I’ve had the privilege of talking to hospital administrators across the United States about the creative strategies being implemented to address the triple aim of the Affordable Care Act. One major outcome of health-care reform that I hear discussed time and again pertains to the associated migration of risk from the payer community to the provider community.
The one thing nearly all find problematic is identifying solutions to mitigate the financial risk of avoidable readmissions. This is not an easy task and one that can prove quite costly for organizations from both a time and financial standpoint.
The Manpower Solution
Probably the most frequent strategy I’ve seen deployed is the manpower solution. This is where organizations hire more discharge planners to follow patients and determine when interventions might be needed. In fact, I heard from one administrator who grew his staff of 11 discharge planners to 26, simply trying to stay on top of the increasing demand for patient oversight. I have to raise the question—is this a scalable solution? Can your budget support hiring enough discharge planners to effectively follow all of your patients?
Likewise, I’ve seen hospitals use the manpower strategy to place frequent, follow-up phone calls. Discharge planners will call at seven days post-discharge, at 10 days, and so on. I really wonder—can you call patients often enough? What happens if your patient is fine on day 10 when you call, but begins to decline on day 11? The technique is fundamentally flawed, not sustainable and terribly time-consuming. And, for the patient who is thriving, repeated calls are an unwelcome intrusion.
The Acquisition Strategy
Another solution I’ve seen used a lot is the acquisition strategy. During my 25-year tenure as a hospital and health system CEO, I remember hospitals buying nursing homes and home health companies, many of which were subsequently divested. Not surprisingly, the new environment has seen the resurgence of this acquisition mentality. There really is nothing wrong with this approach, although I would submit that owning the asset doesn’t necessarily mean clinical integration will result or that the smooth transition of patients will be achieved. And, in fact, without clinical integration, any real impact on readmissions is unlikely to occur whether the asset is owned, or not.
Yet another response to the changes brought about by the Affordable Care Act is the development of narrow networks. It’s a confusing term that traditionally related to options available from a payer’s perspective. However, in this sense, I’m speaking of post-acute narrow networks.
For example, a hospital may decide, “We’re going to pick the two best nursing homes in the community and only work with them.” That may be appropriate in some circumstances, but is it best for patients to have a limited choice in where they can go for care? Consider the variability in specialties across the post-acute providers. Some facilities might have measured success in treating orthopedic patients, but may not have adequate resources to manage the needs of pulmonary patients. Patients are better served by being able to choose the care setting that best suits their personal, social and clinical needs.
What Works Better
While it is true, health-care executives may need to try some (or all) of these strategies to respond to the triple aim of the Affordable Care Act, I would ask you to consider some alternatives. First and foremost, start by gathering great data to help gauge post-acute providers’ clinical strengths and weaknesses. Analyzing patterns of care or deficiencies in service can highlight opportunities for improvement before they become problems. Armed with this information, patients can be routed to those facilities best equipped and most capable of caring for them. This not only affects clinical outcomes, but also patient satisfaction.
Second, don’t overlook the power of leveraging technology. Automating tedious discharge tasks (such as matching a patients’ personal and social preferences to providers that offer them; eliminating time standing at fax machines; minimizing follow-up phone calls that are done simply to check the task off the list) frees up your discharge team to spend more time with high-risk patients—those having specific diagnoses that indicate more careful follow-up, those with a history of non-compliance to discharge orders, or those with limited support systems outside of the hospital, for example. This course of action enables your staff to enact early interventions—long before patients show up in your ER as a readmission liability.
Are there other ways your organization has found to minimize risk in this changing environment? I’d love to hear about them.
Looking for a few other ideas? Get tips about how to control readmissions, improve post-discharge communication, maximize staffing resources and leverage technology by downloading this readmissions e-book.