Bounceback Be Gone

Re: "Diagnosing and Treating Readmissions" by Michael N. Abrams and Matt Levy in H&HN Daily, Jan. 29

Preventing bounceback (PBB) has many complicated components. The problem of no primary care physician will be solved by the government one way or another. One scenario is to distribute the patients to all available — all — docs and provide the support required to ensure theat patients are appropriately followed. Insert your favorite scenario here. The end result will be the PCP will have to deal with PBBpreventing bounceback regardless of preference or how fair the system is. Gone are the "he's too sick for me so I'll send him to the ER" days. PCPs need to reformulate their game plan from patient distribution to treating a few of them.

I envision a system that would employ PCP clinic -based RN case managers (RNCM) who would be responsible for actively tracking patient care post-discharge. A specialized software package will track individual patient progress through updates maintained by the RNCM. The software would act as the dashboard for the PCP, hospital and payer. The system would be started at the PCP level and later extended to the specialists as well. Once patients are in the system, they can be tracked more easily and stratified into risk groups for prioritization. The patient will have multiple eyes on them throughout the 90-day window.

Docs are happy because their day is not demolished, the patients are happy because they are not heading back to the hospital, the hospital is happy because it sees progress, and the payer is happy because it is not paying for unnecessary care.

Some patients can be better managed and some will simply bounce back. If we can identify and track all patients post-discharge, we have the opportunity to minimize the problem. The software solution is the easy part. Getting everyone involved is the challenge!

P.S. Who pays for what will be worked out. Resources are not the problem.

— Matthew Beals

Local Is Better

Re: "It's 'Do or Die Time' for Hospitals" by Bill Santamour in H&HN Daily, Feb. 5

The long-term implications include the shifting of risk to the hospitals (reducing LOS, readmission rates, ACOs but a stop gap).

An advantage hospitals have is their local presence, which can not be duplicated by insurance companies.

Already seeing vertical integration (what's old is new again.), and those hospitals that can integrate with insurance companies WHILEwhile maintaining their local advantage will win.

— Hank Kearney

It's Not About Patients

Re: "Divided Faces of Change" by Joe Flower in H&HN Daily, Feb. 14

As a long-time clinician, an advanced practice nurse, I wonder if the author has ever provided care to patients in any location, but especially hospitals. In the real world, it is beyond hard to provide patient-centered care today. In fact, I hear staff commenting, "I have no time to think." Now that should scare us. LessFewer FTEs for more efficiency ...… hmm. I would like to see this role-modeled on a busy med-surg unit ...… Technology designed to make things more efficient often requires a long learning curve, and new reports show that the EMHR is consuming more time, not less.

The truly tragic aspect of this hype about what the new law will bring forward [is that it] has little to do with patient-centeredness. I am well aware of the emerging models that will address readmissions in particular. The RWJ project "Care About Your Care" and their its recent report identify the disconnects and highlight a few successful projects. But they are demonstration projects at this stage and there is an endless list of demo projects that eventually fade away for budget reasons. This law was never about patient-centered care, but about the financing of health care. Instead of focusing on what would benefit patients quickly by starting with the low-hanging fruit, such as eliminating HAIs and medical mistakes through incentives and pooling of the savings for uninsured coverage, the march forward was insurance overhaul. So we got into this mess because the focus was on the money (fee for service) and now we are focused on the money but from a different angle.

— Lisa Sams, MSN, RNC
Founder and President
Clinical Linkages