Overcoming a Barrier:

It is a capital mistake to theorize before one has data.
— Arthur Conan Doyle

Tired of Facing Readmission Penalties? Now you can get your data…

Know your Post-Discharge Outcomes Every Month, Rather Than Years Later

The Problem:

CMS Readmission penalties are increasingly impacting the bottom line, yet based on data that we do not possess.

Dear Hospital Executive:

CMS calls it a zero-sum game.   I like to call it a stacked deck.  You do your best for your patients. Then three years later you are faced with a significant possibility of readmission penalties.  In 2016, the Centers for Medicare and Medicaid (CMS):

  • Levied fines to 2,597 U.S. hospitals (with 1,400 of the 5,500 hospitals exempt
  • The fines totaled $528 million -- up $108 million from prior year. 
  • Now can eliminate up to 3% of your CMS reimbursement through this program.

This year’s penalties are based on your outcomes for discharges from October 1, 2011 through September 30, 2014 – three years ago!  And you are compared to a benchmark that is reported at the same time as the penalties.  How frustrating that any improvements you make will take 3-6 years to make a difference.

Should I Use Predictive Analytics?

Sometimes it is better to first understand the present than to rely on predicting the future.
— Dr. Phil Smith

The buzz is about predictive analytics, which are pretty good on conditions like CHF (congestive heart failure). Whether you have already gone that route, or contemplating it, they are extremely expensive, narrowly focused and don’t really tell you the whole picture of post-discharge outcomes.  You cannot measure what you prevented.  And it seems that just when you figure it out for one patient population, CMS changes the rules. 

Predictive Analytics do not give you any insights into helping you measure the benefits of any process improvements you make along the way. And they provide no visibility into what happens outside the borders of your hospital/enterprise. Do you really think every hospital has the same failure points in their process?

Wouldn’t it be beneficial to really have the complete story on every post-discharged patient regarding their actual outcomes regardless of their discharge diagnoses? 

Introducing the Post-Discharge Outcome Tracker

The new Post-Discharge Outcome Tracker is the only product that will actually mine patient-centric data from CMS to truly provide you the actual data on what happens to a patient once they are discharged from your hospital.  And it helps you better determine how to improve the outcomes of your specific patient population:

  • For every CMS discharged patient, determine how many days elapsed before the date of discharge and the first doctor visit.
  • Determine who first sees the patient following discharge; not just who, but when, where and what specialty.
  • Determine if post-discharge mortality (death) occurred in the first 60 days following hospitalization. And if the patient did expire, know precisely how soon and in what venue of care (home, hospital, healthcare facility).
  • Determine if any Emergency Department (ED) visits occurred anywhere in the U.S. following discharge from your hospital.
  • Integrate your real post-discharge outcome data either into your EHR and/or your data reporting systems such as your data warehouse.
  • Import data into your existing Care Management platforms.
  • Analyze all DRG’s, not just one.
  • Drill down not only by condition, but by discharge and follow-up providers.
  • Identify high-risk patients for future interventions. Determine precisely what is different between patients with desired outcomes versus those that die, readmitted or return to ED following your hospital discharge.
  • Measure and track outcomes following new interventions that you deploy to address readmission and high-risk patients.
  • Validate your predictive analytic tools or refine them for your patient population.
  • Measure outcomes between groups of patients within conditions such as those remotely monitored and those that are not.
  • Leverage your own system’s data to refine your interventions and predictive models.

And you can leverage the Pre-Admission ED Model:

You can also add a 90-day look-back model to help triage high risk patients presenting to the Emergency Department to provide more data and information to your ED physicians and admitting hospitalists:

  • Let your ED Physicians clearly see upon initial assessment if the patient is high-risk or a “frequent flyer” (even if he/she frequents EDs and hospitals outside of your facility).
  • Help identify what medications have been administered or prescribed within the past 90-days.
  • Be aware of every healthcare encounter in the past 90-days.
  • Know what images, studies and tests have been ordered and who has the results.
  • Know details of the doctors/providers the patient has seen in past 90-days, including date(s), specialty, address, phone number and fax.
  • Push real time alerts into your electronic medical record for the benefits of the physicians, case managers, or other staff who help to proactively manage these patients.

All in a Solution That You Can Afford

The Post-Discharge Outcome Tracker was envisioned and designed by one of the most experienced experts in practical workflow solutions.  He knows that you want practical solutions without long-term commitments and costly set-ups, which are both quick to implement and produce a return on your investment. Most sites will want to start with 90 days of “Discovery” to look at your actual data to best understand how to leverage this solution to improve your patient outcomes.  Initial discovery can be done off-line before committing to further integration.

Recognizes that CMS rules frequently change and you want a solution that doesn’t require costly set-up and long-term commitments.

  • Offered as an annual subscription based on your prior-year CMS discharges and ED visits.
    • Future year’s subscription based on prior year volume.
    • One simple payment annually.
    • Multiple levels of integration offered, so you can start with data discovery first and advance to more complex integration to solve specific problems uncovered.
    • Can do staged deployment, starting with post-discharge discovery and progress to proactive intervention. 
    • Flexible in that you can receive data exports in a variety of formats.
    • Provides a unique bench-marking reference database of de-identified data so that you can determine now just how you are improving, but how you are improving against other clients.
  • If you have committed to a Predictive Analytics tool for readmissions, this offers an inexpensive addition to not only analyze how you are doing but measure your process improvement (PI) efforts.
  • Helps you concentrate your focus on your unique needs, rather than a “one-size-fits-all” solution.
  • Comes at a fraction of both initial cost and total cost of ownership of other solutions.
  • Solves a real problem with your real data, to provide all the pieces of the puzzle rather than just some of them.

Stop waiting three years to hope that you have avoided penalties and start improving your outcomes with the Post-Discharge Outcome Tracker. Contact us today for a confidential discussion with your key decision makers.

P.S. Let us know which benefit heads your list when you contact us.

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