Health Reform: How Hospitals Should Prepare

In the wake of all the health reform discussion, one important issue is rarely raised: Quality of healthcare. Most of the attention is on health insurance and covering the uninsured. However, we know quality reform is on the President's agenda. From the White House website:

"The President’s plan includes proposals that will improve the way care is delivered to emphasize quality over quantity, including: incentives for hospitals to prevent avoidable readmissions, pilots for new "bundled" payments in Medicare, and support for new models of delivering care through medical homes and accountable care organizations that focus on a coordinated approach to care and outcomes."

You can't count on this going away quietly either, because quality improvement is center in the President's strategy to pay for health insurance for everyone.

This could mean a lot of significant changes will be headed toward providers, especially hospitals. The sooner we prepare, the better. So what should you do to prepare your organization?

We'll focus on readmissions here, since some private-sector initiatives are already in place. First and foremost, start looking at your hospital's readmission rates. Don't track them in all areas? Start. Your quality department might already track readmission rates of open heart patients, but this won't be enough. Surely financial incentives will start with the most common diagnostic groups and eventually be rolled out across the board. For many hospitals, just implementing the ability to track and monitor these readmissions could prove to be difficult. If you're using a manual method, you better start thinking about upgrading your technology and improving your process. Otherwise, it will be very costly to manually track readmissions of large numbers of patients down the road.

Once you have an efficient monitoring system in place, you'll need to develop a methodology to determine whether readmissions were clinically related to the initial admission. Make sure your entire team from physicians to coders are properly recording evidence along the way that clearly indicates when readmissions are not related to the initial admission. This could mean re-evaluation of processes, physician and staff education, and building new rules to hold people accountable. As such, this too could prove to be a difficult task, so the sooner you prepare and practice, the better.

With accurate coding data, you'll be able to weed out the unrelated readmissions and focus on those admissions which are related. Only then will you be able to efficiently determine why readmissions are occurring and how you can prevent them. You'll be able to identify trends and sources (such as nursing homes) and solutions will become evident.

Underscoring the importance of reducing readmissions, the Institute for Healthcare Improvement has already begun an initiative to address readmissions. Reducing readmission rates is important from both a financial as well as quality perspective.