Reducing Hospital Readmissions Through Improved Communication and Care Coordination
For many healthcare providers, the aim to improve the quality of patient care while lowering costs represents a significant challenge and one that brings new stresses upon the organization. Simultaneous developments in technology and changes in the legislative environment are rapidly ushering in a new era, one of a more patient-centric environment. With the US health care system representing the most costly in the world, accounting for 17% of the gross domestic product, our industry is now dominated by healthcare organizations seeking the transition to value-based care. The value-based reimbursement model represents a dramatic change from the old fee-for-care model with the responsibility for care management is now shifting from payers to providers.
Now that the final payment and policy changes for hospital readmission from CMS is in effect, thousands of hospitals across the country are facing increased financial pressure. Hospital readmissions significantly increase cost and utilization within a population, and are only expected to increase with the projected growth in Medicare enrollment. Since we know that a small minority of patients drive a disproportionate share of healthcare spending and that the maximum readmission penalties from CMS have risen to 3 percent for fiscal year 2015, focusing on hospital readmission as an opportunity to improve health system performance makes a lot of sense.
Kaiser Health News recently reported that 2,610 hospitals face penalties from Medicare due to high readmission rates with a projected overall cost of $428 million. Another recent study by Modern Healthcare, Crain Communications, Inc. provides some additional perspective; 1 percent of patients make up 22.7 percent of hospital costs. The data clearly exhibits that patients with multiple chronic conditions (MCC) and those with social or financial barriers to care are among the leading demographic for hospital readmissions. Additionally, the data also posits an inverse relationship between readmission rates and quality scores. Lower quality scores negatively impact these institutions by impairing their ability to secure federal funding and result in damaging patient loyalty. In a social media driven world, institutional reputations matter more than ever.
Strategies to reduce hospital readmissions
Hospital readmissions may be related to a number of factors, including reoccurrence of illness, failure to understand or follow physician direction, or lack of follow-up care, among others. The realities that healthcare systems facing readmissions challenges today are daunting, however the majority of readmission is likely preventable by hospitals that involve a few simple steps in their strategies to reduce readmissions and better manage care transitions.
1.) Clear communication during the discharge process and beyond. This typically involves ensuring that patients and their families have understood the discharge instructions fully and receive a follow-up call from the discharge nurse the following day to ensure adherence to the instructions.
2.) Adherence to Medication Management. Ensures that the patients understand their medication lists, have access to fill newly prescribed medications and are taking the correct dosages.
3.) Follow-up appointment within the first 7 days with their primary care doctor or specialist. The hospital needs to be proactive to ensure that patient has the means (including financial and transportation) to attend that appointment. A hospital representative should contact a patient should they miss an appointment and address any barriers the patient may have to making their next scheduled appointment.
4.) Patient education. Recently discharged patients need to be aware of the warning signs and symptoms of a worsening condition as well as how to successfully manage their condition to avoid them.
With the advent of new models of care, health systems and their hospitals often need to overcome non-clinical barriers to achieve the best outcomes, integrate patients’ values into the care plan, and communicate continuously with patients to address and bridge care gaps.
At Fonemed, we assist health systems, hospitals and other health organizations to better improve caregiver/patient communication and leverage patient data to reduce hospital readmissions with our care transitions program. Our population health management software provides for an integrated network that allows information sharing across platforms both within an organization’s walls and across independent providers. By distilling best practices, informed by decades of experience, we are able to develop information-driven care plans that not only reduces hospital readmissions and costs, but leads to improved patient satisfaction and healthier outcomes.
While the goal of advancing the value healthcare providers offer to their patients is consistent across the board, we understand that not every organization is on the same path to accomplish this as the industry transitions to a more patient-centric model. Whether your organization is seeking to develop and launch and population health management program from the ground up, or enhance your existing program, Fonemed is here to help. Give us a call today and see how our care transitions program can help your organization ensure a healthier future for your patients.