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 conducted 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 group of community organizations providing support for seniors nationwide, “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 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, one of the largest hospital operators in the U.S., 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.
Virtual visits are “one of the fastest-growing areas” in healthcare, and they're being used in an array of medical specialties, from optometry to emergency care, said Jonathan Linkous, CEO of the American Telemedicine Association. The trade group's membership grew approximately 15% in the past year.
Patty Mechael, executive vice president of the Personal Connected Health Alliance, a partnership between the Healthcare Information and Management Systems Society and other healthcare technology organizations, said demand for telemedicine is coming from patients who “want to access health services in a way that is both convenient and effective.”
Telehealth also provides technologies that can help with ongoing patient engagement, which can “mitigate risks inherent in value-based care delivery.”
Private health insurers appear to agree and are beginning to jump on the telehealth bandwagon by covering more services.
Telehealth is also popular among investors, who expect adoption to grow. A February report from Accenture noted that investments in telehealth companies are expected to climb from $200 million in 2014 to $1 billion by the end of 2017.
Thwarting the spread of drug-resistant bacteria took third place in the survey. It received 172 votes, just one more than the tally for the use of medical scribes, who enter information into electronic health records to give physicians more time to focus on patients.
But the fact that preventing the spread of deadly bacteria edged its way into the top three doesn't surprise Dr. Arjun Srinivasan, an antibiotic-resistance expert at the Centers for Disease Control and Prevention.
According to Srinivasan, there's never been more focus on beating back drug resistance—in large part because it's becoming impossible to ignore. “You'd be hard-pressed to find a doctor that went through a whole day without encountering an organism that posed some challenge (regarding) antibiotic resistance,” he said.
The CDC has prioritized reining in the use of antibiotics over the past few years.
In 2006, the agency released guidelines calling for the control of multidrug-resistant organisms in healthcare through “attention to judicious anti-microbial use.”
Two years ago, the CDC issued a document identifying the key elements of an effective hospital antibiotic stewardship program—adding to existing guidelines from organizations such as the Infectious Diseases Society of America and the American Society of Health-System Pharmacists among others.
Stewardship programs require a strong commitment from hospital leaders as well as regular tracking of antibiotic prescriptions and resistance patterns.
Some smaller hospitals have used telemedicine-based partnerships that tap into the resources of larger health systems.
But even though certain strategies have proved sufficiently effective to be deemed best practices, “antibiotic resistance is not a problem that can be solved by one solution,” Srinivasan said.
