October 18, 2016

5 Ways to Slow Record Medicare Readmission Penalties

Shail Choksi

5 Ways to Slow Record Medicare Readmission Penalties

We’ve documented Medicare Readmission penalties recently touching new highs. Of the 3,400 hospitals currently participating in the Hospital Readmissions Reduction Program, only 799 performed well enough in fiscal 2016 to face no penalty under CMS’ 30-day readmission program.

For obvious reasons this raises red flags. A host of reasons highlight the challenge in implementing solutions to slow the readmissions problem. Primarily, many of the factors affecting patient readmission are beyond a hospital’s control, such as socio-economic factors.

But this doesn’t mean a hospital system cannot make change today to improve their readmission rates. Immediate steps include:

1. Start by Identifying Business Needs:

To identify business need, it’s important to perform a complete assessment of current business processes, people and technology. Areas that analytics can improve are quickly discovered, and plans can be put in place to reduce readmissions.

Reducing readmissions is an objective, not necessarily a business needs. To best identify a business need, the current patient life cycle must first be reviewed and analyzed. Followed by interviews with each stakeholder across the entire spectrum of care; front desk, physician, nurses and other staff.  By better understanding day to day activities, challenges and the areas requiring leadership attention are discovered.

For example – A shortage of healthcare professionals is a common challenge found across the industry. This often leads to premature patient discharge, even though unstable vital signs are readily identifiable. When a hospital implements a more intuitive workforce management application, more efficient scheduling reduces workloads, ultimately driving improvement in readmission rates.

2. Define Analytics Capabilities Requirements:

Once business needs have been identified, next steps include defining the necessary analytics capabilities needed to satisfy business needs. These capabilities can be paired with current business processes are protocols.

3. Build a Business Use Case:

A business use case highlights areas within a hospital causing higher readmissions. Analytics time-to-value is accelerated by building an agreed strategy that includes specific goals leading to a foundation for long-term success.

4. Develop a Pilot Roadmap:

Every initiative or implementation should be started as a Pilot program.  A pilot program allows organization to test and validate potential solutions before expensive large-scale project implementations. To build success, it’s important to develop a roadmap that channels focus on the best technologies, skill-sets and activities.

5. Continuously Monitor Pilot:

To help leadership teams monitor program performance, a well-designed pilot includes carefully defined metrics. Real time feedback quickly identifies areas working, or those needing improvement. Insights gained during a pilot help save time and investment before rolling out costly enterprise-wide solutions.