Hospital discharge decisions: Why choose your facility?
Raul Valdes-Perez, founder and CEO of OnlyBoth Inc.
Hospitals are more accountable than ever for what occurs after Medicare patients exit their front door. Rehospitalization consequences look grim.
To provide high-quality of care across the provider continuum and avoid financial penalties, hospitals should be proactive during the discharge process to determine what, optimally, comes next. This means planning ahead to understand which skilled nursing facilities are of high quality and able to meet the needs of specific patients and conditions.
There are Medicare metrics available to both hospitals and patients but these metrics hardly give them what they need to know. For example, despite the Centers for Medicare & Medicaid Services' efforts to make the Nursing Home Compare data easily understood, multiple studies have found that the website has had limited impact on consumer selection of nursing facilities.1
Most consumers either don't know about it, or find the Web site challenging to navigate and tough to understand. There is a missed opportunity here for the hospital discharge staff to educate patients about the nursing home performance data and how to interpret it in line with patient preferences.
In short, public data brings transparency like a window does, but both often need help to make sense of what they make merely visible.
Forming hospital relationships built on trust
On the other side, nursing home providers that excel need to connect with hospitals in a manner that outlines how and why they are the provider of choice. To reach key hospital influencers, nursing homes are strategizing with marketing materials that outline performance insights compared to other local institutions.
Metrics don't lie, but they have to be made digestible: They have to jump out and say “I matter because…”
When patients and their families are overwhelmed about what comes next, clear information about their options is vital for confidence, convenience, and comfort. Successful nursing homes will make such facts available for informed decision-making. As it stands now, many hospitals simply give out lists of local skilled nursing facilities. Anyone who can search zip codes can generate that! A nursing home can differentiate itself as a stand-out institution by giving hospitals the important quality data about the facility as compared to others.
So starts the process of proactive communication between nursing homes and hospitals. Through transparent information sharing, a nursing home forges a long-term relationship that begins before discharge and remains after the patient has left the hospital. They can work together on information exchange about the patient condition, treatment, medications and therapies and seek to integrate on the technology side to make this data exchange an ongoing and successful part of continuous care. By presenting clinical, technological and patient-facing strengths, nursing homes give the assurance of a commitment to care and the willingness to work with health system physicians.
Automation is key for understanding performance
Nursing homes can leverage automated benchmarking technologies to generate provider comparisons that truly matter to their future patients. Automation uncovers and expresses comparative performance insights that provide the “I matter because ....” context for data in a way that humans have not and cannot. While traditional benchmarking technologies offer simple comparisons based solely on numbers, they don't offer actual data context that clarifies performance measures and areas for improvement.
Traditional benchmarking methods look at a provider's value (such as hospital readmissions, for example) compared to others' numbers on this same particular value, or state or national averages, but they go no further.
What about considering combinations of attributes and how they work together to impact quality of care? Advanced automation of publicly available data uncovers which ones stand out unfavorably, which attributes may be paired with others for joint outcomes, and in general which performance combinations are linked. This takes peer comparison many steps further into an immense realm of possible insights about performance. These attribute combinations are the means of achieving complete transparency: language-based insights that are without bias, concise and even motivating.
Without automated benchmarking, nursing homes have to comb through data about state and national averages, and study complicated charts and percentage point graphs to get a picture of performance. The author found success developing the OnlyBoth tool to transform the government's hundreds of federal data points from the Nursing Home Compare into sentence-based actionable insights that users can clearly understand. Nursing home providers can demonstrate value among competition with specific language-based content that shows how they are best in class. Hospitals can smooth and soften the complicated nursing home discharge decision-making process beyond a ZIP-code only search briefing.
An illustrative example
To better understand an application of benchmarking automation, consider a Philadelphia hospital's recommendations for the next stage of care for one of its elderly patients. The hospital discharge staff is concerned about rehospitalization. They want to know which homes in the area have a low percentage of short-stay residents who went to the nursing home from a hospital and then were readmitted to a hospital for an unplanned stay.
It finds that the Delaware Valley Veterans Home has the fourth-fewest short-stay residents who were rehospitalized after admission, at 13.7%, among the 46 nursing homes in Philadelphia County. For context, it's revealed that the average is 24.2% in Philadelphia County.
Automated benchmarking also provides additional context about that home: of all the county nursing homes, it is the only one that has a 5-star rating in each of overall, health inspection, quality measures, staffing and registered-nurse staffing. And of all the 698 nursing homes in Pennsylvania, the home is one of just 11 that have a 5-star rating in each of these areas.
This type of contextual data is updated quarterly, without bias, and is the basis for strategizing with comparative based insights. Stakeholders can see how specific facilities are excelling or falling short in an array of categories, and helps them choose next steps accordingly.
To sum it up
Solid, successful discharges generate tangible benefits for hospitals, patients, and nursing home providers alike, not to mention taxpayers. By selecting the right provider and executing the transfer, the care team improves patients' health, reduces readmissions, and decreases costs of the entire healthcare system. Value-based care models will continue to reward such results. Remember that positive outcomes do not occur serendipitously. Excellent planning and communication are paramount, especially at a time when hospitals are rushed to discharge patients in a timely manner.
Skilled nursing or extended care facilities need to make their performance attributes clear, in a way that makes physicians and other discharge team members feel comfortable. The information-sharing should highlight exact areas of excellence and, specifically, how they can fit the patients' demands for supported, continued care.
By using the power of advanced data aggregation, intelligent automated analysis enables thoughtful, informed human action for ultimate transparency. This is the future: of nursing home marketing, of better care across the provider continuum, and of higher quality healthcare provision at large.
1. "Patients Are Not Given Quality-Of-Care Data About Skilled Nursing Facilities When Discharged From Hospitals," Health Affairs 36, No. 8 (2017): 1385–1391.
Raul Valdes-Perez is co-founder and CEO of OnlyBoth Inc.