In October 2013, Medicare will begin penalizing hospitals for frequent potentially preventable readmissions for heart attack, heart failure and pneumonia patients. By 2014, hospitals could face reimbursement reductions of up to 3 percent. Hospitals thus have a financial incentive to improve their discharge processes. Some hospitals have focused on dispensing medication at the patient bedside, educating the patient and his or her family and/or communicating with care providers to improve the discharge process. Regardless of the type of discharge improvement initiative, hospitals need to track data to be successful, according to Tom Ferry, president and CEO of healthcare software-as-a-service provider Curaspan Health Group.
"Quality starts with data," Mr. Ferry says. Data on the discharge process and outcomes helps hospitals identify where weaknesses in the system are and correct them to improve quality. In addition, data drives accountability for the discharge process. "In the past, in the absence of data there was always 'he said-she said' arguments and distrust between organizations," Mr. Ferry says. "We've been able to shed light on the [discharge] process so when they look at the data, they recognize that they have to change in order to survive."
Here are three areas that hospitals should track to drive discharge best practices.
1. Start of discharge planning process. Data on the entire process of creating a discharge plan can help hospitals identify factors that are linked with reduced readmissions and thus develop a list of best practices. "Start to measure the internal performance of [hospitals] and we can begin to set best practices for how someone should best manage [patient discharge]," Mr. Ferry says. For example, hospitals can track when case managers begin developing a discharge plan to determine what the associated outcomes are if they start planning right after admission compared to waiting until later in a patient's stay.
2. Referral responses. Hospitals can also measure the rate at which certain post-acute care providers respond to hospitals' patient referrals and what the responses are. For example, Curaspan generates a score card of the post-acute care providers' performance that lists their response times and whether they accepted or declined referrals. Hospitals can use this data to "start to manage those relationships to ensure they respond more quickly as to their availability," Mr. Ferry says.
"Most hospitals have informal relationships with those resources; we reinforce those relationships and provide better transparency around how that relationship is working [through] data and the flow of information so we can start to set appropriate metrics that drive towards a positive relationship." Mr. Ferry suggests hospitals meet regularly with the post-acute care providers to review the score card and discuss ways to improve patients' transitions from one care setting to another.
"You want to ensure that when a patient gets discharged, it's not only to an appropriate level of care but to an organization that can actually care for that patient appropriately," Mr. Ferry says. Communication with the post-acute care provider is essential to assessing the ability of that provider to care for the patient.
3. Readmissions. Detailed data on readmissions can also be valuable to hospitals as they work to improve the discharge process. Data that breaks down readmissions by diagnosis, post-acute care provider, placement and physician can help hospitals identify the reasons for readmissions and target those issues to reduce readmissions. "With our readmission reports, hospitals can start to analyze what the root cause was for that readmission — was it an internal problem, an incorrect assessment and the patient got sent to the wrong level of care? Or was the third party provider incapable of managing that patient?" Mr. Ferry says.
If a certain post-care provider is associated with more readmissions than others, the hospital may need to evaluate and educate that provider on best practices for preventing readmissions. For example, Mr. Ferry says a hospital may need to notify a provider that heart failure patients are more likely to succeed post-hospital discharge if there is a heart failure coordinator overseeing their care. "Provide data that identifies the root cause, analyze it and make the necessary change to get quality outcomes," he says.
Learn more about Curaspan Health Group.
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"Quality starts with data," Mr. Ferry says. Data on the discharge process and outcomes helps hospitals identify where weaknesses in the system are and correct them to improve quality. In addition, data drives accountability for the discharge process. "In the past, in the absence of data there was always 'he said-she said' arguments and distrust between organizations," Mr. Ferry says. "We've been able to shed light on the [discharge] process so when they look at the data, they recognize that they have to change in order to survive."
Here are three areas that hospitals should track to drive discharge best practices.
1. Start of discharge planning process. Data on the entire process of creating a discharge plan can help hospitals identify factors that are linked with reduced readmissions and thus develop a list of best practices. "Start to measure the internal performance of [hospitals] and we can begin to set best practices for how someone should best manage [patient discharge]," Mr. Ferry says. For example, hospitals can track when case managers begin developing a discharge plan to determine what the associated outcomes are if they start planning right after admission compared to waiting until later in a patient's stay.
2. Referral responses. Hospitals can also measure the rate at which certain post-acute care providers respond to hospitals' patient referrals and what the responses are. For example, Curaspan generates a score card of the post-acute care providers' performance that lists their response times and whether they accepted or declined referrals. Hospitals can use this data to "start to manage those relationships to ensure they respond more quickly as to their availability," Mr. Ferry says.
"Most hospitals have informal relationships with those resources; we reinforce those relationships and provide better transparency around how that relationship is working [through] data and the flow of information so we can start to set appropriate metrics that drive towards a positive relationship." Mr. Ferry suggests hospitals meet regularly with the post-acute care providers to review the score card and discuss ways to improve patients' transitions from one care setting to another.
"You want to ensure that when a patient gets discharged, it's not only to an appropriate level of care but to an organization that can actually care for that patient appropriately," Mr. Ferry says. Communication with the post-acute care provider is essential to assessing the ability of that provider to care for the patient.
3. Readmissions. Detailed data on readmissions can also be valuable to hospitals as they work to improve the discharge process. Data that breaks down readmissions by diagnosis, post-acute care provider, placement and physician can help hospitals identify the reasons for readmissions and target those issues to reduce readmissions. "With our readmission reports, hospitals can start to analyze what the root cause was for that readmission — was it an internal problem, an incorrect assessment and the patient got sent to the wrong level of care? Or was the third party provider incapable of managing that patient?" Mr. Ferry says.
If a certain post-care provider is associated with more readmissions than others, the hospital may need to evaluate and educate that provider on best practices for preventing readmissions. For example, Mr. Ferry says a hospital may need to notify a provider that heart failure patients are more likely to succeed post-hospital discharge if there is a heart failure coordinator overseeing their care. "Provide data that identifies the root cause, analyze it and make the necessary change to get quality outcomes," he says.
Learn more about Curaspan Health Group.
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