LTC must pursue collaboration to reduce readmissions

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Imran Javaid
Imran Javaid

Acute and post-acute providers are increasingly uniting around a shared goal - to lower hospital readmission rates for elderly and other vulnerable patients. Many caregivers and payers agree that readmission rates are unacceptably high.

In 2010, one in eight Medicare patients who underwent surgery was readmitted to the hospital within 30 days of being released. Patients in the hospital for other reasons returned at a rate of one in six, according to a 2013 study by the Robert Wood Johnson Foundation. High readmission rates can now carry financial penalties. The Centers for Medicare & Medicaid Services (CMS) has begun reducing Medicare reimbursement for hospitals with high rates.

Those penalties, combined with continuing financial and economic challenges, have left hospitals searching for solutions. They are increasingly partnering with post-acute providers in an attempt to lower readmission rates and ensure that patients receive proper follow-up care. Post-acute facilities, including skilled nursing facilities, are facing challenges of their own and also see the value in working together.

Under the traditional pay-for-service model, controlling rates by lowering readmissions wasn't typically a top-of-mind financial concern, but shared efforts, including new partnerships and innovative programs, show great promise in managing readmission rates.

Becoming a provider of choice

While post-acute facilities aren't yet facing financial penalties, they are aware of other trends that will impact their reputations and bottom line. For one, some hospitals are choosing to refer patients to fewer -- but higher-quality and more dependable -- post-acute facilities. By becoming “partners of choice” for hospitals, facilities can increase market share in their communities and region. They also put themselves in a stronger position when it comes to contracting discussions.

These developing partnerships are coming amidst larger shifts in the delivery of care. Value-based approaches have proven that better care can be delivered less expensively. These value-based models are directly applicable to acute and post-acute facilities. Collaboration is a clear path to better results, including lower readmission rates.

Steps toward collaboration

So what steps can post-acute facilities take to bolster their ability to collaborate successfully with hospitals and become partners of choice?

Improve staffing levels and quality

To integrate better with acute care providers and provide better care overall, SNFs and other facilities may need to have a higher level of skilled care – particularly registered nurses, but also doctors. Although the cost can be high, they should consider instituting round-the-clock staffing by RNs, having doctors on staff or on call, and increasing the nursing hours per patient.

Build coordination models 

Some providers have benefited by creating a dedicated care group for each resident, to coordinate care both internally and with any external partners. The hospital should have a similar team and protocol in place, and both sides should develop mutually agreed-upon care guidelines and communication channels to monitor medications, doctors' orders and follow-up instructions.

Deploy technology for better communication 

Technology is imperative to coordinate care and avoid preventable errors. Both the hospital and post-acute teams need seamless access to all of the patients' records, including lab test results, images and doctors' notes.

Technology also can provide critical information on costs and outcomes, supplying a picture of each individual's care, as well as the overall performance of the healthcare institutions. This can help point up areas for improvement and systemic issues that might not otherwise be apparent. It is only through the demonstration of quality outcomes, that providers are able to find partners for collaboration. 

Set and achieve metrics and standards

Metrics and standards will vary from facility to facility, but some sample metrics for providers to work towards might include: discharging more Medicare residents back into the community; compliance with federal and state regulations and adherence to quality standards; 30-day hospital readmissions rate at or below national and/or state norms; and high resident satisfaction ratings.

Reinventing relationship and care delivery 

The landscape for hospitals and post-acute facilities is expected to become even more challenging. If these organizations can reinvent their relationships with one another, put safeguards and systems in place at their organizations, and work together for common goals, they can reap substantial benefits, which ultimately help their patients. With the sea change occurring in healthcare, there is only one direction facilities can go – toward enhanced value, better resident outcomes, increased collaboration and measurable results. 

Imran Javaid is the managing director, Commercial and Specialty Finance, Capital One Bank.

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