Reduce Readmissions by Discharging to Better Nursing Homes

In our experience, a common cause of hospital readmission is urinary tract infection (UTI) associated with catheter placement. This is especially true in the elderly and stroke populations discharged to nursing homes.

The belief is that a hospital treats a patient, sends her back to the nursing home from which she came, only for that nursing home to leave her catheter in too long which subsequently causes a UTI and associated symptoms such as "dizziness and giddiness" that look like they could be stroke related. Thus, the patient is admitted to the hospital, treated and the cycle continues.

Meanwhile, the hospital is unable to cover the cost of the admissions for various reasons: failure to document "present on admission," too many resources were used to diagnose the problem and rule out a stroke, the patient didn't meet admission criteria or payment for the billing DRG simply was less than the cost of the admission.

You can prevent these admissions quite simply by knowing more about the nursing homes to which you're discharging patients. We recommend looking at two pieces of quality information and sharing with families when choosing a nursing home:

1. Percent of long-stay residents who have/had a catheter inserted and left in their bladder (the national average is 5%)
2. Percent of long stay patients who had a UTI (the national average is 9%)

A quick search on nursing homes in our neighborhood yielded surprising results. We found one in Taylor, MI where 20% of long stay patients had a UTI. That's 11% above the national average! One might find that hospitals in that area discharging to this nursing home have higher than average readmission rates and are losing needless amounts of money.

If that is the case, these hospitals should quickly implement a procedure to present these simple pieces of information to families as they are making long term care choices. Armed with the right information, families can find better care for their loved ones and help you improve your bottom line.


Both of these indicators can be found on nursing homes across the country at WhereToFindCare.com. Simply search for nursing homes, click on the nursing home desired, click the Quality tab, then "See Details..." next to the Long Stay condition.

WhereToFindCare.com is working on a free tool to help you with this process. Join our mailing list to receive an update as soon as it is available.

Expediting Payment of Insurance Claims

by Jeff Smolen

If you are reading this, you don’t need to be told that the bulk of your revenue is dependent on the major insurance companies, BCBS, HAP, Aetna, etc… Millions of dollars are spent by practices and hospitals on software to “scrub” the claims before they are submitted to insurance companies, but they don’t get you paid. Now tens of millions more are spent on FTEs to follow up and find out why these claims haven’t been paid.

Usually these FTEs are overworked, inexperienced, and turn over frequently. They also tend to be the lowest paid member of any practice. They spend a lot of time on hold, following up on these unresolved claims which are parked in the 90day+ column. Yet these employees fill a need since they try to get money on the 10%-20% of claims which are rejected, lost or “held in review.”

There is, however, another way to effectively handle the follow up on non responsive insurance companies…harness the power of third party impact.

The reason this approach works for hospitals and practices is that Insurance carrier by-laws and internal policies typically require immediate response to licensed third party contacts. In addition, third party demands move the responsibility for the claim from a clerk to a supervisor, who generally settles the claim more quickly. Even if the claim is rejected, the practice can more quickly move the bill to patient responsibility and resolve the balance issue. Bringing in a licensed 3rd party to pursue delinquent claims leads to a quicker resolution of claims, reduced FTE expenses, increased cash flow/profitability and lower office stress.

Jeff Smolen represents GreenFlag Profit Recovery by Transworld Systems. TSI has been providing medical practices, clinics and hospitals with cost effective A/R solutions for over 38 years. TSI has achieved Peer Reviewed status with HFMA, and has been an Adminiserve Partner with MGMA for 10 years. Jeff can be reached at 313-617-7360 or at jeff.smolen@transworldsystems.com.