As a result of healthcare reform law, hospitals face a bevy of regulations including payment reductions for certain readmissions as well as new demonstration and pilot projects related to more accountable care and shared payment. The regulations surrounding these projects are expected to be diverse and complex, but the goal of them all is the same — to better coordinate care and reduce healthcare costs, says Keith Kanel, MD, chief medical officer of the Pittsburgh Regional Health Initiative.
Focus on readmissions
PRHI is a regional health improvement collaborative that works with hospitals and more recently with outpatient providers to better coordinate care through patient-centered medical homes, which Dr. Kanel says is poised to be a successful model post-reform. "If you look at the [Patient Protection and Affordable Care Act], there is a focus on readmission reduction programs, which really requires better coordination of care," he says. In addition to this specific payment reduction, a hospital involved in any CMS project that include shared savings or bundled payments — and there are several in the PPACA — will need to reduce readmissions and length of stay in order to be financially viable.
"Hospitals and outpatient practices tend to work in silos, and there is no good mechanism to carry the patient from an inpatient to an outpatient," says Dr. Kanel.
Although most hospitals understand the need for better "coordinated care" in the future, the term can be rather vague. That is, how can a hospital or ACO determine if it is successfully coordinating care? The answer: hospitals have to assess their ability to "coordinate care" with something more measurable. Dr. Kanel argues that "something" is reduced readmissions. If hospitals and their physicians set measurable goals surrounding reduced readmissions and work toward them, better coordinated care will be the byproduct.
Where to start
Even if a hospital knows its first step is reducing readmissions, finding a specific starting point for a plan of attack can be challenging. Because of this, Dr. Kanel recommends focusing on conditions with the most readmissions. In Pittsburgh, like most areas, that meant reducing readmissions for patients with chronic obstructive pulmonary disease. In the Pittsburgh area, 20 percent or more of these patients are readmitted within 30 days.
Using lean techniques and involving physicians and other stakeholders from local hospitals, the group first began observing COPD discharges. In its observations, the group learned that many of the staff member providing discharge instructions were undertrained, and many patients didn't understand the information being given to them. Patients also faced other barriers such as medications they couldn't afford or the inability to get follow-up appointments. These barriers further increased the likelihood the patients would return to the hospital. The group then brainstormed solutions and developed a program that would provide dedicated nurse care managers to hospitals to coordinate discharges and then visit patients in their homes after the discharge, says Dr. Kanel. Once implemented, the program cut the COPD 30-day readmission rate in half.
Funding care management programs
The program suggests that formal care management initiatives can effectively reduce readmissions; however, setting up these programs can be costly to a hospital since they are currently not reimbursed, says Dr. Kanel. Yet, because the PPACA institutes penalties for hospitals with high admission rates beginning in Oct. 2012, all hospitals need to invest now to address these issues, he says.
In order to reduce the cost associated with coordinated care programs, Dr. Kanel recommends hospitals develop or join coalitions that share resources and split costs. PRHI, for example, manages the Pittsburgh Accountable Care Network, which includes a number of area hospitals that share nurse managers and their services while dividing the costs of the program.
Hospitals, especially smaller, community hospitals, can't ignore the need to address readmissions, and partnering with other organizations to fund programs aimed at this effort could be a means to more efficiently address this problem. These efforts will not only help ensure hospitals receive full payments in the future but will also improve the health of the community the hospital serves. "Healthcare is local. Federal policy changes alone cannot achieve needed reform," says Dr. Kanel.
Learn more about the Pittsburgh Regional Health Initiative.
Focus on readmissions
PRHI is a regional health improvement collaborative that works with hospitals and more recently with outpatient providers to better coordinate care through patient-centered medical homes, which Dr. Kanel says is poised to be a successful model post-reform. "If you look at the [Patient Protection and Affordable Care Act], there is a focus on readmission reduction programs, which really requires better coordination of care," he says. In addition to this specific payment reduction, a hospital involved in any CMS project that include shared savings or bundled payments — and there are several in the PPACA — will need to reduce readmissions and length of stay in order to be financially viable.
"Hospitals and outpatient practices tend to work in silos, and there is no good mechanism to carry the patient from an inpatient to an outpatient," says Dr. Kanel.
Although most hospitals understand the need for better "coordinated care" in the future, the term can be rather vague. That is, how can a hospital or ACO determine if it is successfully coordinating care? The answer: hospitals have to assess their ability to "coordinate care" with something more measurable. Dr. Kanel argues that "something" is reduced readmissions. If hospitals and their physicians set measurable goals surrounding reduced readmissions and work toward them, better coordinated care will be the byproduct.
Where to start
Even if a hospital knows its first step is reducing readmissions, finding a specific starting point for a plan of attack can be challenging. Because of this, Dr. Kanel recommends focusing on conditions with the most readmissions. In Pittsburgh, like most areas, that meant reducing readmissions for patients with chronic obstructive pulmonary disease. In the Pittsburgh area, 20 percent or more of these patients are readmitted within 30 days.
Using lean techniques and involving physicians and other stakeholders from local hospitals, the group first began observing COPD discharges. In its observations, the group learned that many of the staff member providing discharge instructions were undertrained, and many patients didn't understand the information being given to them. Patients also faced other barriers such as medications they couldn't afford or the inability to get follow-up appointments. These barriers further increased the likelihood the patients would return to the hospital. The group then brainstormed solutions and developed a program that would provide dedicated nurse care managers to hospitals to coordinate discharges and then visit patients in their homes after the discharge, says Dr. Kanel. Once implemented, the program cut the COPD 30-day readmission rate in half.
Funding care management programs
The program suggests that formal care management initiatives can effectively reduce readmissions; however, setting up these programs can be costly to a hospital since they are currently not reimbursed, says Dr. Kanel. Yet, because the PPACA institutes penalties for hospitals with high admission rates beginning in Oct. 2012, all hospitals need to invest now to address these issues, he says.
In order to reduce the cost associated with coordinated care programs, Dr. Kanel recommends hospitals develop or join coalitions that share resources and split costs. PRHI, for example, manages the Pittsburgh Accountable Care Network, which includes a number of area hospitals that share nurse managers and their services while dividing the costs of the program.
Hospitals, especially smaller, community hospitals, can't ignore the need to address readmissions, and partnering with other organizations to fund programs aimed at this effort could be a means to more efficiently address this problem. These efforts will not only help ensure hospitals receive full payments in the future but will also improve the health of the community the hospital serves. "Healthcare is local. Federal policy changes alone cannot achieve needed reform," says Dr. Kanel.
Learn more about the Pittsburgh Regional Health Initiative.