Best Practices for Reducing Readmissions Starts with Communication
By Oct. 19, 2015
Two years ago CMS started to use HCAHPS surveys to adjust reimbursement models based on weighted measures, one of which focuses on patient reported satisfaction. Hospitals risk the loss of 1.5% of their Medicare reimbursements, for the Fiscal Year 2015 if they fail to show improvements in both process of care measures and patient experience. That reimbursement cut will increase to 2% in 2017, meaning millions of dollars are on the line for the average hospital facility.
In response, many hospitals are going to extreme lengths to make their patients satisfaction, overall outcomes and thus, their CMS reimbursements. But, they’re often focused on providing creature comforts rather than making major changes in their care practices. Some hospitals are basing their redesign on luxury hotels -- with stone fireplaces, views, and flat screen tv’s -- which is somewhat counterintuitive, since longer length of stay is often correlated with higher risk of complication.
On the other hand, improved communication throughout the perioperative episode directly responds to the metrics measured in the HCAHPS survey. The specifics in the survey cover: extent of communication with caregivers, speed in delivery of help, explanation of procedures, management of pain and post-treatment instructions for recovery, all of which are highly communication centered metrics.
Plus, care continuums with a focus on communication actually produce better results. Findings from a recent study at Tulane, based on six years of data from ~3,000 hospitals nationwide, support the idea that communication with patients is the best way to both improve their satisfaction and reduce readmissions. When combined with strong evidence-based practices, streamlined communication can mean a 5% reduction in 30-day readmission rates.
The basic concept here is simple: the strongest organizations, with the best patient satisfaction scores, are also the leanest, with short LOS, tech-enabled patient + provider communication and low readmission rates. Working to improve the communication in an episode of care is a highly valuable investment.
According to a recent Harvard Business Review article, “Investing in cultural change represents a daunting task for hospitals, investing in amenities might appear to be an attractive alternative.” The authors cite their research which suggests that, hospitals who invest in a proactive, communication-focused strategy average $48 in cost per patient to achieve a 1% increase in patient experience scores. That’s compared to $62 per patient in hospitals who take a reactive-focused investment strategy.
Dr. Bridget Duffy, the former Chief Experience Officer at Cleveland Clinic, has said communication is the most broken aspect of US healthcare. The time patients spend with their physician and care team is measured in minutes. Instructions are delivered on one-dimensional pieces of paper. Leading organizations are looking at new methods for communication and education throughout the continuum that give patients the right information at the right time through an accessible medium, improving their overall care experience.
The moral of the story: investing in communication in order to create a smoother and less stressful process is going to leave a more lasting impression on a patient, than reactive solutions and some time spent with that stone fireplace -- and it’s going to be cheaper in the long run too.