016, the target for alternative payment model reimbursement is 30 percent—increasing to 50 percent in 2018. Private payers, such as Humana and United Health Group, are following the lead of HHS and tying reimbursement to value-based arrangements. Humana aims to align 75 percent of its Medicare Advantage membership to quality of care reimbursements and UnitedHealth Group will tie $65 billion of its reimbursement to value-based arrangements, each by 2017. The landscape is continuing to shift under our feet.

Reduce Readmissions

Strides continue to be made in the overall quality of care delivered in the U.S. New research released by the CMS 2015 National Impact Assessment of Quality Measures Report, finds that between 2006 and 2012 there was significant improvement in reported performance rates across seven quality reporting programs. Performance on over a one-third of the measures was considered “high performing,” exceeding 90 percent in the most recent three years of collected data. Additionally, health disparities across racial and ethnic groups have narrowed.

Hospital_Readmissions_Blog_Table-1.pngWhile the overall delivery of quality of care is improving, the Hospital Readmissions Reduction Program outcomes measures (see table) have shown limited improvements in readmission rates since 2013, the first program year. Outcome measures reported in the 2014 CMS Medicare Hospital Quality Chartbook (reporting period between July 2010 and June 2013), show variation in hospital performance continues along with the persistence of geographic variation by hospital referral region. Only two regions performed better than the national average on four or more of the condition-specific readmission measures.

Impact Quality and Care Delivery

In order to move to true value-based care, the overall health, safety, and well-being of a patient must be addressed. The delivery of coordinated, quality care needs to expand from the acute setting across the continuum with an equal focus on the social determinants of health—including access to care, caregiver support, behavioral health, socioeconomic status, and health literacy.

The identification of high-risk patients along with the development of strategies to address individual patient needs and barriers to achieving them will improve the success rate of transitioning care to the post-acute setting. Key components of a “wholeistic” approach include:

  • Patient/family engagement
  • Tools for effective self-management of chronic conditions,
  • An individualized comprehensive treatment and continuum-based care plan
  • Health education for disease and medication management
  • Primary care and care management follow-up
  • Improved clinician-to-clinician communication/handoffs--all supported with appropriate community-based resources.

Long-term sustainable success cannot be achieved without continuous performance improvement and continuum-based key performance indicators. Delivering quality care across the continuum with a multidisciplinary methodology will impact the usual way care is delivered. Real-time dashboards will foster the analysis of both financial and clinical data allowing for comprehensive, gap in care interventions and strategy development. Staffing skillsets will continue to change and new positions will continue to be created to meet the needs of the population. We are truly in the midst of the new age of healthcare.

The Camden Group, Hospital Readmissions, Readmissions Reduction

Topics: Readmissions, Readmissions Reduction, Quality Outcomes, Care Delivery

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

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

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 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 GE Healthcare 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

Making Patient Experience a Priority [INFOGRAPHIC]

Posted by Matthew Smith on Oct 28, 2013 4:05:00 PM

Key Takeaways:

  • 36% of patients don't get the lab tests, specialist referrals, or follow-up care they need

  • 1 in 5 Medicare patients are readmitted within 30 days

  • 64% of doctors say that non-clinical paperwork has caused them to spend less time with patients

Patient Engagement, EHR

 

Topics: EHR, Readmissions, Infographic, Patient Experience

Addressing the Human Factors Behind Hospital Readmissions

Posted by Matthew Smith on Sep 2, 2013 7:31:00 PM

Hospital Readmissions

By Asad Zaman, MD, FACP, and Lucy Zielinski, Vice President, Health Directions

We wrote an article last summer about reducing readmissions from long-term care facilities. Several  readers commented on the article, providing great ideas on how hospital leaders can work with LTC facilities to lower rehospitalization rates. But one commenter noted that long-term care is just a piece of the readmission puzzle.

In her hospital, she wrote, more readmissions come from discharges to subacute rehabilitation facilities and from patients sent home. The comment is on target, and it raises some important issues. Consider the following scenario:

A patient undergoes emergency bypass surgery. After three nights in the hospital, he is ready for discharge. The medical staff want to send him to a subacute rehabilitation facility for a few days, but the patient wants to go home, and his children are confident they can take care of his needs. In the days that follow, however, the patient develops wound complications. Family members are soon unable to control his pain. Five days later, the patient is back in the hospital.

What does this scenario show? It demonstrates that rehospitalizations are a true communitywide problem that involves providers, patients and family members. Human factors — not just clinical and organizational processes — drive many readmissions. Solving this complex problem requires unconventional thinking. Five planning strategies will help health care leaders to address the human factors that lead to hospital readmissions.

Plan for Success and Failure

Health care today is focused on outcomes. The goal is to design optimal clinical pathways that proceed smoothly from care through recovery. But while it is important to envision success, we are missing an opportunity if we fail to think about minimizing the inevitable failures.

Let's return to the bypass patient. What could have been done to keep this patient in good health? The possibilities include better discharge planning, better use of technology and better use of social services to support home care. Thinking along these lines is important, but we should also plan what happens if patients run into trouble.

One solution is to connect patients proactively with a skilled nursing facility in the hospital network. The hospital forwards the patient's records to the SNF and provides clear instructions to the family about when to turn to the facility for assistance. If the bypass patient's family had been put in touch with this resource, they could have asked SNF staff about wound care and pain control. And if the patient had developed a defined condition (such as shortness of breath), the family could have transported him directly to the facility.

A system that plans for failure will allow many patients to get appropriate care more quickly. It also can prevent a significant portion of hospital readmissions.

Tinker and Troubleshoot

Some ideas for reducing readmissions will fail and should be discarded. Some failures, however, can be turned into successes with just a bit of tinkering.

One reader who commented on our previous article argued for stationing nurse practitioners at LTCs. This is a good idea, but making it work can be a challenge. An LTC in the Chicago area recently experimented with hiring a nurse practitioner. Unfortunately, the NP found it almost impossible to reach physicians to get critical direction. The experiment was both frustrating and ineffective. But should the idea be scrapped? No — better to scrutinize the specific problems and troubleshoot a solution.

One possible modification is simply to rework the chain of command for clinical advice. If an attending physician does not respond to the NP within an appropriate time frame, the NP should page the LTC medical director as the supervising physician. Streamlining the process bypasses communication roadblocks. How will this arrangement be coordinated with primary care providers? One approach is to send physicians a memo clarifying that the LTC medical director will be responsible for all newly admitted and readmitted patients, as well as any patients who need acute attention. This will clarify that patients remain under the care of their primary physician and will avoid HIPAA violations.

Avoid One-Size-Fits-All Solutions

Eliminating variations in care is one key to improving quality and reducing readmissions. At the same time, clinical leaders should not miss opportunities to tailor care paths to different situations.

For example, a hospital's standard protocol when discharging a patient to a subacute rehabilitation facility might include nurse-to-nurse communication. However, this one-size-fits-all protocol might not be optimal for the most complex patients, such as a chronic obstructive pulmonary disease patient with acute pneumonia. For these transfers, consider having the attending physician or hospitalist communicate directly with the subacute rehabilitation facility medical director to discuss patient problems and care needs.

It would be too expensive to apply this process to all handoffs, but it could be appropriate and cost-effective for patients in certain high-risk categories.

Forget about the Small Change

Cost control is a critical part of health care reform, but hospitals should avoid being penny-wise and pound-foolish. Our previous article looked at the problem of missed drug doses following transfer to a long-term care facility. One commenter suggested that hospitals send medications (such as high-end cardiology drugs) to the LTC with the transferred patient and work out reimbursement later.

Why not go one step further? Hospitals should consider sending along an extra day of medications for certain patients, such as those with diabetes or congestive heart failure,and not worry about the reimbursement. You're probably wondering, Won't this add pharmacy costs that are included in the hospital DRG payment? Yes, but focus on the bottom line. If providing transition medications to 100 patients (in certain defined categories) prevents just one readmission, the small investment will be well worth the realized savings. The key here is to look closely at individual situations and identify the true cost/benefit of different approaches.

Create Collaboration within Competition

To secure discharges, LTCs, subacute rehabilitation facilities and other post-acute facilities must now demonstrate that they are able to keep readmissions down. This competition is spurring many providers to elevate their standard of care. However, competition can have negative effects. The least sophisticated facilities (and their patients) may be left behind as the bulk of resources flow to the strongest performers.

This is a problem for hospitals. Even if a hospital cultivates a network of preferred post-acute providers, many patients will "leak out" to other facilities. For instance, many patients will choose to transfer to a non-network LTC if a family member works nearby. From a population health viewpoint, hospitals should foster a collaborative environment that will improve post-acute care in the entire community.

One option is to sponsor regular meetings of the medical and nursing directors of local LTCs and subacute rehabilitation facilities to share information and explore solutions to shared problems. To focus and energize the discussion, the hospital should monitor and share key post-acute metrics such as 30-day readmissions and lab turnaround time. Hospital leaders can encourage cooperation by vocalizing the expectation that all providers will work together to improve performance.

Accentuate the Practical

The common denominator of all these strategies is that they represent a practical approach to a complex problem. Understanding the human factors at play in the post-discharge period will help hospitals and their partners to develop workable systems for preventing unnecessary readmissions.

Asad Zaman, M.D., F.A.C.P., is a member of the board of directors of Advocate South Suburban Physician Partners and the immediate past chair of the department of medicine at Advocate South Suburban Hospital in Hazel Crest, Ill. He is also the medical director of Symphony of Crestwood (Ill.) and ManorCare of Homewood (Ill.). Lucy Zielinski is a vice president at Health Directions LLC in Oakbrook Terrace, Ill.

Topics: Hospitals, Patient Care, LTC Readmissions, Long Term Care Readmissions, Readmissions

5 Strategies that Address the Human Factors Behind Readmissions

Posted by Matthew Smith on Jun 4, 2013 12:34:00 PM

By Asad Zaman, MD, FACP, and Lucy Zielinski, Vice President, Health Directions

Readmissions, Hospital Readmissions, LTC, Health DirectionsWe wrote and published an article last summer in Hospitals & Health Networks Daily about reducing readmissions from long-term care facilities. Several H&HN Daily readers commented on the article, providing great ideas on how hospital leaders can work with LTC facilities to lower rehospitalization rates. But one commenter noted that long-term care is just a piece of the readmission puzzle.

In her hospital, she wrote, more readmissions come from discharges to subacute rehabilitation facilities and from patients sent home. The comment is on target, and it raises some important issues. Consider the following scenario:

A patient undergoes emergency bypass surgery. After three nights in the hospital, he is ready for discharge. The medical staff want to send him to a subacute rehabilitation facility for a few days, but the patient wants to go home, and his children are confident they can take care of his needs. In the days that follow, however, the patient develops wound complications. Family members are soon unable to control his pain. Five days later, the patient is back in the hospital.

What does this scenario show? It demonstrates that rehospitalizations are a true communitywide problem that involves providers, patients and family members. Human factors — not just clinical and organizational processes — drive many readmissions. Solving this complex problem requires unconventional thinking. Five planning strategies will help health care leaders to address the human factors that lead to hospital readmissions.

Health Directions, Readmissions

Topics: Hospitals, Patient Care, LTC Readmissions, Long Term Care Readmissions, Readmissions

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