In the face of increasing patient complexity, hospitals today are actively involved in transfers of care to preserve patient satisfaction and quality. In days gone by, when a patient left a hospital, that patient went home. Today it is a much different story. Hospitals have transitioned away from providing long-term care after acute events, and as a result, the post-acute care (PAC) industry has blossomed.
After an acute care episode many patients are now sent to PAC facilities, including rehabilitation facilities, skilled nursing facilities, long-term care hospitals and home health agencies, all of which provide longer-term health care services to patients after discharge. Though PAC facilities are equipped to care for complex patients, coordinating a perfect discharge is not easy. Hospital discharges to a PAC setting trended upward between 2008 and 2013, and most of these patients were then transferred to a second PAC facility1. Such trends illustrate the massive increase in Medicare PAC spending between 2001 and 2013, from $29 billion to nearly $60 billion, faster growth than all other Medicare spending categories2. Additional services didn’t necessarily stave off readmission; in 2014, 20 percent of Medicare patients were readmitted after discharge3.
Government plans to halve PAC spending in the next decade must contend with the reality of discharge risks4. Readmission after discharge is often a sign of errors in discharge planning or issues with clinician communication. It can also indicate problems with patient education, finding space in an appropriate PAC facility, and reliable quality data to evaluate PAC facilities.
CMS publishes star ratings for PAC facilities, but these ratings are based on annual audits performed in a short time-window: a yearly health inspection, two-week staffing levels, and results for a handful of specific quality measures5. While CMS ratings may provide a standardized metric for providers to track their progress toward certain quality goals, this metric lacks adequate data resolution for a user to know what the real story is on the ground.
According to Tim Goux, CEO of CareRise, a company that aids post-acute facilities in comprehensively measuring and improving performance, high staffing and patient turnover could transform a PAC facility into a place that does not resemble its rating whatsoever in just a few short weeks following an audit. “CMS is not in the business of providing the ongoing support to providers in bettering their performance results,” he says.
Goux founded CareRise nearly two decades ago, when a boom in medical malpractice lawsuits dramatically increased professional and liability insurance premiums almost overnight6. At the time, Goux was CEO of his family health care company, which had a multi-business portfolio, including PAC facilities. “I was the one getting the call from my insurance agent telling me that insurance premiums for one of our facilities were tripling, and this facility didn’t even have any lawsuits or claims at the time,” he says.
For Goux, the fundamental solution was getting a better handle on risk management. He set out to develop a boots-on-the-ground approach to manage risk in PAC facilities based in clinical measures and supported by technological tools. As a result, the company’s clients exceed industry averages by 40 percent on key metrics such as frequency and severity of insurance claims. Most recently, CareRise has attempted to improve upon CMS’ rating methodology by taking clients’ data and generating the CRI|CareRise Index® benchmarking score, an up-to-quarterly quality score incorporating data as close as possible to real time and including information on quality and safety, staffing, and patient satisfaction.
“This score is a great addition for patients, hospitals, and care facilities because it gives everyone something concrete to take to market,” says Clint Maun, founder of Maun-Lemke Speaking and Consulting, LLC, and four-decade veteran of the health care process improvement consulting industry. “Health care is generally different: Customers don’t want to be customers. They didn’t want to be sick and don’t want a post-acute stay, so they’re wondering if they have to stay, where will they get great care,” he adds. For PAC agencies, an on-the-ground solution makes regulatory compliance easier. For hospitals, an updated and robust set of quality data for post-acute care facilities ensures patients will be placed appropriately. For patients, quality and satisfaction are more accessible. For insurers, costs go down everywhere.
Maun tells his clients they should abandon the discharge mindset in favor of one focused on coordination and navigation. Transitions to post-acute care, he says, can happen very well with the right service and right information to coordinate the moving parts: “The whole transition of transferring a person is a handoff in a football game — there’s a chance you’ll fumble. So, it must be a handover, holding on to that relationship to make sure the transition is successful and safe. The patient needs good information and communication to be shared, especially since people are showing up with increasingly complex conditions.”
In a world where care is only becoming increasingly complex, and data is liable to pile up in indecipherable mountains, a solution that enables all key players to achieve successful outcomes, reduces dissatisfaction, improves health, and saves money sounds too good to be true. But, it is this attention to detail that may be the future of health care’s unending demand for metrics to build improvement. Goux is abreast of this trend in CareRise and the CRI|CareRise Index®. “Our goal with CRI|CareRise Index® is to be the ‘J.D. Power – Google’ of post-acute care ratings,” he says.
Indeed, a shift in hospital function toward becoming a command center, rather than a catchall provider, for care has led to the demand for better systems to aid in discharge7. Resulting changes in technology and monitoring capabilities in health care have assisted case managers in achieving quality goals, and financial incentives spur the free market to turn out increasingly comprehensive and innovative solutions.
1 American Hospital Association. (2015, December). The Role of Post-Acute Care in New Care Delivery Models. Retrieved from http://www.aha.org/research/reports/tw/15dec-tw-postacute.pdf
2 Tian, Wen PhD MD. (2016, May). Healthcare Cost and Utilization Project Statistical Brief #205: An All-Payer View of Hospital Discharge to Postacute Care. Retrieved from https://www.hcup-us.ahrq.gov/reports/statbriefs/sb205-Hospital-Discharge-Postacute-Care.pdf
3 The Dartmouth Atlas of Healthcare. (2014). Percent of Patients Readmitted within 30 Days of Discharge, By Cohort. Retrieved from http://www.dartmouthatlas.org/data/topic/topic.aspx?cat=30
4 Medicare Payment Advisory Commission (2017, March). Report to the Congress: March 2017. Retrieved from: http://www.medpac.gov/docs/default-source/fact-sheets/mar17_medpac_report_factsheet.pdf?sfvrsn=0
5 Centers for Medicare & Medicaid Services (2017, April). Five-Star Quality Rating System. Retrieved from https://www.cms.gov/medicare/provider-enrollment-and-certification/certificationandcomplianc/fsqrs.html
6 The Council of State Governments (2003, May). Trends Alert: Medical Malpractice Crisis. Retrieved from http://www.csg.org/knowledgecenter/docs/TA0304MedMal.pdf
7 The Economist (2017, April 08). How hospitals could be rebuilt, better than before. Retrieved from http://www.economist.com/news/international/21720278-technology-could-revolutionise-way-they-work-how-hospitals-could-be-rebuilt-better