Readmissions: The Big Picture
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"The hospitals in the higher range have a less synchronized and less coordinated medical staff leadership structure," he says. "Therefore, care is delivered in a silo fashion without regard to the patient as a whole. How we got down to 8% is we got into clinical service line management."
WellStar expanded its clinical service line management from seven departments to 11 over the years, and includes both its employed and its independent physicians on clinical service line councils, on which more than 100 physicians, both independent and employed, serve. Those councils meet and figure out how physicians can and should collaborate on the sickest patients.
Further, under an accountable care organization, the health system can redistribute dollars to allow primary care physicians to spend time they need on, for example, predictive modeling, care managers, and call centers for medication management.
"Quality of care to the patient represents the keys to the kingdom," says Jennings. "You'll cut some revenue if you tackle all-cause, but if you go after the easy-to-solve issues on readmissions, you won't always get there. That's why we got into Medicare Shared Savings: We saw the wisdom of attacking all spectrums simultaneously."
One of the key strategies that healthcare organizations should consider to get to the best practice of all-cause readmissions prevention is to look at ways they can identify patients who might be at higher risk of readmissions, as WellStar has begun to do, says Huron's Jacquin.
"More clinically integrated systems can accomplish this better, and that's an opportunity for some revenue," she says. "But the bottom line is, it's not something you can turn on overnight."
She also says such leaders recognize that doing medical management work with an eye toward reducing readmissions is going to impact revenue negatively, but it's the right thing to do and will pay off in the long run as penalties are increased and diagnoses added.
"At this point, there's not really much you can do to limit the revenue impact," she says. "And besides, CMS won't sit still."
Leaders need to develop different tools and different approaches for high-risk, moderate-risk, and low-risk patients, but most important, they must identify such patients.
"Building these things anticipating all-cause means it won't be quite as difficult later," she says.
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