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The Patient Protection and Affordable Care Act (PPACA) does more than try to expand healthcare coverage to all Americans, it also has new programs and regulations intended to cut healthcare costs for both the government and its citizens.
One of these programs, a penalty for hospitals that readmit patients with the same conditions multiple times over the course of a 30 day period, recently swung into effect. Essentially, if patients are readmitted to a hospital unnecessarily within 30 days of discharge, the hospital faces fines in the form of reduced Medicare reimbursements from the government.
This is particularly worrisome for hospitals because it looks back retroactively over a three year period and hospitals have traditionally worked to increase admission rates to drive profits. In fact, over 2,000 hospitals were already penalized in the first month of the program, some as much as $1 million.
Ultimately, these new regulations have to create a shift in the ways hospitals and healthcare providers approach patient care. Instead of working to admit every patient, they now need to think about engaging the patient and their families in their own care, working with their family physicians and other doctors to coordinate care and trying to keep discharged patients as healthy as possible and out of the hospital.
Gone are the days when a patient is discharged with a set of instructions for follow-up care and wished the best of luck in their future endeavors. Hospitals now need to ensure that discharged patients keep up with their treatments, attend follow up appointments, take their medicines or use urgent care facilities if they need them. When the patient leaves the hospital, they are now more accountable for their own care, but the hospital now has a vested financial interest in how well the patient cares for themselves.
But how do hospitals accomplish this? Well, it all starts when patients are discharged.
When creating discharge instructions, it’s important that hospitals ensure that the directions and recommendations contained within are actionable. This is achievable by utilizing today’s advanced location intelligence solutions to identify the pharmacies, urgent care facilities and physicians that are closest to the patient. By providing information about where patients can go for the best care, instead of the emergency department, they can work to keep the patient out of the hospital.
But the improved interaction and communication can’t end there. The hospital needs to stay on top of the patient and communicate with them to ensure they attend follow-up appointments with physicians and take their medications.
Today’s advanced master data management (MDM) and customer communication management (CCM) solutions can aggregate data from a patient’s EMR records that enable the hospital and other healthcare providers to see what communication went to the patient and what communication needs to go to the patient. This can enable them to send reminders about appointments, and allow increased transparency between the physician and hospital.
Utilizing data analytics, hospitals can even be more proactive. Analyzing data in a patient’s EHR, predictive modeling, propensity to seek treatment and intelligence of various systems can enable hospitals to identify high-risk patients and collaboratively communicate before they present back at the emergency department.
The new readmission fines impacting hospitals are designed to cut healthcare costs for the country, but they also could be a significant financial burden on the country’s hospitals and healthcare providers.
However, there are ways to enhance patients overall well-being and keep them healthier to reduce readmission. By communicating with patients, care-givers, long-term care facilities and physician offices and providing patients with actionable intelligence so they can seek alternative treatment and become more proactive and preventative when it comes to care, hospitals can improve patient compliance and reduce unnecessary emergency department readmissions.
by Bill Sinn
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