HIE, clinical data, quality measures, financial and claims data along with healthcare analytics – what does it take to decrease readmission rates in nursing homes?
There is so much attention these days on making the most of all of the clinical and financial data regarding healthcare, hospital readmission costs and reimbursement, but do we really know what changes can or will make a difference?
It has been a long time since I have done bedside nursing, but I can remember how often I would have one or more patients assigned to me who had come from a skilled nursing facility, long-term care facility or “nursing home.”
The American Health Care Association (AHCA), the largest association representing skilled nursing care centers in the country, reports that every year, nearly 2 million Medicare beneficiaries are readmitted to the hospital within 30 days of being discharged, at a cost of $17.5 billion. Of readmissions, one fourth are skilled nursing care patients, receiving post-acute care (recuperative or rehabilitative services).
According to the recent Office of Inspector General (OIG), Medicare Nursing Home Resident Hospitalization Rates Merit Additional Monitoring report, in Fiscal Year 2011, one quarter (24.8%) of Medicare residents in nursing homes were transferred to hospitals for inpatient admissions, at a cost of $14.3 billion for the hospitalizations. The hospitalizations were required for a wide range of conditions with septicemia the most common. While the majority (67.8%) were transferred to hospitals only once, 20% transferred two times, 7.2% transferred three times, and the remaining 5% transferred four or more times. Of the Medicare costs for hospitalizations in FY2011, care for a nursing home resident cost an average of $11,255 per hospitalization, which is 33.2% higher than the average Medicare hospitalization ($8,447).
CMS concurred on the recommendations from the report to:
- Develop a quality measure that describes nursing home resident hospitalization rates and
- Instruct State survey agencies to review the proposed quality measure as part of the survey and certification process.
As noted in David Gifford’s blog on January 17, 2014, AHCA also agrees however does not think the OIG went far enough.
What will it take to get the right data to actually make the changes needed to decrease readmissions, cost of care and, most importantly, quality of health for nursing home residents? What would it take to get timely access to risk-adjusted Medicare claims data in addition to claims data for supplemental coverage by other insurance and health plans? What other clinical data would be critical to this analysis?
Seems that there is no way around having to optimize claims and financial data with other clinical data and quality measures. Population management and predictive analytics could help identify what changes are needed to decrease these and other readmission. Stop by the Perficient booth #2035 at HIMSS 2014 and talk with us about your experience in decreasing readmission rates.
