It’s unclear whether President Obama’s request for funding to combat HAIs will be met by Congress, but regardless of whether or not the funding comes from the federal government, hospitals will need to find the money somewhere to continue investing in HAI prevention, especially as it becomes more inextricably linked with reimbursement as we march forward this year.
For the third year in a row, Medicare will be increasing the percent penalty for hospitals who have high readmission rates: up now to 3% in 2015. Despite efforts through the ACA and readmission reductions programs, the rate of readmissions continues to rise. Initially, Medicare attempted to stifle this by forcing hospitals to be transparent about their numbers. By making the number of readmissions public, the hope was that there would be a certain accountability and hospitals would then attempt to discern why their rates were so high. When this didn’t prove to drop the rates as much as Medicare would have hoped, they tacked on a financial penalty that hospitals would need to pay if their rates continued to rise.
No hospital will ever achieve a zero readmission rate--nor would they want to, as it may be an indicator of poor quality of care. However, there are many factors that lead to higher readmission rates--some of which can be avoided or at least more properly managed. In today's post, we'll discuss some of those factors as well as how they can be addressed.
Healthcare has become something of a hard science, if the focus on data and numbers is any indication. It would seem that the research, the endless reporting and spreadsheets of healthcare administration, has served to at least shed light on the problems healthcare is currently facing as an industry - but the fix isn’t likely to be in black and white.
When we think of costly health conditions, the first that comes to mind for many is cancer. Treatment costs alone can bottom out even the best insurance plans. But did you know that behavior health conditions cost just as much per year as cancer? At a whopping $57 million per year, behavioral health conditions are one of the most costly health conditions in the United States today. While behavioral health conditions are rampant, they often don’t get as much attention as their more physical counterparts. Research tells us that mental health woes like anxiety and depression can greatly worsen, or at the very least contribute to, chronic pain conditions and even affect the length of our lives - but these conditions are often not diagnosed and treated effectively, or, in conjunction with the other comorbidities of a particular patient with complex health needs.
When was the last time your organization performed a SWOT analysis? If you aren’t familiar with SWOT (strengths, weaknesses, opportunities and threats) it’s a widely used strategy in many industries, not just healthcare, for identifying areas for improvement. You can break SWOT down even further: Strengths: What sets your hospital apart from all the rest? What can you offer that makes you competitive? Weaknesses: What puts your hospital and employees at a disadvantage compared to other hospitals? What of these factors can you change? Opportunities: How can you show your strengths to others? Threats: What could cause big trouble for your hospital or employees?
October 1st of last year, CMS cracked down on readmission rates for hospitals nationwide, handing out millions of dollars in penalties. The Affordable Care Act put these measures into place in order to curb the problem of readmissions, which are not only costly, but reflect an overall poor population health in the U.S. - especially for those patients with chronic conditions. For FY ‘14, 2% was withheld from payments per the guidelines for penalties. By 2015, the rate of withholding for penalties is expected to top 3%. In addition to the higher payments, there will also be additional diagnoses included in the readmission criteria list - it began with heart attacks, pneumonia and heart failure and will now expand to include COPD and complications from chronic lung conditions.
For many hospitals, the emergency room is the busiest place for both staff and patients. Overcrowding, long wait times and inefficient care plague a lot of U.S. hospitals and there is a growing need for solutions. Not only is the overutilization costing money, but it is affecting patient satisfaction scores, meaning that hospitals aren’t meeting their annual measures. Of course, there are times in the life of any emergency room, when it’s unavoidably busy: during summer months, hospitals that are in prime vacation areas need to plan for an influx of one-time patients. In the event of a disaster or outbreak of communicable illnesses in a community, utilization of emergency room services are certain to skyrocket. But what about in general, when physicians find that they are treating patients who, ultimately, do not need emergency services - meaning that patients who do are left in a lurch?
Are you one of many hospitals being dinged with CMS penalties? Are you ready to be dinged for Hospital Acquired Conditions, in addition to readmissions and value-based purchasing? How can a hospital remain profitable? In terms of hockey, the penalty box is where players are sent when they have committed an act which is against the regulations of the game. The player is forced to sit in the penalty box for a period of time, causing the team to play with less players, until the penalty time has lapsed.
While there are plenty of complex reasons for high rates of readmission, there are plenty that are preventable. Here are the Top 5 Mistakes made by hospitals who top this list.