As a novice newspaper copy editor, I was entrusted to handle only the soft stuff: horoscope, school lunch menu, community calendar, Ann Landers.
I'd never read advice columns, but came to appreciate Landers' common-sense responses. One of my favorites was the elegantly simple "MYOB." Tell your niece to think twice before marrying that guy with the orange mohawk and purple eye shadow? MYOB. Tell the neighbor you spotted her husband lunching with the checkout clerk from the A&P? MYOB. Tell your future father-in-law how to barbecue a London broil so he can slice it without a table saw? MYOB.
Ever since, when I have to choose between butting my nose in or butting it out, out always wins.
Unfortunately, minding your own business is not an option for hospital leaders in the emerging era of accountable care. Providers can't concern themselves only with what happens to patients directly in their charge; what happens next — even if it's at a facility you have no commercial stake in — is suddenly your business. And it will directly impact your bottom line. A Health Affairs article assessing the STate Action on Avoidable Rehospitalizations (STAAR) Initiative, puts it bluntly: "Although hospitals will be solely accountable for payment penalties for 30-day rehospitalization rates under the Affordable Care Act, they will not be able to reduce these rates sustainably without the explicit partnership of community-based providers."
This new reality is put into high relief when it comes to nursing homes and skilled nursing facilities. One in four Medicare SNF patients are readmitted to a hospital within 30 days of discharge, according to the Interventions to Reduce Acute Care Transfers program, known as INTERACT II. And up to two-thirds of hospital transfers are rated as potentially avoidable by long-term care professionals.
INTERACT II helps nursing home staffs identify and manage residents' conditions before they require hospitalization; focus attention on common conditions such as respiratory and urinary tract infections; and improve advanced care and palliative care planning to avoid hospitalization at the end of life.
The Centers for Medicare & Medicaid Services is enlisting hospitals in its own project to reduce preventable hospitalizations of nursing home residents. Tactics might include using nurse practitioners, supporting transitions between hospitals and nursing facilities, and implementing best practices to prevent falls, pressure ulcers and urinary tract infections.
Clearly, hospitals must better understand where their patients go after discharge, whether the care at those facilities is high quality and whether the staffs, from APNs to LPNs, have at least basic training in geriatrics. And hospitals must involve nursing home staff in discharge planning, make sure they understand the protocols prescribed and give them a name to call whenever they have questions.
Nowadays, butting your nose in is the only way to mind your own business.