By Geoffrey Martin, MBA, Executive Vice President, GE Healthcare Camden Group
Let’s face it—hospital throughput represents a daunting challenge for providers throughout the country. As the population ages and more individuals find themselves with health insurance, hospital use—particularly emergency department utilization—has exploded.
For hospital operators, historic approaches to acute throughput are coming up short, and a typical focus on inside-the-walls solutions, while important, are short-sighted. When it comes to literally thinking “outside the box,” hospitals need to look closer at post-acute care (“PAC”), especially skilled nursing facilities and home health agencies.
It’s true that PAC has received considerable attention over the last few months, given PAC’s role in bundled payment, especially for the CJR joint bundle mandate. But post-acute also represents an essential component of any acute throughput improvement plan and broader patient flow strategies across the continuum. As a “pressure relief valve,” PAC can help address acute bed length-of-stay issues, limit unwanted admits passing through the ED, and accelerate hospital thinking around continuum solutions.
Here are some key applications where PAC might be able to foster acute throughput redesign.
PAC Oriented Discharge Planning
While PAC is a destination for many acute discharges, it is often considered too late in the discharge-planning process. As a result, patients often stay longer than necessary in the acute bed while case management “looks for a bed” or tries to “find someone who will take this patient.” New requirements around discharge planning may be exactly the lever needed to start thinking (and talking) about PAC destinations immediately after admission. Patient assessment efforts within the first 24 hours should incorporate appropriate screening efforts that not only identify PAC as an option but also point to a specific PAC setting. This data, in turn, should guide case managers and discharge planners to more effectively apprise PAC about pending transfers and should also inform hospital-wide analytics about pending PAC needs.
Acute Admit Avoidance
Identifying patients who might be served outside the hospital is an often overlooked but essential step in both reducing wait times and avoiding unnecessary admissions. Emergency Department (“ED”) triage efforts must consider PAC as a viable alternative for appropriate patients, either via clinical assessment efforts or expanded case management. In many instances, community-based settings (like a skilled nursing facility) are capable of managing patients who present with non-urgent, non-surgical issues, like pneumonia or UTIs. In-depth evaluation of historical ED use should clarify the potential for acute avoidance opportunities and characterize specific patient types appropriate for PAC.
Real-Time Patient Management
As more organizations consider adoption of advanced transfer centers, command centers, and similar efforts to better manage hospital performance in real time, PAC must be an omnipresent option for appropriate use. Bed managers, transfer leaders, and others making decision around the flow of patients must understand resources available to them outside the hospital and drive the use of these resources. While many PAC HIT systems have not reached a high degree of interoperability with acute systems, alternative approaches to identifying resources “on-call” or available, reinforcing PAC as an option, and directing patients to these options can be a powerful component in the command center information flow.
Integrating PAC into improved throughput efforts is likely easier said than done. To build strong ties with post-acute entities, many hospitals will first need to engage directly with these providers and identify quality- and capacity-oriented organizations who can serve in a hospital’s narrow network or collaborative. The use of data to clearly articulate how PAC fits into your overall patient flow strategy and to establish expectations with PAC providers is critically important. Once identified, hospitals and PAC providers will need to build strong and reliable infrastructure to support quick and efficient transfer of patients. Linking PAC network strategies related to population health management or bundled payment initiatives to the care redesign effort will reinforce the impact. In some instances, financial incentives (with clearly defined ties to quality) may serve as both carrot and stick on both sides.
Mr. Martin is an executive vice president with GE Healthcare Camden Group and leader of the Care Design and Delivery Practice. Mr. Martin specializes in the areas of hospital operations, process improvement, and the use of advanced analytics to develop innovative solutions. He also has extensive experience in strategy development, care design, population health development, value management, and large scale technology implementations. Mr. Martin has worked with leading academic medical centers and large integrated delivery networks across the country to improve clinical, financial, and operational performance. He may be reached at firstname.lastname@example.org.