With the advent of the Affordable Care Act, healthcare continues to be a competitive game of sweeping change. Quality is no longer based on a fee-for-service model of healthcare reimbursement, but rather a pay-for-performance plan where incentives or penalties are measured, in part, by patient outcomes and readmission rates.
So what are the rules of the game? Key to keeping score of the quality of a hospital is tracking the number of patients who experience unplanned readmissions to a hospital after a previous hospital stay. The standard benchmark used by the Centers for Medicare & Medicaid Services (CMS) is the 30-day readmission rate. Rates at the 80th percentile or lower are considered optimal by CMS. And who doesn’t want to be optimal?
In 2013, almost 18% of Medicare patients who had a hospital stay were readmitted to that same hospital within a thirty-day period. That’s a ratio of almost one in five people putting on a hospital gown again.
So, if Aunt Loretta has hip replacement surgery, and later develops a wound infection that requires her to be re-admitted to the hospital for further care, this reflects poorly on a given hospital’s scorecard. Add up enough of these readmissions—preventable or not—and the shame of the penalty box waits.
Since readmissions are often viewed by insurers and other payers as “wasteful spending” being sent to the penalty box can be expensive to a hospital’s bottom line. In 2014, federal readmission data published by Kaiser Health News showed that 39 of 2,610 total hospitals penalized received a three percent fine, which is the highest fine allowed, and hospitals collectively will pay an estimated $428 million in penalties for readmission rates deemed higher than expected by CMS formulas.
Is this jarring? Yes! And it’s supposed to be. Medicare wants hospitals to pay attention to what happens to patients after they leave a facility. Officials estimate that out of the $26 billion that Medicare spends on readmissions, $17 billion of that could potentially be avoided. And who doesn’t want to save $17 billion dollars? Money talks. And with dollars like that at stake, hospitals are being forced to speak a different language than they were less than a handful of years ago.
Can your hospital come back from behind? Truth be told, there is no magic formula, but knowing where to put your time and attention and then being able to effectively communicate your message is half the battle to to reaching your goals. Here are some ideas to get your started:
- Set expectations with the patient and family about a patient’s transition from hospital to home.
- Be consistent and thorough with education and support for a patient to self- manage their recovery and care.
- Create process improvement initiatives for core discharge planning issues.
- Ensure post-acute care is coordinated and a follow through plan created.
Duke University Hospital’s Ambulatory Surgery Center is taking a progressive approach to providing same day surgery patients discharge education that aims to decrease anxiety, increase knowledge and, ultimately, reduce readmissions. How are they doing it? Through the creation of easy to understand post operative training videos that focus on key topics like how to properly use crutches; the proper use of an orthopedic sling; and how to set up and use polar care, a piece of equipment that when used properly can reduce swelling at a given surgical site.
With hospital staff increasingly using the teach-back method with patients and their families, training materials involving video make perfect dollars and cents. Though we retain only approximately ten percent of what we see, we happen to hold onto ninety percent of what we see, hear, AND do.
The videos, produced by Contrast Creative, are presented to patients post op with an ASC staff member available to answer any questions. But even better, the videos are also available online on the Duke Medicine YouTube page so patients can watch them again if needed when they return to the comfort of their own homes.
Since instituting this teaching method, Duke’s ASC has received rave reviews from patients who value access to these simple yet informative videos. If needed patients can watch and learn from them again, and again and again both consistently and correctly, as presented by an experienced healthcare provider.
In the end, the result is a win-win situation for patients and hospitals alike. As much as hospitals want to reduce readmissions and the penalties associated with them, their patients would prefer not to be readmitted. It’s clear that developing a care transition strategy that includes a patient centric communication plan is vital to reducing readmission rates and improving patient care.