Читать книгу You Make the Call - Healthcare's Mandate for Post-discharge Follow Up - Kristin Boone's Baird - Страница 10

Another key reason hospitals implement PD calls is to improve clinical outcomes. You want to make sure that patients understood their discharge instructions and what to do next. PD calls help to validate patient comprehension and follow through of the instructions. They also give the opportunity to reinforce teaching.

When people are in a hospital, they often become very compliant because they feel vulnerable and out of their comfort zone. In fact, many people become highly compliant just to get through the ordeal and out of the hospital. But, once patients get back home in their familiar environment, a false sense of security often takes over. In such cases, and especially if patients are feeling better, they become convinced that things aren’t so bad, and they can resume normal activity.

Once a patient is feeling better, the less motivated he is to follow up on the discharge instructions, including medications and physician appointments. Or, if there’s been rehab or some other follow-up care needed, he may rationalize that it isn't really necessary. After all, the patient feels fine now.

This mindset, or false sense of security, is one of the most important reasons for making a PD call. First, the call continues the great care that you gave while the patient was in the hospital. Second, it reminds the patient that just because he is home and, perhaps, feeling better, it doesn’t mean he should ignore the treatment plan. This type of reminder improves clinical outcomes.

Improving clinical outcomes has additional implications in today’s reimbursement environment. Readmissions are costly to payers and disruptive to patients. But now, readmissions of a specific diagnosis-related group (DRG) have financial ramifications. The CMS have begun monitoring specific patient cohorts, which are currently being tracked on the CMS Hospital Compare site. The first three DRGs listed under evaluation for readmission rate include heart attack, heart failure, and pneumonia. The CMS will use a severity-adjusted methodology to calculate what is deemed an excessive readmission rate for each organization evaluated. Then, based on the calculation for excess readmissions, each organization could be penalized a portion of its reimbursement in the event of excess readmissions.

I won’t pretend to be an expert on the reimbursement aspect of either the readmission rates or Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS), and I highly recommend that you familiarize yourself with the CMS calculations and regulations. Keep in mind that these maximum penalties are going to continue to grow over time—up to 2 percent in fiscal year 2014 and 3 percent in fiscal year 2015—and they’re going to continue to add more patient groups to those that are already being tracked for avoidable readmissions. In the future, additional DRGs that could be added include COPD, bypasses, angioplasties, and other vascular procedures.