Medicare Readmission

Innovaccer’s customers counter Medicare readmission penalty trend

Erin Boor, RN, MBA, CPHQ
Thu 13 January 2022
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Connected patient care drives reductions in readmission rates

Medicare recently cut payments to 2,499 hospitals, nearly half (47%) of the nation’s facilities. The reason: high readmissions. Moreover, of the 3,046 hospitals Medicare evaluated for readmission rates, 82% received a penalty—nearly the same number penalized last year.

The average penalty is a 0.64% payment cut for each patient stay from October 2021 through September 2022. And these penalties will add up, saving the government an estimated $521 million over the next fiscal year.

Only 547 hospitals had readmissions low enough to escape a penalty, while other facilities (including Innovaccer customers) are making steady progress in reducing readmissions overall. One of our customers reduced readmissions by 10%. Another by 7%, and still another by 4%.

What separates the best from the rest? What’s their secret to reducing readmission rates?

Readmission management needs a reboot

Clearly, current strategies for managing readmissions aren’t working. I see hospitals struggle with this challenge every day: A lack of patient visibility and outdated discharge planning along the care journey are at the heart of the problem.

By using inadequate technology and fragmented data, hospitals are forced to use outdated and largely manual processes for coordinating patient care.

Caregivers are issuing dispatch work orders on paper or via instant messaging, email, or various data and SharePoint portals. As a result, patients get lost in the system and experience care and communication gaps all along their journey.

Examples abound. One healthcare management services organization (MSO) I know spent roughly 23 hours a week just collating files and sending out assignments to the appropriate team members to reach out to their patients.

That’s a full-time employee spending half a week using an inefficient manual process. Compound that across a health network, then add in the general public’s lack of health literacy post-discharge, and you can quickly see that the entire process is fractured and inefficient. This is why half of the nation’s hospitals are being penalized for high readmission rates.

Reducing readmissions: People, processes, technology

Lowering readmission rates is a daunting challenge, but it’s one that can be overcome through effective communication, processes that enhance coordination between care sites, and technology that truly ties it all together with integrated workflows, analytical insights, and increasingly automated actions that drive readmission rates down.

As far as our customers go, the results are clear. Bucking the readmissions trend and avoiding penalties, Innovaccer clients are seeing evidence of positive financial impact, more efficiency, and—most importantly—marked reductions in readmission rates. Here are just a few of many compelling examples:

  1. A leading health system, part of a regional network of more than 140 hospitals, reduced readmission rates by an absolute 10% and doubled Medicare patient wellness visits through transitional care management protocols and automated workflows.
  2. A large Midwest provider network with more than three million patient visits annually reduced its readmission rates by 7%, tripled health coach interventions, and increased annual wellness visits by 31%.
  3. A large Southeast health system with eight hospitals and more than two million patients reduced its readmission rate from 17% to 13% this year and saved $3.1 million.

From manual to magical: A case study

Let’s take a deeper look at how a large health system with more than 90 hospitals achieved lower readmission rates. The system lacked a common standard for storing and sharing patient information, which resulted in siloed data and operational inefficiency. Disconnected patient engagement negatively impacted care experiences and patients failed to adhere to medication cycles, clinical appointments, and annual wellness visits.

In the absence of care automation, care teams at the health system spent hours compiling reminders and confirmation texts, finding patient information, and sending messages manually. Teams depended heavily on spreadsheets and time-consuming manual interventions for bulk outreach campaigns, slowing down processes and creating barriers to communication with patients.

The network sought to improve overall post-discharge care and provide consistent patient-centered care. To help ensure that patients received appropriate post-discharge care, the network replaced its traditional CRM technology solution with the Patient Relationship Management (PRM) solution on the Innovaccer Health Cloud.

The Data Activation Platform on the Innovaccer Health Cloud securely integrated patient data and created unified patient records from disparate healthcare sources—clinics, claims, labs, and pharmacies—to create a holistic view of patients. The health system used the PRM solution to make communication more efficient by automating patient outreach workflows, scheduling follow-ups with primary care providers, and sending reminders and push notifications to patients.

The PRM solution also allowed care teams to use Transitional Care Management (TCM) protocols to identify patients who were at high risk for readmission. It allowed the network to offer omnichannel communication support for providers, and reduce its readmission rate from 15% to 5.6% through TCM outreach. The PRM solution helped the system close care gaps through superior data management and save $180,000 in five months—with a projected annual savings of about $432,000.

Reducing readmissions through connected patient care

This level of connected patient care is enabled by our Patient Relationship Management solution on the Innovaccer Health Cloud, which helps our customers integrate data from myriad IT silos--EHRs, claims, labs, pharmacy, and crucial third-party sources (such as Admission Discharge Transfer (ADT) sources--to provide a unified view of the patient and the process.

In addition, our customers can integrate third-party SDoH data sources, such as census and lifestyle information, to build up patient records. This helps them understand that patients in specific areas or situations may face issues related to income, transportation, food insecurity, health literacy, or high chronic diseases like asthma and diabetes, putting them at a greater risk for readmission.

With complete visibility into a longitudinal patient record, care teams can see a patient’s full clinical history, where and how the patient traveled through the system, and their location after discharge. This includes insight into variation of performance by facility, by physician, by teams, by patient condition, and much more. This reveals outlier performance, both good and bad. Moreover, care teams can see how performance is trending, allowing proactive interventions as well as continual learning and adaptation.

All of that information is used to foster intelligent care coordination and build patient relationship management workflows that track key interactions between hospitals and patients. Care managers also received automated reminders for follow-up from day zero to day 30. At its core, the PRM solution is designed to maintain a patient’s health at home and prevent a trip back to the hospital.

Far too many patients are being readmitted within 30 days of discharge. The numbers are cause for concern for both providers and patients, and the resulting penalties are staggering at a time when providers can’t afford revenue shortfalls.

Over the past decade, the Hospital Readmissions Reductions Program (HRRP) has penalized 93% of acute care hospitals and more than half of all hospitals at least once. Additionally, 1,300 hospitals have been penalized for all 10 years.

This doesn’t have to be the case. You can reverse the trend by fundamentally rethinking your approach to readmissions. Armed with an integrated solution that leverages all of your patient data, you can enable connected patient care with better end-to-end processes for care coordination, discharge planning, and after-care follow-up to help eliminate unnecessary readmissions, reduce penalties, and achieve better patient experiences and outcomes.

Contact us to learn how your organization can reduce readmissions using improved processes and advanced technology—or to get more information on patient relationship management on the Innovaccer Health Cloud.

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