Data Integration: Helping healthcare organizations reduce readmissions
A total of $280 million in hospital readmissions penalties will be paid by 2,213 hospitals this year as a result of the Hospital Readmissions Reduction Program administered by the Centers for Medicare and Medicaid Services (CMS). Hospitals reporting more readmissions within 30 days of discharge than expected for specific diagnoses are penalized by losing up to one percent of their regular Medicare payments.
Healthcare organizations have two options for reduction of readmissions rates:
• Make sure patients are as healthy as possible before discharging them from the hospital – which means longer stays in the hospital to give physicians more information about their status and follow-up care needs. Or,
• Create a program that improves monitoring and evaluation of the patient’s status after discharge to provide support that leads to higher compliance with discharge instructions.
The first option is unrealistic for hospitals and health systems because healthcare providers are also charged with reducing lengths of stay for all patients. This means hospitals must develop a program that addresses potential reasons for readmissions to produce better outcomes for patients and to avoid financial penalties.
While in the hospital, a patient’s bed is surrounded by clinical and ancillary personnel who evaluate health status, recommend treatment and medication, and share information through medical chart notes and conversations. Once the patient leaves, providers have limited information about the patient’s health status and compliance with discharge instructions. Even when telephone calls are made to the home, the patient or caregiver may not share all information with a hospital representative because they do not understand its importance or they told a primary care provider (PCP). They do not realize the PCP’s notes are not shared with hospital staff.
A successful readmission reduction program re-creates the scenario of “gathering around the hospital bed.” A holistic approach that combines personal interaction with technology-supported communication among patients and providers ensures patients take medications as prescribed, schedule follow-up visits and seek intervention prior to the need for readmission. Components of an effective program to reduce readmissions include:
• Discharge education for patient and caregiver to explain instructions regarding medication, follow-up visits and communication with discharge team;
• Daily health check questionnaire completed by patient or caregiver through a live phone call, interactive voice response (IVR) or patient portal;
• Email reminders to patients about medication or follow-up visits;
• Automated alerts to providers when there is a need for personal follow-up with a patient; and
• Continuous update of information in a patient record along with easy access for all providers to ensure each has information needed to prescribe care.
The key to effective communication among providers is access to real-time data that supports patient care decisions. The challenge for most health systems is the ability to integrate disparate systems such as electronic health records and a system to collect patient information after discharge. Integration as well as aggregation and harmonization of data to make it available to multiple users are daunting tasks for overworked healthcare information technology (IT) staffs.
A cost-effective and time-saving solution is the use of a cloud-based platform to integrate, aggregate and harmonize data. The use of one platform to perform these tasks eliminates the need for providers to learn how to use new systems or to remember to enter the same data into multiple programs to support communications. Healthcare IT staff are then free to focus on day-to-day issues as well as regulatory challenges. Automated communications activities such as email and IVR also limit the number of employees needed to administer the program.
The concept is not unlike personal security. The ideal security system for anyone’s home and family is a personal guard who patrols 24 hours a day. The cost, however, is prohibitive so most people choose an alarm system that relies on a centralized response center to receive alerts and contact assistance for the homeowner.
In much the same way, technology that aggregates and harmonizes healthcare data, and then sends alerts to the most appropriate person for action, minimizes staff time and maximizes effect on patient care. For example, if a patient neglects to refill a prescription, a message is sent to a nurse overseeing the program, who then calls the patient to discover the reason. This intervention reminds the patient of the importance of taking medication as directed and provides an opportunity to troubleshoot financial or logistical barriers that prevented the prescription refill. In this model, the nurse is able to track hundreds, if not thousands, of patients as opposed to the current model of a nurse only being able to keep up with a few discharged patients.
Committing to a new program that requires staff and technology support is a difficult decision. However, hospitals and health systems that don’t implement cost-effective readmission reduction programs face loss of future revenue. CMS penalty caps for readmission will increase one percent each year – reaching a potential three percent penalty in 2015.
Technology can support hospital and health system efforts to reduce readmissions. The key is to combine data integration with personal support for patients. The ability to focus on key behaviors, enhance communications and offer patients an opportunity to collaborate with providers for their continued recovery results in benefits for both the healthcare organization and the patient.
Gary Palgon is the Vice President of Healthcare Solutions for Liaison Healthcare Informatics. He can be reached at gpalgon@liaison.com.
