Combat 30-Day Hospital Readmission Penalties with Predictive Analytics
Overall, readmission rates have fallen slowly over the last four years, but they are still too high. In 2013, the Centers for Medicare & Medicaid Services (CMS) reported nearly 18 percent of Medicare patients were readmitted to the hospital within 30 days of release. That equals two million patients at a cost of $26 billion annually, $17 billion of which came from potentially avoidable readmissions.
The CMS recently announced that more than half of the country’s hospitals would face penalties for failure to reduce the number of 30-day readmissions to acceptable levels. The organization also finalized a rule increasing potential penalties for failing to reduce readmissions to three percent.
Add to that the demographic challenges of an aging population (by 2030, there will be a billion people aged 65 or older) and the fact that 80 percent of 30-day hospital readmissions are aged 65 or older. This year’s penalties will total about $420 million spread over 2,592 hospitals. For most large hospitals, it isn’t a big enough problem to worry about. But sooner or later, even the largest hospitals will have to pay attention.
There are many ways to approach the problem, but one of the most effective is through the use of home health and hospice care. These clinical services not only improve the quality of end-of-life care but also reduce unnecessary readmissions. At Medalogix, our predictive modeling and workflow solutions assist home health providers by analyzing patient health records to identify patients who are most at risk for returning to the hospital and those who would most benefit from hospice care, both of which help reduce hospital readmissions.
Reduce readmissions with predictive analytics
Medalogix Touch is Medalogix’s readmission reduction solution. It leverages the power of predictive analytics to rank patients according to their relative risk of readmitting to the hospital within 30 days. To make the information actionable, the technology then provides clinicians with workflow steps, like automated calling, to improve the risky patients’ quality of care.
Touch incorporates Interactive Voice Response (IVR), where an automated system calls risky patients and asks a series of yes-or-no questions. If a patient gives a problematic answer, Touch will flag him or her for follow up with a clinician. The clinician can then dig deeper into the patient’s records and make calls directly from Touch. For example, say an organization has 1,500 patients on its total census, and 300 automated calls are made to the top 25 percent who are most at-risk. Two patients are flagged for follow-up. That saves the clinicians an immense amount of time by eliminating manual calls (and ensures that all calls are being made). This creates the most efficient clinical review and allows clinicians to keep tabs on the most at-risk patients in a timely manner.
In a case study, we implemented Touch in three of a home health agency’s clinics. Over a six-month period, Touch made 1,299 automated calls based on the patient’s risk for readmission. Of those, 702 (or 55 percent) required follow-up with a nurse. The three clinics reduced their relative 30-day readmissions by more than 20 percent, which amounted to 155 patients who didn’t go back to the hospital a month after being discharged.
Reduce readmissions with hospice care
Many seriously ill older patients who go back to the hospital could have avoided readmission. A recent study by the University of Southern California found that patients seen by an inpatient consult service followed by a palliative home care program or hospice may have lower rates of 30-day readmissions.
By identifying those home health patients who would be appropriate for hospice care, you can help the patient avoid rehospitalization while also offering a higher quality of life at the end.
Another Medalogix solution, Medalogix Bridge, is helping to solve the readmissions challenge by helping to solve the end-of-life care challenge. The technology predicts which patients on the home health census could benefit most from hospice care.
Equipped with this information, clinicians can delve deeper into those patients’ records to assess the situation further.
Once a patient is identified and the process to engaging in the hospice conversation with the patient is initiated, Bridge organizes the process with a custom workflow. This reduces lag time and helps pinpoint bottlenecks in the system, all of which helps increase the number of days a patient can spend on the hospice census.
Predictive analytics is about more than models and rankings—it’s about improving the end-of-life conversation. Every family must deal with the death of a loved one. End-of-life discussions are an unpleasant, but necessary part of patient care. Knowing when to begin these conversations can help both clinicians and patients prepare in the most effective way possible.
Our models can help clinicians empower families and patients to make informed choices about what treatments the patient wants at the end of life. In 2011, Ken Murray wrote an essay titled “How Doctors Die” in which he noticed that his doctor colleagues usually didn’t die like the rest of us. Most of them died at home, having refused the sort of “heroic measures” often taken with terminal patients in hospitals. Without some guidance, death in a hospital can be prolonged and painful – not to mention expensive.
Predictive analytics can provide the support clinicians need to guide patients and their families through the final days of care.
Clinicians usually rely on their education, experience and instinct to treat patients. Using predictive analytics adds a new dimension to patient care and provides decision support for clinicians and administrators. More information helps inform better care decisions.
As the industry moves toward alternative payment plans that value efficiency and patient outcomes over fee-for-service models, it will be more important than ever for clinicians to take advantage of new technologies. Medalogix Touch and Bridge will make a significant difference for patients, clinicians and administrators alike by providing analytics-based information to support decisions and streamline workflows to improve efficiency.
We all deserve to have the best information possible to help us plan and make an informed decision about how we want to live our final days. By pairing sophisticated analytics that can recognize patterns the human eye can miss with a clinician’s experience, education and instinct, patients are hearing about their options at the optimal time.
Dan Hogan is founder and CEO of Nashville, Tennessee-based Medalogix, a health care technology company that provides analytics, workflows and business intelligence solutions to home health and hospice providers.