1.800.360.0603

GE Healthcare Camden Group Insights Blog

Best of 2015: Leveraging Post-Acute Care to Address Acute Readmissions

Posted by Matthew Smith on Dec 30, 2015 9:57:22 AM

By Andy Edeburn, MA, Vice President, GE Healthcare Camden Group

hospital-readmissions-reduction-program.jpgLeading into the new year, GE Healthcare Camden Group will be re-publishing the most shared and popular blog posts of 2015.

For 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 DocumentationThe 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.png

Mr. 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.

Topics: Readmissions, Readmissions Reduction, Post-Acute Care, Andy Edeburn, Acute-Care Readmissions

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

Quality Outcome Achievement and the Impacts to Care Delivery

Posted by Matthew Smith on Apr 30, 2015 2:23:35 PM

By Bridget Gulotta, MBA, MSN, RN, Senior Consultant, and Tina Pike, MBA, MSN, HCM, RN, Senior Manager, The Camden Group

016_healthcare_consultant.ju.jpgThe 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



Gulotta_headshot.pngMs. Gulotta is a senior consultant with The Camden Group with more than 10 years of experience in the healthcare industry, including clinical experience. She specializes in clinical integration and patient care management, with a focus in quality and performance improvement, financial analysis and budget administration, as well as regulatory compliance, and strategic planning. She may be reached at bgulotta@thecamdengroup.com or 312-775-1700.

 

 

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, Quality Outcomes, Bridget Gulotta, Care Delivery

Hospital Readmissions Reduction Strategies: The Impact of the Hospitalist

Posted by Matthew Smith on Apr 22, 2015 10:24:03 AM

By: Tawnya Bosko, MHA, MSHL, MS, Senior Manager, and Vinnie Sharma, MBA, MPH, Manager, The Camden Group

RA-thumb5As penalties associated with avoidable readmissions continue, hospitals across the country are attempting to identify the most effective approaches to tackle this challenge in order to limit monetary as well as reputational losses. While the solutions required will likely be as multi-faceted as the problem itself, one specific group that can play a pivotal role in reducing readmissions are the hospitalists.

Hospitalists play a central role in process improvement within hospitals, which gives them a head start in tackling the readmissions challenge. However, in certain cases, over-emphasis on length-of-stay (LOS) reduction may contribute to the problem, which can lead to higher readmissions, patient dissatisfaction, and increased liability for the physicians and the hospital. Thus, the hospitalists and the hospital leadership need to develop a proactive, coordinated set of strategies to achieve the desired results of efficient care as well as reduced readmissions. Use the following ten tips to support your organization’s coordinated strategy.

1. Promote a Team Approach

Reducing readmissions requires a team effort with other physicians, nurses, care coordinators, case managers, family members, and post-acute providers. Hospitalists typically work in a team-based environment and are used to playing “quarterback” to a multidisciplinary team of healthcare professionals to improve inpatient processes and quality, and thus are best qualified to lead efforts to reduce readmissions. Because many of the areas that can impact readmissions are outside the immediate purview of the hospitalists (e.g., case management or post-acute care), some organizations utilize a dyad approach where the hospitalist co-chairs the taskforce with an administrative leader.

2. Coordinate Discharge Planning

Hospitalists are often asked to balance hospital efficiency (e.g., through managing LOS and cost per case) while ensuring that the patient receives appropriate care in the most appropriate setting. Hospitalists can manage this balancing act by working with case managers and care coordinators to develop a plan of care starting on the first day of admission. The tasks of planning post-discharge care, coordination with the Primary Care Physician (“PCP”), specialists, and communication with family should be initiated as early as possible.

3. Improve Patient Education

The best preventers of readmissions are often the patients themselves. If properly educated on symptoms, medications, warning signs, and need for follow-up with PCPs, many of the most common problems that result in readmissions can be prevented. While it certainly depends on the ability of the patient to follow instructions, hospitalists can lead the effort by providing written as well as verbal instructions in an easy to understand way. Depending on the situation, it may be appropriate to engage family members. Additionally, deploying a patient education specialist or case manager to follow-up with the patient to make sure they understand the hospitalist’s recommendations and plan of care identifies areas where patients may be unclear and resolves those issues before discharge. This also serves as a vehicle to improve patient experience. Optimally, patients should be given a phone number to call should they have questions after their discharge. That number should be given by the hospital, hospitalist, case manager or in coordination with the PCP.

4. Strive for Smoother Hand-offs

Transition from the inpatient setting to post-acute or home setting is a critical step in preventing adverse outcomes and potential readmissions. Effective communication about the needs of the particular patient applies to not just the inpatient stay, but to the discharge process and post-discharge environment. Hospitalists need to pay particular attention to effective and timely communication with the PCPs or post-acute providers. While a letter or faxed copy of discharge notes is common practice, it is usually not sufficient; phone calls can be much more effective in relaying important information and developing a game plan, especially for complex patients. Additionally, electronic exchange of health information and shared viewing of the electronic patient record is optimal. This often remains a challenge due to lack of integration between inpatient and ambulatory records.

5. Schedule Follow-up Appointments

Patient follow-up appointments should be scheduled with the PCP before discharge, and an appropriate outreach and communication process should be structured so that patients who miss their follow-up appointments are identified. This requires a tightly coordinated effort between the hospitalists, the hospital and the patient’s PCP or other relevant specialty provider. Further, home health agencies can support the transition to home with home visits to assess the patient’s condition, home environment, and ensure compliance with medications. Hospitalists should drive the communication with the PCP and coordinate efforts with internal hospital departments to ensure appropriate post-discharge visits are arranged.

6. Improve Medication Reconciliation

Multiple studies have demonstrated that proper medication reconciliation can result in a significant decrease in readmissions and adverse events. Hospitalists can take a leading role in improving medication reconciliation through a coordinated effort with the pharmacist, pharmacy technicians, and nursing staff. Depending on the approach, the process may require additional staffing resources, and the hospitalists can spearhead the task of communicating the expected benefits to administrative leaders. Further, medication reconciliation doesn’t stop within the hospital walls. Ensuring that the PCP is updated regarding changes in medications while in the inpatient setting and the ambulatory record is updated are pertinent; as is coordination with post-acute care providers.

7. Utilize Post-Acute Care

As the healthcare system moves to an integrated delivery model, hospitalists can play an important role in the post-acute arena to improve care coordination. Several organizations now send hospitalists to round in skilled nursing facilities (“SNFs”) and nursing homes to ensure a safe transition and follow-up. Some organizations have dedicated physicians to the SNF setting, often referred to as “SNFists.” For less acute patients, several programs offer post-discharge clinics that are staffed either by hospitalists or through a partnership with the PCP. While utilizing hospitalists or advanced practice professionals with hospitalists’ oversight, outside of the inpatient setting, may require financial support from the organization, the benefits from reduced readmissions, lower costs, and higher patient satisfaction can be significant.

8. Identify Those at Greatest Risk for Readmissions

Hospitalists are in the best position to identify patients that are at greatest risk for readmissions. Using data analysis to provide a greater level of detail and feedback to hospitalists is important to overall success, as is instituting a feedback process to account for the hospitalist’s identification of high risk individuals, processes and conditions. Utilizing a risk stratification tool and arming hospitalists with information from that tool at the time of admission are recommended.

9. Encourage Communication Between Admitting and Discharging Physicians

Studies have shown that often there isn’t communication between the admitting and discharging hospitalists regarding patients that are readmitted. While basic information is often exchanged, there isn’t a tightly coordinated effort to discuss readmitted patients between the physicians that are involved in the care. Closing the communication loop between hospitalists could provide valuable information and lessons learned and ultimately reduce readmissions as well as improve quality and support a team-based environment.

10. Design Incentives Models that Matter

Having clear guidelines and processes that should be followed by the hospitalist program are important. Additionally, since the readmission penalty is structured to only impact the hospital at this time, and hospitalists are still compensated for seeing readmitted patients, creating an incentive model methodology that bonuses the hospitalists for improving or maintaining a given readmission rate may help align overall incentives in the program and engage hospitalists in the process. Hospitals should work collectively with the hospitalists group and other stakeholders to design effective incentive models.

Readmissions reduction requires a well-coordinated approach among many providers along the continuum of care as well as with the patient, family, and other participants. Hospitalists can play a critical role in the development of a culture of safety that improves patient outcomes, reduces penalties for the hospitals, and also minimizes the medical-legal risk exposure. Readmissions reduction is a clear first step in transitioning to a more value-based delivery system, and hospitalists can and should play a critical role in this process.

The Camden Group, Hospital Readmissions, Readmissions Reduction


 

bosko_headshotMs. Bosko is a 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.

 

 

 

Vinnie_Sharma_SquareMr. Sharma is a manager with The Camden Group with more than ten years of experience providing advisory services to physician organizations and health systems. Mr. Sharma has an extensive background in managing or consulting for medical groups, faculty practice plans, and health systems, with a focus on operational and financial improvement. He may be reached at vsharma@thecamdengroup.com or 310-320-3990.


 

Topics: Readmissions, Hospital Readmissions, Tawnya Bosko, Readmissions Reduction, Vinnie Sharma, Post-Acute Care, Patient Education

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

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

Subscribe to Email Updates

Value Model, Health Analytics

Posts by Topic

Follow Me