Five years ago, most healthcare providers were painfully aware they had problems with residents heading back to the hospital, but few were addressing the issue. Today, regulatory reform has put rehospitalization rates higher on the list of battles to be waged.
“Unnecessary hospital readmissions is a priority in the national conversation about the quality of healthcare. This is no exception for the senior care market,” observes Jayne Warwick, RN, HBScN, director of market insights for PointClickCare. “It is important for senior care providers to use technology to help manage the level of acuity of their residents to understand the resources needed to manage care and population health.”
While hospitals reluctantly had a head start in harnessing their readmission problem with new software, the long-term care market is starting to ramp up.
Change can’t come soon enough for Tina Beskie, vice president, Business Development and Marketing for Constant Care Technology.
“It’s time to deploy the kinds of advanced technologies found in acute-care settings to provide accurate, early identification of incipient health deterioration,” she declares.
Nearly one in five patients discharged to a post-acute care setting are readmitted within 30 days, and at an average cost of more than $10,000.
As McKesson points out in its recent “Readmissions Resource,” failing to lower rehospitalization rates can lead to fewer or potentially lost referrals, bigger financial penalties, and higher costs to deliver care. Overall, they more than double the cost of providing care to an individual, analysts say.
Rehospitalizations have a cascading effect. Hospitals are penalized if the rates are too high (as much as 3% cuts in reimbursement) and now nursing homes are in line for financial penalties as well. Any entity that participates in the Medicare program is accountable for how care is delivered.
“Value-based payment models, accountable care organizations, and the IMPACT Act are changing the way acute-care providers interact with post-acute care facilities and agencies,” McKesson notes.
Significant incentives await those providers that perform well: Beginning Oct. 1, 2018, post-acute facilities will be able to receive up to a 2% Medicare reimbursement boost that is redistributed as an incentive payment for performance related to readmissions quality measures.
Risk and reward
Post-acute care providers are now focusing on greatly enhancing the way they communicate and share vital data to mitigate risks and keep readmissions as low as possible.
Steven Littlehale, chief clinical officer and executive vice president for PointRight, believes nursing homes that are able to lower rehospitalization rates have a nearly 90% chance of success in the Medicare value-based purchasing program. The reward is simple: More business.
“Organizations that have extremely low hospital readmission rates are going to the top of the hospitals’ referral lists,” observes Jeremy Spradlin, chief executive officer of CareServ. “This is going to net more of the premium mix of patients and residents to allow them to increase revenue.”
As LeadingAge’s Senior Vice President of Technology Majd Alwan, Ph.D., points out, hospitals, ACOs and payers like managed care plans are using the data to identify top performers and contract with them or include them in their ever narrowing referral networks.
As post-acute preferred provider networks continue to narrow, health systems are driving business to those organizations that have the ability to connect into them, leveraging technology to not only share data, but deliver outcomes-based measures on the patient population they are treating, adds Dawn Iddings, senior vice president of post-acute strategy for Netsmart.
“A lot of our clients are asking how they can better position themselves as a referral partner,” Iddings says. “Everyone is looking for that competitive advantage as health systems are shifting from a library of referral partners to a small handful that can prove they are delivering quality care. This is why actionable data is so important to have.”
Software selection advice How can providers best select software that improves readmission rates to save money and improve quality ratings? It begins with looking in the mirror. In a word: analytics.
“Though some software providers won’t admit it, there’s no silver bullet to fix a rehospitalization problem,” says Jason Jones, chief technology officer of SimpleLTC. “The key is to effectively use analytics within an overall process that helps you make important decisions. Evaluate your process to see if it — along with your software tools — supports effective decision making.”
“Providers need to know their readmission rates and identify where they need to improve,” adds Alwan, who also serves as executive director of the Center for Aging Services Technologies. “To achieve this, they need data analytics tools [in EMRs, or as add-ons] to help them slice and dice that data by location, diagnosis, conditions, care plan, and understand the root causes of higher readmission rates.”
This helps them implement changes or institute quality improvement programs.
Other resources to consider include shared care planning and coordination tools that support information exchange and allow providers to work with their partners around transitions of care, as well as shared care, so that their care plans are based on the latest information, he adds.
Chris Schoenrock, vice president, Industry Marketing for CPSI, advises providers to first inventory the features of their current EHR system. Document goals to accomplish with investing in new readmissions tracking technology.
Next, evaluate most wanted and needed features, and account for the total cost of ownership — not just acquisition cost.
With so many choices, Alwan advises providers to match such tools as closely as possible to their patient population. For example, a home health agency serving individuals with chronic conditions and high hospitalization and readmission rates might want to consider a telehealth or remote patient monitoring solution.
A skilled nursing facility with high readmissions of newly admitted patients may benefit from two-way video telemedicine to connect and coordinate with the hospitalists and stabilize newly admitted residents and avoid sending them back to the hospital.
Cheryl Field, chief product officer at Prime Care Technologies, believes software with broad and flexible measurement capabilities provides the most desirable solutions.
“For example, to save money in PPS rates in 2019, providers need to monitor their CMS claims-based rehospitalization rates, which are risk-adjusted using data from claims and some clinical data,” Field says. “If you want to score high marks with an ACO provider, you will need to know rehospitalization rates for a variety of payer types, and for a variety of diagnostic groups.”
Littlehale reminds providers to choose software that uses nationally recognized measures, such as those endorsed by the National Quality Forum, which will allow proactively marketing to referring providers and payers. Make sure your software vendor is regulatory savvy, adds Cynthia Morton, executive vice president of the National Association for the Support of Long Term Care.
“I want to be sure that the vendor I choose understands and tracks the myriad technical specifications related to regulatory requirements as well as the existing certification requirements and emerging standards being reviewed by federal health IT policymakers,” she says.
Care coordination capabilities are essential. As Iddings says, “Your healthcare IT partner should be able to support connections to the healthcare ecosystem in a broad way.”
Doing so requires a seamless solution, experts say.
“Providers should seek software that has the capability to be interoperable with healthcare systems and to internally integrate data from various disciplines or systems such as therapy,” adds Eva Bering, chief operating officer for Landis Communities.
Finally, there are definitely “must-ask” questions to pose of prospective vendors. “How is risk adjustment calculated? Is it based on clinical or claims data? And how old is the data being analyzed?” says Jones. “These variables can make a big difference in your readmission trends.”
Harnessing the data Understanding the value and importance of tracking and managing readmission rates, and choosing the software solution that best fits a facility’s needs is only half the battle. Knowing what to do with all that data is perhaps the most critical part.
Iddings and others refer to it as “actionable data. Our view on analytics is that they aren’t just for the C-suite,” she says.
“We believe that analytics should be used to guide treatment plans and to show you data on outcomes for population health management.”
In the end, managing and mitigating readmission rates pays off with bigger dividends. The process alone can improve quality measures across the organization and improve Five-Star ratings, adds Spradlin.
“Having access to good data and the ability to effectively analyze the data can change the way a provider operates,” adds Robert E. Baker, II, president of the Senior Housing Division of Collain Healthcare. “The data can help them improve their outcomes and better predict new patient outcomes.”