Hospital readmissions remain a costly factor in our health care system. In an attempt to reduce health care costs, for the past several years the Centers for Medicare and Medicaid Services (CMS) has penalized hospitals that have higher-than-expected readmission rates for patients returning to the hospital within the first 30 days after being discharged.
For those hospitals that post actual readmission rates greater than their predicted rates, the penalties can be stiff — as much as a 3 percent reduction in CMS payments for the new fiscal year.
Whereas the financial ramifications are significant, equally important — if not more so — is the impact readmissions have on patients. Improving the quality of care that patients receive will have a positive impact on reducing readmissions. Moreover, it will help improve overall patient satisfaction, as well.
Seemingly lost in the health care debate is the growing importance of the patient experience. Patients are increasingly placing as much importance on intangible aspects of health care, such as the tastiness of hospital food and the friendliness of staff, as they are on the actual care itself. Indeed, as far back as 2006, Harris polls were showing that patients value their medical team’s interpersonal skills as much as they do the team’s technical skills.
There are, however, proven methods that combine sound medical practices with better patient engagement that will result in reduced readmission rates. For example, post-hospital outreach to patients soon after discharge can prove invaluable. Simple steps such as calling to discuss the medications prescribed, their efficacy and any side effects being experienced allow potential adverse complications to be addressed before they cause additional issues. That outreach also provides the level of care patients have come to expect.
One imperative variable that is often left out of the readmissions equation is the vital role that primary care physicians, their staff and care managers can play in helping to reduce those hospital readmissions. Post-hospitalization follow-up by the patient’s care team, can help alleviate any problems that may arise following discharge. This coordination of care can prevent those problems from advancing to a stage that would require the patient to return to the hospital. Furthermore, for the over 50 perent of adult Utahns with three or more chronic conditions, timely post-hospitalization outreach to schedule an office appointment can prevent one or more of those other conditions from negatively being impacted.
This level of care coordination quite literally saves both lives and money. However, for it to be successful, all of Utah’s hospital systems must be willing to securely share their admission and discharge transactions with the appropriate health care community responsible for the patient’s care – including those outside their own system. This includes the patient’s primary care physician, care managers and any other hospitals that may have seen the patient or to which the patient is newly admitted. Simply put, the patient’s data must securely follow them no matter where they are in the health care continuum.
For nearly a decade, the health care community in Utah has had the ability to exchange that admission and discharge information electronically through the state-designated clinical health information exchange. This secure and cost-effective method provides the patient’s entire medical team, regardless of where they work, with the important information they need to coordinate care. That coordination is important to reducing readmission rates, and helps health care professionals provide a better experience to patients.
That’s a win-win for everyone.
Teresa Rivera is the President and CEO of UHIN, the state-designated Health Information Exchange. She has over 40 years of healthcare experience.