Effective Transition Planning and Discharge Follow-Up
Is your hospital trying to reduce readmissions?
Clinical efficiencies is where the top performing hospitals start. And reducing dropped communications is a top priority for them. A care team collaboration plan improves transition planning and ensures excellent discharge follow-up.
A quick query of the Hospital Compare data at the Medicare.gov site shows that for the latest reporting period (July 1, 2016 thru June 30, 2017) 1,912 hospitals scored below the 50th percentile for 30-day hospital-wide all cause unplanned readmissions. 1,152 hospitals scored in the 50th – 74th percentile. In a value-based reimbursement environment the penalties and costs to hospitals for excessive readmissions are very real.
Reducing readmission rates is one strategy for lowering health care costs and improving overall quality. Readmissions are one of the costliest episodes to treat, with hospital costs reaching $41.3 billion for patients readmitted within 30 days of discharge, the Agency for Healthcare Research and Quality (AHRQ) reported. Reported costs vary depending on patient age and severity of illness but hospital readmissions cost Medicare about $26 billion annually which includes $17 billion spent on avoidable hospital trips post-discharge, according to data from the Center for Health Information and Analysis.
Readmissions for privately insured and Medicaid beneficiaries cost $8.1 billion and $7.6 billion, respectively, AHRQ found. It’s not surprising then that payers across the healthcare industry have added hospital readmission quality measures to their value-based reimbursement programs. Hospitals who participate in value-based payment arrangements face financial penalties for not reducing readmission rates.
Hospital Readmissions Reduction Program (HRRP)
Section 3025 of the Affordable Care Act required the Secretary of the Department of Health and Human Services to establish the Hospital Readmissions Reduction Program (HRRP) a value-based reimbursement program that penalizes hospitals for excessive readmission rates for six conditions. HRRP reduces payments to hospitals with excessive readmissions and aims to improve healthcare by linking payment to the quality of hospital care.
CMS uses excess readmission ratios (ERR) to measure performance for each of the six conditions/procedures in the program:
- Acute Myocardial Infarction (AMI)
- Chronic Obstructive Pulmonary Disease (COPD)
- Heart Failure (HF)
- Coronary Artery Bypass Graft (CABG) Surgery
- Elective Primary Total Hip Arthroplasty and/or Total Knee Arthroplasty (THA/TKA)
The Hospital Readmissions Reduction Program (HRRP) decreased readmission rates by 8% nationally between 2010 and 2015. The 21st Century Cures Act also requires CMS to assess penalties based on a hospital’s performance relative to other hospitals with a similar proportion of patients who are dually eligible for Medicare and full-benefit Medicaid beginning in FY 2019. The payment reduction is capped at 3%. Payment reductions are applied to all Medicare FFS base operating DRG payments between October 1, 2018 through September 30, 2019.
There are many reasons for readmissions to occur. Health Affairs reported that inadequate care coordination and care transition management accounted for $25 to $45 billion in wasteful spending in 2011. The key is for hospitals to identify individuals at the greatest risk for readmission at the time of admission. Case management and discharge planning teams are tasked with addressing a myriad of issues while effectively planning for the transfer of care. This requires a coordinated and streamlined approach to communication and care planning.
Eliminating Clinical Care Inefficiencies and Reducing Readmission Rates
Patient-centric secure messaging technology offers a solution for real-time communication and care coordination, direct influencers of reducing readmission rates. As dynamics change within the family or receiving location, information can be shared instantly with members of the care team to include the physician, nurse, case management and other ancillary departments as needed (e.g., pharmacy, physical therapy).
MEDarchon’s secure messaging and care coordination platform QUARC offers patient-centric communication to decrease errors in patient identification while organizing high value and relevant patient conversations in an easy to follow digest that persists one shift to the next. Hospital physicians and other providers are on the go and need communication technology that moves with them. Communication solutions should fit within current workflows and staff experience to see the highest adoption and best clinical outcomes.
Ninety six percent of Americans own a cellphone; 81% own a smartphone. QUARC operates as an app on a provider’s iPhone or Android. A desktop version is available for staff located within a hospital unit or ancillary department. Hospital device management policies have moved slowly as compared to the rate of adoption of mobile technology. Hospital Chief Information Officers can be overly conservative, and rightfully so, given the consequences of data that is not “locked down”.
The management and provisioning of devices and mobile device management (MDM) software manages and secures employees’ mobile devices that are deployed across multiple mobile service providers and across multiple mobile operating systems being used within a hospital. MEDarchon works with each client to assess where they are in the adoption and deployment of mobile technology. MEDarchon’s operations and client support teams provide best practice recommendations for device management and policy development.
Planning for Successful Adoption
Before deploying any new technology within a hospital, clear expectations and goals should be established. Executive buy-in and support is critical for successful implementation. Engaged clinical leaders will work alongside MEDarchon to execute an organization specific communication strategy to inform and generate excitement with eventual end users (care teams and individual providers). Clinical champions also assist in managing change control and mitigating obstacles.
MEDarchon ascribes a crawl – walk – run approach to technical and clinical implementation. Phased training and rollout are based upon organizational needs and clinical workflows. No secure communication care coordination platform is successful without the adoption levels needed to achieve the desired clinical outcomes.
Adoption rates by role (e.g., nurses vs. physicians) and department should be monitored closely to identify potential areas of needed education or workflow review. Pre and post implementation data analysis will measure the success on specific clinical outcomes such as reducing length of stays, responsiveness to patient requests as well as reduction in readmission rates.
QUARC Client Impact Studies
Pre and Post QUARC Implementation
To ensure a positive impact with our clients, MEDarchon is committed to measuring outcomes. Although studies related to readmission rates have not been an area of measurement that clients have ventured to assess, we welcome an opportunity to report this level of measurement with engaged clients.
- Average length of stay reduced 6.5 hours for surgery and 5.5 hours for other medical*
- Reduced nurse response times to patient requests by 43%
- Reduced the incidence of patients paging the nursing station multiple times for same request by 100%
- Reduced total pages to hospitalists by 52%
- Overall, 10% (or 20 minute) reduction in Emergency Department length of stay
*Note: Analysis included 1,640 patients covering 5,714 inpatient days (ALOS=3.48 days). Other Medical Cases was defined as any discharge with a DRG that was not related to cardiovascular or infectious disease process.
Conclusion: Effective Transition Planning and Discharge Follow-Up
Hospital readmissions are not only costly but are also disruptive to the patient, caregiver and family; and, they are often avoidable. While some readmissions are unavoidable due to the progressive nature of a particular illness or disease, effective transition planning and discharge follow-up are two areas that directly impact the success of a patient being able to maintain post-discharge.
These are also areas where hospitals can directly impact. A first question to consider is this: are hospital leadership teams supplying their providers with the tools they need to communicate and collaborate effectively and timely regarding patient care, discharge planning and instructions to help reduce the risk of readmission?
Reducing readmission rates?
Check out QUARC.