The Affordable Care Act did more than create the opportunity for all Americans to access affordable health insurance — it changed the standards by which hospitals are held.
Since its implementation, there has been a heavier focus on patient quality and care. In particular, hospitals are fined for having readmission rates that exceed a certain percentage. These fines could spell trouble for facilities with stringent budgets. Not to mention this information is public, which could result in bad press for any hospital.
The Affordable Care Act did more than create the opportunity for all Americans to access affordable health insurance — it changed the standards by which hospitals are held.
Since its implementation, there has been a heavier focus on patient quality and care. In particular, hospitals are fined for having readmission rates that exceed a certain percentage. These fines could spell trouble for facilities with stringent budgets. Not to mention this information is public, which could result in bad press for any hospital.
That being said, it’s more important than ever to use analytics to deliver high-quality patient care and lower readmission rates, especially when hospitals are moving to a pay-for-performance structure and finding overall improvement. This is also important because hospitals with excess readmissions may get reduced payments from the Centers for Medicaid and Medicare Services.
Leverage Analytics to Lower Readmission Rates
Analytics have always been a part of any well-oiled business, but healthcare has been lagging behind when it comes to taking advantage of this. The changes brought about by the ACA up the ante. Readmission, complication, and mortality rates are the key indicators of a hospital’s overall performance and quality of care, so if either are high at your facility, it’s time to figure out why.
Yet many of the obvious factors that affect readmission rates happen after a patient is discharged, making it difficult for a hospital to lock down exactly how to adjust protocol and improve rates. A good starting point, however, is identifying other performance metrics and cross-analyzing them with readmission rates, which can reveal potential factors.
Take these five action steps to improve your facility’s readmission rates:
1. Understand your limitations. Find the cracks in your hospital’s system so you can understand exactly where patient care is failing. To start, answer these questions:
- Why are people being admitted in the first place? Is there a surplus of patients coming with specific conditions or preventable conditions?
- What complications are repeatedly occurring at my hospital?
- When patients are readmitted, what are the major issues they face?
- Are patients from one particular unit readmitted more frequently?
- How is my nurse-to-patient ratio? Have any changes been made to this recently?
- After patients are discharged, do they take advantage of home care services available to them? Do they follow discharge orders?
- Are there any identifiable trends with readmitted patients such as same insurance plans, certain months of the year, same symptoms, etc.?
2. Measure success. Create “scorecards” for different departments of your hospital to gather accurate metrics for analysis. Grade factors like staffing, productivity, quality, operations, finances, and education. Transparency across the hospital’s departments will allow the administration and staff to make quick, educated decisions.
3. Care for quality. Evaluate what your data means. Are there obvious holes or flaws in your system? Are there ways to improve patient care in your facility or after discharge? Create an action plan that could remedy the situation, and set a timeline for the plan so you can re-evaluate the situation to see if an improvement was made.
4. Set goals. Once you’ve gathered and analyzed your data, set a goal for improvements in specific departments or even the whole facility if necessary. Realign all of your performance metrics — even small changes — to move toward one shared goal.
5. Over-communicate. Make sure your leadership team effectively communicates your company-wide and department-specific goals to all employees; everyone needs to be on board to meet goals. Try using a cloud-based dashboard system that will report the results of measured data in real time. This will constantly update your employees on how they’re performing.
See the Difference
By gathering accurate metrics and analyzing the data to pinpoint exactly where the system is breaking down, you can make real improvements in your hospital.
For example, at El Camino Hospital in California, hospital administrators identified 25 characteristics they predicted could lead to readmission; rated discharged patients as low-, medium-, or high-risk for readmission; and issued follow-up measures such as videoconferencing for high-risk patients. As a result, they were able to reduce readmission rates by 25 percent.
On a similar note, at Texas Children’s Hospital, Dr. Charles Macias was frustrated when he found himself repeatedly treating the same child for severe asthma. He was further aggravated after the child’s mother showed him six contradictory versions of action plans given to her during their previous visits. Dr. Macias led the way to reforming the hospital’s analytics system — including evidence-based guidelines and team-based care — to improve patient outcomes and lower readmission rates.
Analytics can give your hospital an in-depth look into what things are (and aren’t) working and allow you the opportunity to take action and fill holes in your patient care program. As a result of gathering and analyzing data for your facility, you can lower readmission rates and save your hospital from financial penalties and harmful press.
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