Outcomes Reporting: It's Waaaay More Than Just Mining MDS
Posted by Jennifer Clement on Tue, Dec 13, 2011
With the October 1 payment changes behind us, the post-acute industry is waking up to the next hot topic: Outcomes Reporting. There are a couple of industry business drivers at play:
1) The first ACOs can officially raise their hands in January, with another option to sign up a few months later. These entities will be looking for partners to meet targets for quality, cost, and importantly outcomes to reduce readmissions.
2) Hospitals, whether they are part of an ACO or not, are looking for partners who can reduce readmissions for the big three focus conditions: heart attack, heart failure, and pneumonia. Hospitals in the top quartile with low readmission rates will be looking for partners to help them stay there; hospitals in the bottom quartile with high readmission rates will be doing everything they can to avoid Medicare cuts.
Readmissions are a national problem, whether you operate in an urban or a rural market. They are responsible for an estimated $17 billion in avoidable healthcare costs to taxpayers, and as a result, will continue to be an attractive opportunity for savings. One in five Medicare patients who is discharged winds up going back to the hospital within 30 days.
Up until recently, nursing homes have been largely off the radar for direct readmission scrutiny. That could all change with a new policy currently proposed by the Obama Administration, one given the nod by The Alliance for Quality Nursing Home Care, a trade organization representing for-profit providers. The Alliance supports the Obama Administration proposal, as long as it takes into account geographic differences related to physician practice patterns. Indirect scrutiny of readmission rates for nursing homes will likely evolve into direct scrutiny. To date it has been indirect, where hospitals are the targets for cuts and nursing homes are being recruited by hospitals to better coordinate care, with the promise of census in exchange. If the proposal passes, everyone – including hospitals and nursing homes with high readmission rates – will be squeezed to lower readmits.
Demand is on the rise for Outcomes Reporting as the new must-have core competency by the C-Suite. Execs are turning to IT and Clinical to team up, mine data, and do detective work to answer questions like: who are we sending back to the hospital? Why? And importantly…what could we have done to keep them? “The data they’re looking for goes way beyond what can be mined from MDSs,” explains Tina Schrader-Berte, RAC-CT, industry Financial & Performance Operations expert with Pro Ed Continuum. “Providers must be ready to take a 360 view of their operation – to root out every possible cause of readmission, and challenge interdisciplinary teams to proactively drive programs that have measurable results. Data-driven decision making will be essential.”
Outcomes Reporting, must, as a result, come from every corner of the operation – and be creatively used to challenge the status quo. Outcomes reporting is like a Swiss Army Knife; it has many uses. As a marketing tool, outcomes show hospitals your readmit rates, but the real power lies in dozens of other reports you can use across the spectrum of your clinical operations to drive quality and continuous improvement. The ability to easily mix and match many reports across your operation is key.
Needing more information? Download a white paper “Marketing Your Outcomes: How to Make Your Most Strategic Information Assets Work to Your Competitive Advantage to Win Medicare Census.”