How to Grow Your Health Care Network While Preventing Readmissions

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Generotti_LBy Linda Generotti

A few years back, Becker’s published a 10-point hospital acquisition checklist. The regulatory changes of the Affordable Care Act demand we add an 11th factor: readmission rates.

Readmissions have long indicated the quality of the inpatient stay, and they are a primary contributor to the high cost of health care. But because hospitals are now taking on more risk-sharing agreements, the focus is turning to the impact of post-acute care quality on readmission rates.

Simultaneously, health care mergers and acquisitions are happening at a breakneck pace. Hospital networks in a state of growth must now work to reduce readmissions in their existing properties and plan to do the same in newly acquired properties. The sections that follow outline three key steps to reducing readmissions during periods of growth and acquisition.

Assess the target hospital’s current care transitions procedures and readmission/penalty data.

As a health care network grows – through acquisition of in-patient facilities, other hospitals, and/or physician practices – due diligence activities must include efforts to understand the best practices of the newly inherited organization.

Given the deviation between quality standards (and the government’s lack of agreed-upon measurement), it’s likely that the target organization’s current care transitions procedures look drastically different from the acquiring network’s. Keep in mind: The bigger your organization is, the more challenging it will be to ensure quality and consistent protocol across the network.

Many individual care settings have unique characteristics that must be acknowledged prior to procedure changes. For instance, if acquiring a sole community provider, there may be population-specific needs that the buying organization does not typically accommodate. Such services would need to be preserved in the acquired hospital. In the case of a metropolitan-area provider, careful examination of readmission and penalty data can drive decisions about where to consolidate operations or launch centers of excellence.

Understanding the gap between organizations is a challenging but critical step before introducing procedural changes. Once the research reveals penalties and procedure gaps, you can prioritize corrections accordingly.

Establish the priority status for integrating new care transitions procedures.

Once a thorough assessment of care transitions procedures is complete, the findings should be measured against the acquiring network’s existing standards. Readmission rates and penalties for the acquired hospital will determine how quickly remediation should begin.

In general, procedures for patient intake and transition of care should be prioritized for standardization, particularly if the network participates in value-based reimbursement arrangements.

Engaging case managers and social workers is especially critical at this stage, so that each team can outline what’s working well and what needs improvement in their respective facilities. It’s risky to assume that wholesale changes can be made to the acquired organization without deeply understanding the needs of the patient population and available surrounding resources. That’s why case manager input is vital when planning to integrate new care transitions procedures.

Choose technology that can be used across the network and easily integrated with future acquisition targets.

Just as procedures differ greatly between separate organizations, so do EHR and medical software. Merging an acquired organization’s EHR system with the main network platform will undoubtedly be a daunting task. Hospitals in growth mode can mitigate risk by selecting software that can be quickly and easily deployed to any newly acquired hospitals or practices.

Such software is often referred to as incremental technology, hyper-focused on solving one piece of the puzzle to create greater impact overall. RightCare, for instance, is a software used specifically for patient intake, risk assessment, and care transitions planning – all of which reduces chances of readmission. Plenty of other apps and services are making their way into modern hospitals, as well.

Incremental software, which typically integrates with EHR systems, can be implemented across organizations in less time and with less effort, leading to faster quality improvement and ROI. When assuming risk, it becomes a valuable tool to manage the ecosystem of patient care inside your network and out.

In a state of growth, healthcare networks need to provide the “connective tissue” between hospitals and post-acute facilities. Technology makes that possible with tools for sharing information and connecting with patients.

Linda Generotti is the Vice President of Business Development at naviHealth (www.navihealth.us), a post-acute care management company. She has a B.S. in Health Policy in Administration, and more than 35 years of experience in healthcare IT.