(We have published this Webinar invitation on behalf of our partner, Baptist Leadership Group [BLG]. You are invited to use post-discharge outreach to improve patient experiences and outcomes.)
There is a good chance that your hospital is already making post discharge phone calls of some sort. It's also likely that these are pretty basic calls — not much more than a survey. Until recently, these may have been enough.
Affect Patient Experience and Readmissions with Outreach
But with patient satisfaction playing a more direct role in reimbursement — and the looming CMS penalties for excessive readmissions on the horizon — viewing post discharge phone calls as a 'nice to have' rather than a strategic asset could be putting your hospital at risk. With roughly 39 million inpatient discharges each year (not to mention ER discharges), connecting with patients quickly after they leave your facility by telephone has become a central part of any successful patient transition program — if done correctly.
Join Baptist Leadership Group’s Practice Leader Beverly Begovich on Wednesday, March 27, 2013, from 11am to Noon Eastern for our free webinar Improving the Patient Experience with Post Discharge Outreach. She will share how you can positively impact the patient experience and drive outcomes using the best practice of Discharge Phone Calls. You will learn how to:
- Personalize the process for each patient and their unique needs, instead of just a script
- Garner important feedback to help a positive transition from hospital to home, which also improves patient satisfaction
- Reduce readmission rates
- Involve the entire care team so that it’s not just a “phone call,” but a call to action to connect with the patient, evaluate, and escalate them with the appropriate care
Click here to register. Access to the webinar slides and additional related resources will be provided to participants after the webinar.
Patient-Centered Medical Homes (PCMH) are growing in number across the U.S. The medical home is no longer just a concept, thanks to provisions in the Affordable Care Act (ACA), which call for the government to begin supporting efforts to establish and test medical homes.
Patient Centered Medical Homes are being Developed Country-Wide
Currently, more than 40 states are developing patient-centered medical home programs through the Medicaid and Children’s Health Insurance Program (CHIP). Additionally, the Centers for Medicare & Medicaid (CMS) Innovation Center, formed through the ACA, supports the advancement of primary care services through its Comprehensive Primary Care Initiative, a public/private collaboration that provides funding for primary care activities that take place outside of the physician-patient visit. As well, the Federally Qualified Health Center Advanced Primary Care Practice Demonstration includes 500 community health centers in 44 states that are receiving funding to reorganize as patient-centered medical homes.
PCMHs are NOT Just Government Solutions—Employers and Insurers are Involved!
But it’s not just government that is promoting the rapid growth of PCMHs. A multitude of healthcare stakeholders are either starting or supporting PCMH initiatives, including medical groups, medical societies, insurers, quality organizations, and large employers. As of June 2012, the National Committee for Quality Assurance (NCQA) recognized 4,220 PCMHs, a big leap from 3,300 practices at the end of 2011. Large insurers, such as Aetna and WellPoint Inc., as well as integrated delivery networks, including Group Health in Seattle, have launched PCMH networks.
An Emphasis on Patient-Centered Care
The patient-centered medical home is gaining ground because it provides a solution to a big industry problem: lack of patient-centered care. By coordinating all care through the primary care medical practice, the PCMH is poised to address the healthcare needs of growing numbers of patients with chronic, complex conditions and the Baby Boomers who are entering their senior years.
The PCMH model offers financial incentives for primary care physicians (PCP) to form and direct caregiver teams comprised of specialists, nurses, pharmacists, social workers, chiropractors, and other healthcare resources to provide specific services for the patient, saving time and costs, and ideally improving quality and patient outcomes.
Better in Terms of Patient and Financial Outcomes
In addition to the PCMH taking a significant step toward providing “whole” patient care, the opportunity for financial rewards is great. Already, some large pilots are demonstrating millions in savings. These favorable outcomes mean 2013 is likely to be an even bigger growth year as primary care physicians and others decide the time is now to enter the medical home business.
This white paper examines:
- The PCMH Model and its value for optimizing patient care
- How medical homes can be agents of change
- Why an emphasis on primary care can deliver positive results
- How NCQA recognition is critical to PCMH success
- How HealthStream supports practices seeking NCQA recognition and distinction
Download the White paper.
By Bo Hansen, Research Consultant (HCAHPS and Other Surveys), HealthStream
What Hospitals are Doing to Curb Readmissions
Following is information on transitional care models taking hold at hospitals across the country in efforts to curb readmissions:
Care Transitions Interventions
The Care Transitions Intervention, developed by Eric Coleman, MD, professor of medicine and head of the healthcare policy and research division at the University of Colorado, is a four-week program in which a transition coach teaches patients with complex conditions how to self-manage their medication and how to recognize red flags if their condition gets worse. The coach, who makes a single home visit and three follow-up phone calls, also coordinates with primary care and specialist providers, community organizations, home care agencies, skilled nursing facilities and clinics, making sure patients are active participants in their own care.
"Rather than providing the patients with a 'fish,' we are helping them learn to fish and thereby apply their newly acquired skills to the immediate transitions but also to future transitions," Coleman told FierceHealthcare.
The transition coaches explicitly focus on promoting those skills through activities such as role-playing. They "do not provide skill care but rather use simulation … to reinforce key skills" Coleman explained.
The model has been adopted by 750 organizations, 20 percent of which are hospitals. And out of the 47 communities under the Centers for Medicare & Medicaid Services' Community-Based Care Transitions Program, 34 are using Care Transitions Intervention, Coleman said.
The Care Transitions Intervention has been shown to cut 30-day readmissions by 20 to 50 percent--even six months down the line, according to Coleman.
The Transitional Care Model
The Transitional Care Model, designed by Mary Naylor, professor of gerontology and director of NewCourtland Center for Transitions and Health, and colleagues at the University of Pennsylvania, targets older adults with two or more risk factors, including a history of recent hospitalizations, multiple chronic conditions or medications and poor self-health ratings.
The model, although complementary to, is not care management, according to the researchers.
"The major goal of this model is to help the patient and family caregivers develop the knowledge, skills and resources essential to prevent future decline and rehospitalization," according to the Transitional Care Model website. "At the end of this episode of care, continuity is assured by excellent communication with the primary care providers continuing to follow patients who have made a commitment to their self-management goals."
Key to the model is the care coordinator called a "transitional care nurse," who ushers the patient through in-hospital planning and home follow-up. The role, which is different from traditional roles, incorporates the skills of a nurse, care manager and patient advocate, according to the website.
Within a day of enrollment in the program, the transitional care nurse assesses the patient's health status in the hospital. The transitional care nurse then visits the patient's home within 24 to 48 hours of discharge and then again once per week during the first month, followed by semi-monthly visits until discharge from the program, as well as offers phone support seven days a week. After the patient completes the program, the transitional care nurse prepares a summary for the patient and primary care provider and provides access to other care services, if needed.
U Penn's model, which partners with Aetna and Kaiser Permanente, cut readmissions by 28 percent within the first 24 weeks and by 13 percent within a year. It also has cut costs by 39 percent per patient, or nearly $5,000, within the year after hospitalization.
Project BOOST
Project BOOST, led by the Society of Hospital Medicine (SHM), combines multidisciplinary leaders with existing process models for transitional care.
"It's really an aggregation of tools that help hospitals put into place interventions that have been shown in the literature to help reduce readmissions," Greg Maynard, clinical professor of medicine of University of California, San Diego and director of the Center for Innovation and Improvement Science, told FierceHealthcare.
BOOST mentors provide a site visit, where the mentor spends a full day with the QI team and C-suite. They coach sites for a year on how to get institutional support, help with a data repository and integrate tools into their own organizations.
"What sets Project BOOST and in general, the Society of Hospital Medicine and mentor implementation projects, aside from the rest [of care models] is they have experts in the both the content and quality improvement, coaching the improvement teams through each step of the process," Maynard added.
The mentoring also is supplemented with Web resources, webinars and a listserv with active community sharing about pharmacy interventions, follow-up phone calls, getting patients to see the primary care provider soon after they leave hospital and making appointments, as well as teach-back and other patient engagement strategies.
"What we've come to realize, of course, is that you can't just … have someone come into your hospital, grab the patient and think everything's fixed, nor can you just fix the inpatient side without regard to what happens once the patient leaves the hospital. What we're seeing across the country now is better partnership between the inpatient and outpatient settings," Maynard said about building bridges with skilled nursing facilities, community clinics, safety nets and social services.
Maynard hinted the next version of Project BOOST will help bridge the inpatient and outpatient resources.
"This is not just fixing one process; it's really a dozen related processes that go across disciplines. So to be successful, people will have to not get overwhelmed by this and keep chipping away at these processes with an eye toward trying to make them a more coordinated whole," he said.
Nearly 3,900 sites have downloaded the BOOST toolkit, as of February, and the mentoring program has been implemented at more than 100 sites, according to an SHM fact sheet. Project BOOST has resulted in a 21 percent drop in all-cause readmission rates, although Maynard noted updated data will be published soon.
Project BOOST also collaborates with Blue Cross Blue Shield Association of Michigan and the California Health Care Foundation.
Project RED
Researchers at Boston University Medical Center created Project RED, short for Project Re-Engineered Discharge, which combines components that have been proven to cut readmissions and yield high patient satisfaction.
With 38 million hospital discharges taking place each year, the discharge process plays an important role in transitional care.
Among the best practices that Project RED uses is language assistance, in which RED promotes "complete implementation guidance and is adapted to address language barriers, cross cultural issues and disparities in health care communication and trust," according to the website.
RED also encourages following up on appointments, making sure the patient not only has a primary care provider but also that the patient knows when and how to get there. Providers organize post-discharge outpatient services and medical equipment, help with medication management, lay out a discharge plan and write a discharge summary. To support patients, providers also expedite the discharge summary and offer telephone support if problems arise.
Another publicized aspect of the model is a Virtual Discharge Advocate, otherwise known as "Louise." To cut down the time it takes for nurses to deliver RED, the virtual patient engagement system shows video animations that instruct patients on their medications and other discharge information--which patients seem to like. According to the pilot study, nearly three-quarters (74 percent) of hospital patients said they prefer discharge instructions from a virtual nurse over human providers, noting that the computer goes at a patient's pace.
The model, supported by the Agency for Healthcare Research and Quality, the Blue Cross Blue Shield Foundation and the Patient-Centered Outcomes Research Institute, among others, has proven successful, lowering hospital utilization by 30 percent and saving nearly 34 percent in costs ($412) per patient who received intervention, according to a Project RED fact sheet
Read more: Project RED - FierceHealthcare http://www.fiercehealthcare.com/special-reports/project-red#ixzz281HLAW1c
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Read more: Project BOOST - FierceHealthcare http://www.fiercehealthcare.com/special-reports/project-boost#ixzz281GnnnB5
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Read more: Transitional Care Model - FierceHealthcare http://www.fiercehealthcare.com/special-reports/transitional-care-model#ixzz281GHuuhX
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Read more: Care Transitions Intervention - FierceHealthcare http://www.fiercehealthcare.com/special-reports/care-transitions-intervention#ixzz281FXajM9
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Read more: Transitional care models to combat readmissions - FierceHealthcare http://www.fiercehealthcare.com/special-reports/transitional-care-models-combat-readmissions#ixzz281EayZET
Data to assess the penalties have been collected and crunched, and Medicare has shared the results with individual hospitals. Medicare plans to post details online later in October 2012, and people can look up how their community hospitals performed by using the agency's "Hospital Compare" website.
CMS Incentives to Reduce Readmissions
In April 2011, the Center for Medicare and Medicaid Services (CMS) announced funding opportunities for acute-care hospitals with high readmission rates that partner with community based organizations (CBOs) or CBOs that provide care transition services to improve a patient’s transition from a hospital to another setting, such as a long-term care facility or the patient’s home. Created by Section 3026 of the Affordable Care Act, the Community-Based Care Transition Program (CCTP) provides funding to test models for improving care transitions for high risk Medicare patients by using services to manage patients’ transitions effectively. Participants will use process and outcome measures to report on their results.
CCTP supports the three-part aim of making health care safer, more reliable, and less costly for all Americans. This initiative is part of the Partnership for Patients, a public public-private partnership charged with reducing hospital-acquired conditions by 40 percent and hospital readmissions by 20 percent by 2013. The Department of Health and Human Services plans to invest up to $1 billion in Affordable Care Act funds in the Partnership to reduce millions of preventable injuries and complications.
Who can participate?
CMS invites CBOs, or acute care hospitals that partner with CBOs, to submit an application describing the proposed care transition intervention(s) and people with Medicare who are at high risk of readmission in their communities.
CBOs must provide care transition services across the continuum of care and have a formal organizational and governance structure, including formal relationships with hospitals, other providers, and consumer representatives. Preference will be given to Administration on Aging (AoA) grantees who partner with multiple hospitals and practitioners to provide care transition interventions or entities that provide services to medically-underserved populations, small communities and rural areas.
What will participation require?
CBOs will be required to provide care transition services across the continuum of care, which may include at least one of the following:
Care transition services that begin no later than 24 hours prior to discharge;
Timely and culturally and linguistically competent post-discharge education to patients so they understand potential additional health problems or a deteriorating condition;
- Timely interactions between patients and post-acute and outpatient providers;
- Patient-centered self-management support and information specific to the beneficiary’s condition; and,
- A comprehensive medication review and management, including—if appropriate—counseling and self-management support).
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Applicants must explain how they will align their care transition programs with care transition initiatives by other payers in their communities, including Medicaid, Medicare Advantage, and private payers.
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All awardees must agree to and sign terms and conditions governing their participation in the program prior to initiating their programs.
How long will CMS accept applications?
CMS will accept applicants and enroll participants on a rolling basis as funding permits. The program will run for 5 years (initiated April 2011). Participants will be awarded two-year agreements that may be extended annually through the duration of the program based on performance.
What does the application require?
Interested parties must submit a written proposal that addresses all of the evaluation selection criteria described in the solicitation on the CCTP web page at: http://go.cms.gov/caretransitions.
As part of the proposal, applicants must:
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Identify community-specific root causes of readmissions, define the target population, and strategies for identifying high risk patien
- Specify care transition interventions and services that will address readmissions, including strategies for improving provider communications and improving patient activation;
- Describe how care transition strategies will incorporate culturally appropriate, beneficiary-centric, effective care transition approaches to reach ethnically diverse beneficiaries, and how other community and social supports will be incorporated to enhance beneficiaries’ post-hospitalization outcomes;
- Provide an implementation plan with milestones;
- Provide a clear budget proposal, including a per eligible discharge rate reflecting direct costs for care transition services; and,
- Describe prior experience with managing care transition services and reducing readmissions.
For application and additional information: http://www.innovations.cms.gov/initiatives/Partnership-for-Patients/CCTP/index.html?itemID=CMS1239313
[This blog post introduces the fifth installment of HealthStream's new Accountable Care Organization (ACO)-focused white paper series. As the fifth of eight sponsored papers, it describes how ACOs may be a good choice for state Medicaid programs.]
Across the country, health purchasers are exploring the potential of accountable care organizations (ACOs) to provide higher quality and more cost-effective care. Progress is being made for Medicare and commercial populations: the Brookings-Dartmouth ACO Pilot1 is developing commercial shared savings contracts with private payers; the Centers for Medicare & Medicaid Services (CMS) released a final ruling for a Medicare Shared Savings Program2; and the Center for Medicare and Medicaid Innovation is supporting a Pioneer ACO Model (32 approved for participation) for Medicare and multi-payer ACOs.
ACOs Have Value for Medicare AND Medicaid
As a result of this Medicare activity, ACOs are also gaining ground in Medicaid. As Medicare, commercial payers, and providers begin the process of introducing ACOs within various markets, state Medicaid agencies, managed Medicaid organizations, and providers have also been evaluating various initiatives for their beneficiaries. As Medicaid prepares to expand coverage to an additional 16 to 20 million Americans in 2014, the program is rethinking how it delivers care, particularly for its highest–need, highest-cost beneficiaries.
Patient-Centered Care
To improve overall Medicaid health status, ACOs must build a foundation of consistent, team-based and patient-focused care coordination in order to truly manage Medicaid patients across an ever expanding continuum of medical, behavioral, and social services.
The Health Home
The health home provision authorized by the Patient and Protection Affordable Care Act (PPACA) provides an opportunity to build a person-centered system of care that achieves improved outcomes for beneficiaries and better services and value for State Medicaid programs. This provision supports CMS’s initiative of improving healthcare through the simultaneous pursuit of three goals: improving the experience of care, improving the health of populations, and reducing the per capita costs of healthcare. The health home service delivery model is an important option for providing a cost effective, longitudinal “home” to facilitate access to an inter-disciplinary array of medical care, behavioral healthcare, and community-based social services and supports both children and adults with chronic conditions.
The health home is another alternative care model that will play a significant role in the success of an ACO. States or managed Medicaid organizations will initially build health homes for the Medicaid programs as a separate program (already in Missouri & Rhode Island) or an integrated tool set of the ACO (established in New York). The health home could be offered in all segments of the insured population: Medicare, Medicaid, and commercial. As developed, this will be the first integrated care coordination and management of a high-risk population that has both medical and behavioral health issues. In the past, these population management services have been segregated thus not accomplishing the overall aspects of reducing healthcare costs and improving health status.
In examining ACOs and Medicaid, this white paper covers:
- The Focus on Patient-Centered Care
- State ACO Initiatives and Structure
- State Home Health Initiatives and Structure
- State Medical Home Initiatives and Structure
- Medical and Health Home Survey and Measurement Solutions
Download the White Paper.
By Bo Hansen, Research Consultant (HCAHPS and Other Surveys), HealthStream
Get Ready for New HCAHPS Questions about Care Transitions!
Beginning January 1, 2013, CMS is mandating that hospitals currently participating in the HCAHPS data submission (nearly 3900 hospitals) use the Expanded HCAHPS Survey titled, Understanding Your Care When You Left The Hospital. This section consists of three rated questions intended to assess how well the hospital staff transitioned the care from the hospital setting to home or another healthcare setting, which, by the way, can be within the same setting such as from one hospital treatment area to another. The questions read as follows:
- During this hospital stay, staff took my preferences and those of my family or caregiver into account in deciding what my healthcare needs would be when I left.
- When I left the hospital, I had a good understanding of the things I was responsible for in managing my health.
- When I left the hospital, I clearly understood the purpose for taking each of my medications.
(The scale for all three questions is Strongly disagree, Disagree, Agree and Strongly agree.)
Just to review the questions we have seen included in the HCAHPS survey since its inception relative to discharge planning, these are the two rated questions:
- During this hospital stay, did doctors, nurses, or other hospital staff talk with you about whether you would have the help you needed when you left the hospital?
- During this hospital stay, did you get information in writing about what symptoms or health problems to look out for after you left the hospital?
(The scale for these two questions is Yes or No.)
These two discharge questions are preceded by a qualifying question that asks the patient:
After you left the hospital, did you go directly to your own home, to someone else’s
home, or to another health facility?
If the patient answers “another health facility”, these two questions are skipped! They are only asked if the patient is being discharged to his/her own home or someone else’s home.
Why Transitional Care is Important
To better understand how Transitional Care differs from the existing discharge questions in the HCAHPS survey, here is a position statement from the American Geriatrics Society defining transitional care:
“For the purpose of this position statement, transitional care is defined as a set of actions designed to ensure the coordination and continuity of health care as patients transfer between different locations or different levels of care within the same location. Representative locations include (but are not limited to) hospitals, sub-acute and post-acute nursing facilities, the patient’s home, primary and specialty care offices, and long-term care facilities. Transitional care is based on a comprehensive plan of care and the availability of health care practitioners who are well trained in chronic care and have current information about the patient’s goals, preferences, and clinical status. It includes logistical arrangements, education of the patient and family, and coordination among the health professionals involved in the transition. Transitional care, which encompasses both the sending and receiving aspects of the transfer, is essential for persons with complex care needs.”
Source: Coleman EA, Boult CE on behalf of the American Geriatrics Society Health Care Systems Committee. Improving the Quality of Transitional Care for Persons with Complex Care Needs Journal of the American Geriatrics Society. 2003;51(4):556-557.
Care transitions occur when a patient moves from one healthcare provider or setting to another. The Transitional Care questions are intended to ensure follow up care no matter where the patient goes after his or her current place of treatment. And the survey results of these questions allow hospitals to gauge if they are creating a comprehensive plan of care that includes all possible providers necessary to provide optimal care for their patients after discharge.
Risks of Readmissions
We know that people living with serious and complex illnesses who are moved from the hospital to a home environment or a nursing home are at risk for readmission back to the hospital if they develop a complication. These complications are often preventable. Nearly one in five Medicare patients discharged from the hospital—approximately 2.6 million seniors—is readmitted within 30 days, at a cost of over $26 billion every year.
(http://www.cms.gov/site-search/search-results.html?q=transition%20of%20care)
CMS Readmission Penalties
As of October 1, 2012, Medicare will start fining hospitals that have too many patients readmitted within 30 days of discharge due to complications.
About two-thirds of the hospitals serving Medicare patients, or some 2,200 facilities, will be hit with penalties averaging around $125,000 per facility this coming year, according to government estimates.
The Hospital Readmissions Reduction Program, under the Affordable Care Act, requires that Centers for Medicare & Medicaid Services (CMS) reduce reimbursements to Inpatient Prospective Payment System (IPPS) hospitals with excess readmissions. Hospitals that perform worse than average, with patients coming back to the hospital within 30 days of discharge, will be dinged with up to a 1 percent penalty, worth up to seven figures--a rate that will only increase as time goes on.
According to the CMS website, IPPS hospitals will be hit with the following penalties:
- October 2012: Up to 1 percent on acute myocardial infarction, heart failure and pneumonia
- October 2013: Up to 2 percent
- October 2014: Up to 3 percent, with additional measures expected around chronic obstructive pulmonary disease, vascular problems, angioplasty, and heart bypass surgical complications
Part II of this blog will be published next week.
Learn more about HealthStream’s HCAHPS/Patient Insights Survey.
[This blog post introduces the third installment of HealthStream's new Accountable Care Organization (ACO)-focused white paper series. As the third of eight sponsored papers, it describes how ACOs may have a special role for companies and other organizations who provide healthcare coverage to employees.]
There’s a lot of discussion these days about Accountable Care Organizations (ACO), but employers still need help understanding what they are, how they work, and who is developing them. Today, more providers are engaging and communicating with employers directly as part of their business strategy.
Healthier Employees and Better Management of Chronic Conditions
As employer engagement efforts expand, and certain programs and services grow, the focus must remain not on conceptual thoughts for business as usual, but on the real, tangible benefits to employers such as healthier employees, better management of chronic conditions or high risk/cost patients, fewer lost days of work, risk assuming reimbursement, and lower healthcare costs. The ACO is the newest of these provider business strategies and is confirmed by the two surveys included in this white paper.
The Different Models of Employer-Directed ACOs
Just as there is not a single type of healthcare program, there is no one way to position an ACO in the market place. There are many forms of the model in use today, and it’s important to review your health plan needs and choose the method that works best for your company. Here are a few examples:
- Developed for Employer Participation: Some provider organizations have created ACOs for their own employees and dependents much in the same way that they’ve created health plans or medical homes.
- Direct Contracting for Total Healthcare Services: Some employers may have the opportunity to contract directly with a forming or developed ACO.
- Direct Contracting for Specific Healthcare Services: There may be an opportunity for the employer to contract with an ACO for specific healthcare services or programs.
This white paper discusses multiple ways that employers may want to think about engaging in ACOs for the benefit of employees and their organizations. Among the topics discussed are:
- Potential ACO models
- Potential Employer Risks
- ACO Surveys – Perceptions and Expectations of Employers, including:
- Survey highlights
- Questions asked and responses received
- What the Future holds for Employers and ACOs
Employers Could Benefit Tremendously from ACOs
ACOs have the potential to improve quality and reduce costs for the employee/dependent and employer alike by providing more patient-centered, coordinated, and integrated care. The PPACA only provides a broad outline of the ACO initiative. But with the appropriate vision, design, and strategic provider partnerships, employers could benefit tremendously from an accountable care delivery system.
Download the White Paper.
Throughout 2012, uncertainty has been the only thing certain about the financial impact on hospitals of a wide array of government initiatives, laws, programs, and legal wrangling. However, some uncertainty has been cleared up now that the Supreme Court has handed down a decision on cases related to various aspects of the recent healthcare legislation, the Affordable Care Act.
Now That the Affordable Care Act is Ruled Constitutional, What Does it Mean for Hospitals?
Now that it has been ruled constitutional, the Affordable Care Act (and related legislation) will extend healthcare insurance coverage to more than 32 million Americans who are currently uninsured. The Supreme Court-approved program should increase significantly the revenues of most hospitals, as more patients will have insurance coverage. However, these gains are balanced against a number of other initiatives that may negatively impact revenues.
Health Reform Dates back to as Early as 2005
Some of these changes are in the Affordable Care Act, but many of them are found in government policies and initiatives dating back to legislation passed in 2008 and 2009 and as far back as 2005. They relate to policies and regulations that lawmakers and both the Obama and Bush Administrations enacted that tie reimbursement directly to the quality of care provided by the hospital and to attempts to streamline the costs of healthcare by mandating the adoption of new technology and approaches related to electronic health records.
What’s Creating the Uncertainty for Hospitals?
For example, the Centers for Medicare & Medicaid Services (CMS) and other state and federal agencies, after many years of anticipation, are this year phasing in various “pay for performance” (P4P) programs, a phase-in anticipated to last over the next five years. The net result of these various regulatory mandates and pricing factors is the uncertainty all hospitals face. So, unsure of their financial footing, many hospitals are cutting costs in anticipation of lower revenues in the future.
HealthStream`s New White Paper, Government Initiatives are Leading to Financial Uncertainty for Hospitals, provides a brief overview of some of the most significant government issues having an impact on healthcare institutions during the coming months and years, issues that will need to be monitored by hospital management for the foreseeable future.
It discusses:
- The Economy and Slow Healthcare Growth
- Unnecessary Readmissions
- Value-Based Purchasing
- Hospital-Acquired Conditions
- Disproportionate Share Hospitals
- Market Basket Reductions
Hospital Success Will Require Planning and Vigilance
With so much financial uncertainty, it is critical for hospital leaders to stay up to date on a wide array of news and policy decisions that could have a major impact on a hospital’s bottom line, perhaps even its ability to survive the changes that will occur during the next decade. Hospitals currently in a good financial position will have to continue to improve just to maintain their position. Organizations whose financial position is currently unstable will need to take action right away to reduce expenses, increase revenue, or both. Hospital leaders should be planning beyond the changes they’ll see during the transition period and set into place a plan that will enable their hospitals to meet the specific, long-term demands of healthcare reform, and the never-ending challenge of ensuring that their hospital is fiscally sound while providing the highest quality healthcare services.
Download the White Paper.
A HealthStream Partner Blog Post from Medical Simulation Corporation
Earlier this year, the US Department of Health and Human Services announced the launch of “Partnership for Patients,” a program focused on patient safety. As the healthcare industry is seeing a shift in reduced payments from government and private insurance companies, Partnership for Patients aims to bring together major hospitals, employers, physicians, nurses, patient advocates as well as state and federal governments in a shared effort to strengthen patient safety by making hospital care less error-prone, more reliable, and less costly.
The goals of Partnership for Patients are:
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Keep patients from getting injured or sicker (by reducing hospital acquired conditions by 40%)
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Helping patients heal without complication (by reducing hospital readmissions by 20% (compared to 2010 stats).
These goals stem from the following startling patient safety statistics:
HACs (Healthcare-Acquired Conditions):
- At any given time, about one in every 20 patients has an infection related to his/her hospital care
- On average, one in seven Medicare beneficiaries is harmed in the course of his/her care
- The mean length of stay among patients who acquired an infection during their hospital stay was 21.6 days. The mean length of stay for patients who did not acquire an infection was 4.9 days
- Patients who contract infections in the hospital are much more likely to be readmitted
Readmissions:
- About 60% of hospitals’ costs are generated by readmitted patients, yet readmissions occupy on 1 of 6 beds
- Nearly one in five Medicare patients discharged from the hospital is readmitted within 30 days
- Medicare patients acquiring infections are more likely to be readmitted than those without infection
Proud to be a HealthStream partner, Medical Simulation Corporation (MSC) is recognized for simulation-based education and training programs for physicians and hospital staff. We have researched and developed educational programs based on nationally recognized guidelines to address some of the most costly Hospital Acquired Conditions (HACs) affecting healthcare and patient safety today.
MSC has pledged to provide information, tools and resources to support the aims of improving people’s health and reduce the costs of care by improving care quality and patient safety. As we strive to meet our commitment, we would like to hear from you about this important subject.
Is Your Hospital Partnering for Patients and Improving Patient Safety?
Do you feel your hospital has the tools to prepare you to address the HAC and readmission goals of Partnership for Patients?
Is your department going to be providing tools to help your hospital reduce HAC’s and readmission?
If so, what tools are you using and are they proving to provide a positive return on investment?
If not, have you identified the barriers to meeting the Partnership for Patients goals (funding, communication, education, patient safety improvements, etc. for your hospital?
We invite you to share your feedback about patient safety with us! You can email us directly at HealthcareGroup@medsimulation.com. Look for our next blog to provide a summary of your feedback!
Learn more about MSC’s SimSuite courseware offerings via the HealthStream store.
Learn More about the Partnership for Patients at http://www.healthcare.gov/compare/partnership-for-patients/index.html.