Hospitals are concluding they have to work very closely with healthcare providers, community organizations, families and patients themselves if they're going to keep people out of hospital beds—the new mandate under Medicare and fast-growing models of value-based payment.
Collaborative approaches to cutting readmission rates garnered by far the most votes in our reader survey on the most important efforts we've profiled in our regular Best Practices feature. Modern Healthcare is conducting a series of reader surveys in conjunction with the publication's 40th anniversary to gauge where healthcare is headed next.
Using collaboration to cut hospital readmission rates garnered 323 votes, significantly more than the 176 votes received by the second-place choice—boosting patient outcomes with telehealth.
Under the Affordable Care Act's Hospital Readmissions Reduction Program, hospitals have to keep readmission rates below the national average to avoid Medicare penalties of up to 3%. Only 799 of the more than 3,400 hospitals subject to the program avoided penalties for fiscal 2016.
One way hospitals are tackling the issue is by working with outside organizations to improve patient transitions.
“The whole system is shifting to a model that has more shared risk and accountability,” making it more critical “to manage patients outside the four walls of the hospital,” said Beth Feldpush, senior vice president of policy and advocacy at America's Essential Hospitals, which represents the nation's safety net providers.
Collaboration represents an evolution in thinking about readmissions. When penalties were first introduced, providers focused on clinically addressing the illness that landed the patient in the hospital. The focus on medical management alone “proved to be naive as it largely ignored how broader social factors contribute to readmissions,” said Dr. Eric Coleman, head of the University of Colorado's healthcare policy and research division.
Creating partnerships with specialty providers, such as skilled-nursing facilities, as well as organizations such as the Area Agencies on Aging, a national group of community organizations providing support for seniors, “is proving to be a win-win solution,” said Coleman, who won a MacArthur Foundation “genius” grant for his work on transitional care in 2012.
Bundled payments and accountable care organizations also encourage these collaborations because they give providers an incentive to care for a patient throughout an episode of care even though it might involve multiple settings and extend beyond the acute period of illness, Coleman said.
He noted that a collaboration is more likely to succeed when there is a trusted convener, all parties have agreed on the goals and when data are used to identify opportunities for improvement. “Even more promising is to invite patients and families to share both positive and negative experiences.”
Although telemedicine was a distant second for readers, its showing confirms that the use of remote technology continues to gain traction as a legitimate means of augmenting face-to-face visits with clinicians. Last year, Community Health Systems, which runs more hospitals than any other U.S. healthcare company, expanded its telehealth services to offer 24/7 urgent care in at least four states. Meanwhile, the Cleveland Clinic has partnered with CVS Health's MinuteClinic to give customers in Ohio virtual on-demand access to their providers for consultations.