Wednesday, November 16, 2016

3 Ways to Reduce Avoidable Hospital Readmissions with a Patient Experience Contact Center



During 2015, one in five elderly patients was back in the hospital within 30 days.  Some 78% of acute care hospitals — 2,610 of them — were assessed a penalty for excessive avoidable readmissions. Those penalties totaled $428 million. (Robert Wood Johnson Foundation, 2013)

Preventable readmissions represent a substantial portion of unnecessary medical spending. According to data from the Center for Healthcare Information and Analysis (CHIA), the estimated annual cost of this problem for Medicare is $26 billion — $17 billion of which is considered avoidable.

The Readmission Reduction Program, created under the Affordable Care Act in 2012, initially targeted readmissions for patients with acute myocardial infarction, heart failure and pneumonia. In 2016, CMS expanded the target conditions to include chronic obstructive pulmonary disease, total hip arthroplasty, total knee arthroplasty, coronary artery bypass graft and additional pneumonia diagnoses.

In addition to the readmission penalties, hospital reimbursements from CMS are determined by how well the hospital is meeting certain quality criteria including clinical care, safety and patient/caregiver experience. How a hospital handles a patient after discharge can have a dramatic effect on their overall reimbursement.

Enter the patient experience contact center. Yesterday’s call centers processed transactions. Today’s patient experience contact centers are the new communications nerve center. They deliver intentionally memorable experiences that mitigate risk, solidify loyalty and reduce unnecessary readmissions.

Download our case study on how St. John Providence Health System reduced preventable readmissions.  It summarizes how their contact center was central to their solution for reducing avoidable readmissions.

  • Readmission rate declined from 25% to 15%
  • $2.5 million fine from CMS was reduced by $1.9 million over two years
  • Their percentage of primary care physicians with patient follow-up appointments within 7 days of discharge climbed from 30% to 85%. 

The St. John Providence Health System case study includes 4 action steps, 6 success secrets, and 5 lessons learned. Here are three actions you can take now.

# 1 - Create a Centralized Communication Hub 



A key component of discharge care management is scheduling patients' follow-up appointments with primary care physicians within 24 hours of the time they leave the hospital. Hospitals shouldn’t leave that important follow-up visit to chance. Follow-up appointments occur within 7 days of discharge to catch any medical problems before they require acute-care services.

Hospitals should do everything they can to ensure discharged patients keep that first follow-up appointment, including reviewing patients' insurance benefits for appointments and arranging transportation to and from appointments.

It is no longer just about the phone. Call Centers have become Contact Centers, using multiple communication modalities including phone, email, Web-response, and text, to enable patients to ensure that they have engaged the patient in the next steps of care.

#2 - Engage the Caregiver in addition to the Patient


Discharge from hospital to home requires the successful transfer of information from clinicians to the patient and family to reduce adverse events and prevent readmissions. Engaging patients and families in the discharge planning process makes this transition in care safe and effective.

The Agency for Healthcare Research and Quality in their IDEAL Discharge Planning Guide lists five key areas of discussion with the patient and caregiver during discharge to prevent problems at home:


  • Describe what life at home will be like
  • Review medications
  • Highlight warning signs and problems
  • Explain test results
  • Make follow-up appointments


Before the patient is discharged, get the patient’s permission to also contact their caregivers. These are family members, loved ones, neighbors, friends or other trusted individuals whom the patient identifies as appropriate to help them confirm follow-up appointments and if necessary to transport them to medical appointments.

St. John Providence Health System implemented this approach. The result was an increase in their post-discharge kept appointment rate to an enviable 87%. 

#3 - Follow-up with the Patient’s Physician


Not only is it important to make and confirm a patient’s follow-up appointment, you should close the loop by contacting the physician’s office to make sure the patient kept their appointment. If the patient failed to make his or her follow-up appointment, then another round of communication with the patient and/or caregiver is necessary.

Perhaps they didn’t have transportation; perhaps they were confused about the date, or perhaps they simply forgot the appointment. The key is to try to eliminate these obstacles, so that the patient receives the care they need to prevent them from being readmitted to the hospital.

Now you have three initial steps you can take to begin to reduce avoidable readmissions with your patient experience contact center. By standardizing on best practices, you can significantly reduce or eliminate readmission penalties and can concurrently increase your quality scores to earn higher reimbursements. Want to learn more? Click here.



2 comments:

  1. It is unfortunate that accidents happen but that is a well known fact of life that we can in fact do very little about.
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    ReplyDelete

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