5 Reasons Why Readmission Reductions Require Integrated Care

Many hospitals are targeting readmissions as a way to improve quality and reduce costs. Beginning in October 2013, Medicare will reduce reimbursement for hospitals with frequent potentially preventable readmissions for heart attack, heart failure and pneumonia patients. By 2014, hospitals with high readmission rates could lose up to 3 percent of their regular Medicare reimbursements.

Tackling readmissions is a difficult task, however, because transitioning patients from the hospital to another care setting involves the coordination of multiple care providers, including specialists, primary care physicians, pharmacists and potentially home health providers. The traditional model of hospitals operating in silos is thus the antithesis of an appropriate structure for successfully preventing readmissions. Hospitals instead need to integrate their services to ensure the patient will receive adequate care post-discharge.

"A readmissions [initiative] is a good place to start learning how to integrate hospitals, clinics, home health and other services in a more patient-centric way to coordinate care," says Alan Kaplan, MD, vice president and CMO of Des Moines-based Iowa Health System. "Focusing on readmissions requires we break down silos and focus on the continuum of care and not just what happens in the hospital."

Dr. Kaplan shares five reasons why reducing readmissions requires integrated care.

1. Primary care physicians. Physician integration with hospitals facilitates communication, such as notifying physicians when their patient has been admitted and providing the physicians a discharge summary. This integration also helps ensure the patient is seen by the primary care physician shortly after discharge.

IHS, an integrated health system, has encouraged its employed physicians to implement best practices in their clinics to reduce readmissions. One of these best practices is seeing the patient within three to five days after discharge to confirm the patient is educated about his or her condition and that medication reconciliation has been performed. If the patient presented to the emergency department, the physician also discusses the reason for the patient's visit to try to prevent the need for another hospital stay.  

2. Home health. IHS owns a home health agency in addition to hospitals and clinics, which allows the health system to more easily plan patients' care after leaving the hospital. In fact, a lack of a home health referral for patients may be one cause of readmissions, Dr. Kaplan says.

3. Stakeholders. Integrated hospitals and health systems can also more easily bring stakeholders together when coordinating a patient's post-discharge care. "People across the care continuum need to start working together in a way [they] have not worked together before," says Dr. Kaplan. Essential to working together is effective communication both between healthcare providers and between providers and patients. "There needs to be communication between hospitals, home health, clinics and skilled nursing facilities to make sure patients are well-educated about their condition."

Family members are also stakeholders in a patient's care. "It is extremely important that close family members are brought in on decision-making and understand the care plan," Dr. Kaplan says. Family members can help create a home environment that supports the patient's care, reinforce education and medication requirements and transport patients to appointments after discharge. Integrated healthcare organizations can more easily connect family members with the resources necessary to support the patient because of the variety of services the organization offers.

4. Culture.
Integrated healthcare delivery also helps focus an organization's efforts on reducing readmissions through a unified culture. The different cultures and philosophies that exist between separate healthcare providers make it more difficult to coordinate care.

5. Reimbursement. In addition, integrated care can reduce readmissions more effectively because incentives and payment systems are aligned under one organization. "It's very difficult to coordinate all the providers involved [if] they all have different interests and different ways they're reimbursed," Dr. Kaplan says. In fact, he suggests that one of the causes of healthcare's current silo-based system is the different reimbursement systems for separate organizations. "It was driven [in part] by the payment system and the fact that most of us don't exist within an integrated delivery system. We have our own corporations, strategies and cultures, and so each business is separate and not necessarily coordinated. Sometimes it's very difficult to share information and collaborate under those conditions."

Dr. Kaplan anticipates the change from a fee-for-service to pay-for-performance model under healthcare reform will encourage more integrated care and thus facilitate system-wide initiatives such as reducing readmissions. "It will drive people to work together more collaboratively to improve care and eliminate waste."

More Articles on Hospital Readmissions:

Remote Telemonitoring at Geisinger Health Reduced 30-Day Readmissions by 44%
Study Suggests Medicare Advantage Patients Experience Fewer Readmissions

New York Hospital Queens Outlines 5-Point Plan to Reduce Readmissions

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