The Centers for Medicare & Medicaid Services will penalize hospitals for readmissions beginning this autumn. As a result, many healthcare providers are taking a cold hard look at their bottom line in an effort to meet or exceed projected targets for the year. The difficult part, of course, is that each healthcare provider has its own unique challenges. There is no "one size fits all" solution.
It's important to examine the quality of the referral processes in place. Are there any patterns? Is your hospital providing enough information in your referral packets in a timely manner? "Healthcare providers should also identify the source of readmissions, looking at discharge referrals and post-acute provider relationships and performance to see which facilities have the best success records," explained Tom Ferry, CEO of Curaspan Heath Group, a company that helps providers, payers and suppliers improve care for patients. "Can your organization meet with underperforming facilities to discuss steps to improve? You need to know your readmission rates and track them regularly."
Ferry has a five-point strategy for the best practices to reduce readmissions.
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1. Think globally about technology.
Don't view technology solutions as purchases that the IT department makes. To be effective, they should be considered investments that align with the common goals of internal and external constituents. For lower readmission rates, that means a shared platform with your community-based partners. It should support timely, meaningful two-way communication about the next, best level of care and services that, for instance, will keep a skilled nursing facility or home care patient from being readmitted. This communication should include the exchange of clinical documentation in order to optimize care coordination.
2. Conduct due diligence beyond the four walls of a hospital.
"Since efforts to lower readmissions depend in part on external care partners, don't make a technology decision in a vacuum," said Ferry. Solutions that advance this strategic initiative must reflect feedback from your post-acute providers and payers. After all, whatever you deploy will have an impact on your partners' performance and ultimately your reimbursement as ACOs, value-based purchasing and other new models of care and reimbursement requiring collaboration take root. Your decision making about technologies to support them also requires collaboration.
3. Forget about "one throat to choke."
No one can do everything, never mind do it all well. If there was one silver bullet for cutting healthcare costs, improving care and driving efficiency, readmissions wouldn't be a problem. Go with a best-of-breed solution that integrates with other superior point solutions. From a technical standpoint, it should be interoperable with all HIS. Additionally, it should come from a vendor that knows how to partner with other vendors. After all, if you're going to create a connected universe in which providers from separate but related levels of care not only communicate but collaborate, you should have vendors that know how to collaborate too. Further, if you want to protect your investment should problems surface, look for a strong SLA – not a one-company panacea.
4. Deploy technology that drives utilization.
Input from internal and external stakeholders must include assessing whether a product is easy to use and demonstrates immediate, clear benefits. For example, since making a dent in readmissions requires first identifying the issues underlying the numbers, you'll need a system that users readily adopt, generating data necessary for ongoing root-cause analysis – and action. Knowing whether particular nursing homes or physicians are behind a disproportionate number of readmissions, explained Ferry, equips staff for a discussion with those providers, which should drive better outcomes and create more utilization.
5. Keep cultivating relationships with community-based partners.
Controlling readmissions is an ongoing challenge that requires periodic meetings with your post-acutes and payers to review data about how you're doing. "We know from our own customer base that those organizations that regularly review and respond to data cut their annual readmissions to well below the national average," said Ferry, "improving clinical as well as financial outcomes."