Access can prevent 30-day readmissions
Collaborate with clinical leaders
Most readmission efforts are focused on patient education and engagement during and after discharge, says Paul Shorrosh, founder and CEO of AccuReg Patient Access Solutions in Mobile, AL.
"But to effectively avoid readmission penalties requires intervention at the front door, in addition to education at the back door," he says. Shorrosh recommends these approaches:
The patient access team should be empowered to detect and alert clinicians prior to an admission.
"But how will registrars know when a patient has been in the hospital within the past 30 days? The answer is automation and exception-based workflow technology," says Shorrosh.
In real time, after a Medicare patient is registered, systems can automatically check against the hospital’s historical accounts to determine if the patient has had an inpatient stay in the past 30 days. "If diagnosis codes are captured in scheduling or registration from physician orders, the results can be narrowed down to the big four’ conditions CMS [Centers for Medicare & Medicaid Services] is targeting in 2014," says Shorrosh. These are heart attack, heart failure, pneumonia, and chronic obstructive pulmonary disease (COPD).
"Even without diagnosis codes, an automated process can effectively flag patients who have been inpatients in the past 30 days in a work queue, with priority alert pop-ups," says Shorrosh.
Scripting can be provided on what to do next, such as to inform the physician, nurse, or case manager. "The appropriate person can confirm and manage the situation, with the option to change the admission plan to observation, a treat-and-release plan, or a home health plan," says Shorrosh.
Patient access leaders need to work with clinical leadership to understand the transition of care from the inpatient setting to the ambulatory setting, says Larry E. Stuckey II, managing director of the Huron Consulting Group.
"Through this understanding, these two areas can work together to establish the appropriate scheduling protocols to ensure that a patient’s post-discharge care is scheduled timely," he says.
In organizations with highly efficient patient access areas, he says, patients can access post-acute care follow-up visits with primary care and specialty physicians within 48 to 72 hours. "Quick follow-up post hospital stay is key to ensuring a patient’s understanding of medications and coordination of ongoing testing and outpatient care," says Stuckey.
Adherence to the scheduling protocols should be one of the metrics that is measured as a strategic initiative is developed and implemented to decrease readmissions, he says.
"Patient access can impact the availability of care post-discharge to determine if this adherence is yielding fewer readmissions," Stuckey says.