83% of all eligible US hospitals are being penalized for excessive readmission rates. $563 million in Medicare payments are being withheld, and Medicare isn’t the only payer pressuring hospitals to prevent hospital readmissions. AHRQ found that readmissions of privately insured and Medicaid beneficiaries cost $8.1 billion and $7.6 billion, respectively.
With the announcement of the Hospital Readmissions Reduction Program (HRRP), CMS is clearly serious about driving a value-based reimbursement program by encouraging health systems to think about readmission avoidance. This has become especially magnified in the era of COVID-19 recovery.
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The road to recovery has many paths, and the less-traveled path of readmission avoidance ensures optimal care while also reducing cost and increasing patient share.
The Necessity of a Readmission Avoidance Strategy
While the need for recovery is ever-present, what has troubled me is the myopic approach focused on what feels immediately tactical while missing a more strategic approach that will lead to greater long term returns.
Sure, telehealth, online scheduling, patient notifications, and other new technologies continue to be important for developing digital operations, but a more holistic strategy would include optimizing care coordination.
Why do I say that?
Well, ineffective care transitions following a hospitalization increase the rates and costs of hospital readmissions. Health Affairs has reported that inadequate care coordination, especially within care transition management, accounted for $25 to $45 billion in wasteful spending in 2011.
Frankly, the industry can’t handle that kind of spending anymore. We need to be planning for readmission avoidance.
Health Affairs recently reported that inadequate care coordination, especially within care transition management, accounted for $25 to $45 billion in wasteful spending in 2011.
What Would a Readmission Avoidance Strategy Do?
The good news is that avoiding readmission is not an impossible task and most certainly doesn’t need to be avoided due to the perceived disruption. Gathering from a variety of resources, we’ve found that three primary adjustments can greatly reduce readmissions for any hospital. A readmission strategy should...
Ensure patients schedule a seven-day follow-up. Studies show that patients who followed up with their physician within seven days of discharge were less likely to be readmitted to the hospital.
Ensure smooth transitional care. In addition to home healthcare, transitional care has been shown to reduce hospital readmissions. Transitional care could feature a transitional care team or professional who facilitates the coordination and continuity of care for patients as they change providers post-discharge. One Baylor Medical Center at Garland (Texas) study found a transitional program reduced 30-day readmission rates by 48 percent. Researchers have also conducted a systematic review of literature, analyzing 21 randomized clinical trials of transitional care interventions involving chronically ill adults. They discovered nine common interventions that helped drastically lower readmissions 30 days post-discharge. Many of these interventions included some sort of care coordinator involvement. Care coordination roles are also outstanding jobs for healthcare experienced military veterans. If you are interested in learning more about this, visit www.heroestohealthcare.com. Armed with Blockit, they deliver impressive results.
Clearly communicate post-discharge instructions. Patient communication and education is a critical component for readmission prevention. At UCSF Medical Center, a team of multidisciplinary heart failure experts monitored heart failure patients after discharge. These experts target preventable readmissions by educating patients about their disease and utilizing the "Teach Back" method. This method requires the patient to repeat the information they have been taught to ensure full understanding. UCSF Medical Center's multidisciplinary-expert approach helped reduce 30-day and 90-day readmissions for heart failure patients 65 and older by 30 percent. On the other end, failing to include patients in the discharge process results in higher hospital readmission rates. One recent Patient Experience study found that patients who reported that they were not involved in their care during the original encounter were 34 percent more likely to experience readmission.
How Digital Tools Can Help Your Practice’s Readmission Avoidance Strategy
Despite all of the opportunities for improvement, busy ED leaders struggle to embrace the role that digital tools could play in readmission avoidance.
Platforms like Blockit leverage the technology that already exists within the system, allowing providers and staff to easily facilitate a post-discharge care plan. Blockit’s current metrics show that these transactions take five minutes or less.
It is vital to incorporate a digital care coordination platform that can identify and schedule the right post-acute provider, at the most convenient time and location, automatically send patient instructions, reminders, and notifications, seamlessly schedule transportation, and most importantly allow for the tracking of adherence. Blockit can do all that and more.
The tech will never replace the touch but high tech can enable high touch especially in the areas of care transition and readmission avoidance. An effective readmission avoidance strategy will utilize digital tools that help optimize care coordination while reducing cost and increasing patient share.
Dave Gregorio is the Chief Customer Officer at Blockit and the author of the Purpose Quotient®, a nationally recognized framework for Organizational Development. A 30 year healthcare industry professional with a passion for people, Dave is the founder of the Heroes to Healthcare mission and CEO of ImPowerQ Associates LLC.