If healthcare reform had a tagline, it’d probably include the phrase, “more for less.” In other words, most reform efforts fall in line with the ubiquitous call for providers across the entire healthcare spectrum to deliver higher-quality care at a lower cost. This have-your-cake-and-eat-it-too approach to change places a heavy burden on the leaders responsible for ensuring their organizations live up to that lofty tagline—and that’s especially true for those leaders at the helm of large hospital systems.
That’s because, while financial incentives—and penalties—are evolving to encourage providers to always act in the patient’s best interest (i.e., to embrace a patient-centered mode of care delivery), incumbent hospital reimbursement structures tend to work against that objective. This conundrum is especially evident when it comes to readmission reduction initiatives.
After all, a truly patient-centered care protocol would require hospitals to:
- provide the right type of care—at the right time—to each individual patient;
- create the best possible patient experience (i.e., optimize patient satisfaction levels and outcomes); and
- discharge when—and only when—the patient has demonstrated a high enough level of function to keep the probability of readmission to a minimum.
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The problem is, Medicare—which serves one of the patient populations most vulnerable to readmission—still reimburses on a case basis. So, the longer a patient stays, the more it costs the hospital to keep that patient there—and that puts hospitals at the center of a financial tug-of-war. On one side, emerging reform initiatives and alternative payment models—like the Hospital Readmissions Reduction Program (HRRP), accountable care organizations (ACOs), the comprehensive care joint replacement (CCJR) model, and the recently announced cardiac bundled care model—aim to:
- keep patients out of the hospital in the first place, and
- prevent discharged patients from coming back to the hospital.
On the other side, existing payment structures push hospitals to:
- admit patients in order to maintain revenue flow, but
- minimize the length of hospital stays—thus putting some patients at greater risk for unplanned readmission.
And as any inpatient care provider knows, the earlier you discharge a patient—especially if that patient isn’t quite ready to transition to a home environment—the greater the chance the patient will end up back in the hospital at some point. That’s a costly quandary: with an estimated annual price tag of $15 billion, unplanned hospital readmissions for Medicare patients represent one of the most expensive problems in the US healthcare system. And that cost isn’t measured only in dollars and cents; readmissions also compromise the quality of care patients receive, and thus, the value of that care.
But, readmissions are also one of the most preventable events in the patient care journey, which is exactly why federal organizations—namely, the Centers for Medicare and Medicaid Services (CMS)—have recently intensified their focus on implementing regulations (like those mentioned above) designed to incentivize readmission prevention.
In the meantime, hospital leaders find themselves at the center of a transitionary catch-22: should they compromise patient experience in the name of preserving revenue levels as governed by the existing reimbursement framework, or should they embrace the future of healthcare payment philosophy and put all of their eggs in the value-based/patient-centered care basket?
Well, in some cases—namely, those involving orthopedic surgical episodes or neuromuscular issues—they might not have to choose. Stay tuned to the WebPT Blog to learn more about the cost-effective readmission reduction solution that’s already hiding in plain sight in most hospital systems—just waiting to help hospitals achieve that seemingly impossible “more for less” standard.