13 October 2013
Author: The ExecuSearch Group
As a part of the Hospital Readmission Reduction Program, one of the many facets of the Affordable Care Act that’s been getting so much attention as of late, hospitals will have even more motivation to increase quality of care as costs rise due to excess cases of rehospitalization. It’s been estimated that the cost of Medicare amounts to more than $17 million each year as a result of hospital readmissions, and much of this issue can be attributed to poor communication and improper post-discharge care—both of which can have long-lasting, serious effects on patients’ health. To help mitigate these risks, hospitals that have a large number of patients readmitted within 30 days of discharge will be fined, not only to lower costs associated with treating future issues but to ensure that patients are getting the proper care to prevent such issues. So how can you ensure that your facility makes quality patient care a greater priority? To help answer this question for you, The Execu|Search Group called upon the expertise of an Associate Director of Care Management for a leading Manhattan hospital. The answer? Consider developing a care management pilot program in a high-risk department, such as cardiology. As a part of this program, hire Care Managers and Coordinators to assist in the patient’s experience and care—from the moment the patient enrolls with the hospital to a set number of days after discharge. Although fees only apply to readmissions within 30 days of the patient being checked out, hospitals should consider providing follow-up care for a longer period of time, especially for those who have undergone serious procedures and/or fall within specific health risk factors. In order to effectively provide this longer-term care, consider organizing a program in which Care Coordinators can prepare patients before their visits, assess their risk of rehospitalization, plan their discharge, and follow up with them on all aspects of their health and recovery post-discharge. Then, call upon Care Managers to provide all services within the hospital to make the patient’s stay comfortable and informative. “With the implementation of Healthcare Reform and the Affordable Care Act, we are seeing a steady rise in demand for Care Management professionals,” says Amanda Bleakney, Managing Director of The Execu|Search Group’s Healthcare division. “Both healthcare organizations and patients are seeing the need for a strong clinician with knowledge of reimbursement processes to help navigate their healthcare. Care Management professionals help patients through these processes at the times when they need the most guidance.” Such professionals don’t just manage medical needs. They connect patients with all the facets of their unique care plan that are conducted outside the hospital, such as social services or physical therapy. To foster these connections and facilitate proper communication, you should ensure your program trains and meets with a variety of professionals, including pharmacies and outside facilities to ensure they can provide a comprehensive spectrum of care for patients and their unique needs through the end of the predetermined time period. As a result, patients can be better informed and monitored, ensuring that they understand their needs and medications, which in turn helps prevent rehospitalization and long-term health issues. Certain patients may be higher risks than others, and that is when Care Managers and Coordinators are especially helpful. They can perform a risk assessment prior to a patient’s visit and determine certain factors—low literacy, difficulty with English, hesitancy or reluctance toward medication—that can pose them as a high risk for rehospitalization in the future. From there, Coordinators and Managers can work together to make sure the patient’s needs are met and that they are properly monitored with follow-up calls and visits for the duration of the post-discharge care period.