Monday, August 13, 2012

Reducing ReAdmissions... Another Obvious Thing We Need To Do!

Reducing readmissions is a very hot topic now since the government and other payors are starting to create an incentive system which punishes hospitals who have high readmission rates (at least for some of the top categories like CHF and Pneumonia), they do this by basically saying they will not pay if the patient is readmitted within 30 - days of discharge. So I do like the idea of creating well aligned incentives... as long as there is also upside to doing things well.

So how can a hospital succeed here? CSC recently published a report about reducing readmissions. Key Points include:

• Hospital efforts to reduce readmissions have become more visible and important because of the financial stakes — disincentives being incorporated into payment reform — are now high enough to be noticeable in the bottom line.

• Variability in rates across hospitals and regions of the country suggests that significant reductions are possible if practices in better performing hospitals are adopted more uniformly.

• Current measures employed in Medicare incentives target acute care hospitals and high-risk patients defined as those with heart failure, pneumonia, or an acute myocardial infarction. Any re-hospitalization to any hospital within 30 days, for any condition, is counted.

• Preventing readmissions is very challenging because so many community and patient factors contribute to the problem, many of them outside of the direct control of the hospital.

• However, research, combined with practices in hospitals with a track record of reducing readmissions, shows that comprehensive discharge planning and post-discharge care and support during the transition period reduces readmissions in high-risk patients.

• The next scope of work will be to achieve a formal connection with organized care management for every patient covered by this type of program.

• As more high-risk patients are covered by these programs, this will decrease the role of the hospital in providing post-discharge care and support, but formally link patients back to organizations accountable for ongoing care.

• Key elements of the resulting model will be organizing and operating transitional care as a process in its own right, laying out each patient’s transition and hand-off in a time-limited transition clinical pathway, and new uses of health IT in patient tracking and transition care planning.

So the report states that one major key to reducing readmission rates is patient-centered discharge planning. That absolutely makes sense... but hey - it is certainly not a surprise! The real surprise is simply that it is not done more often (Why? Because payors don't pay for it - they pay for procedures over process or thinking). Like much of what we do, if you ask someone outside of healthcare if they thought we did this routinely - they would assume that of course we did it - it just makes sense to create a highly personalized and integrated discharge plan for a complex medical patient when they are discharged from the hospital.

Of course, times and incentives are changing, so clearly we will hear about more emphasis on this type of patient centered planning; on the other hand, we will see hospitals having to cut corners by firing discharge planners and asking RNs to do more of it themselves.

But assuming we are doing more of this, the next issue is "The Details"... will there be a secret sauce or consistent algorithm to make this easy, safe and cheap? Or is it simply about having a smart person use higher order thought processes to create a very personalized approach to each patient. I think it will be a bit of both; the more in the former category - the more likely we can spread this work and make it cost-effective and successful!

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