The Centers for Medicare and Medicaid Services (CMS) defines what a hospital readmission is. “An admission to an acute care hospital within 30 days of discharge from the same or another acute care hospital.” They have created several programs to deal with the problem of readmissions. In an effort to reduce the number of patients returning to the hospital, they have lowered reimbursements to the hospital for medicare and medicaid patients. That can be a real hit to the bottom line. CMS has recognized two key factors in increased readmissions: a lack of care coordination and communication. So the question becomes: What can hospitals do to improve the way we communicate with patients? The answer may be closer than you think. It might even be in your pocket. Secure texting is a mobile solution for a global problem.
What Counts Toward Condition-Specific Readmission Rates?
To better understand the problem we need to understand what readmissions are. CMS uses a formula to measure the facilities’ performance for each of the following conditions:
- Heart Attack
- COPD
- Heart Failure
- Pneumonia
As well as the following procedures:
- Coronary Artery Bypass Graft surgery (CABG)
- Total Hip and/or Total Knee replacements (THA/TKA).
Hospitals are losing money. Kaiser Health News reported all but 174 hospitals of those penalized in 2018 also faced penalties in 2017. They estimate that CMS will withhold $564 million in payments over the next year,up from the $528 million last year.A 2016 study in the New England Journal of Medicine (NWJM) looked at whether or not this tactic is working. They found that readmissions declined 3.7% in 2017 and that the hospitals facing penalties had the greatest decrease overall.The National Quality Forum (NQF) released a 2017 Technical Report examining all-cause readmissions. Again, effective communication and coordination of care are the ideas promoted to help solve the problem. Researchers estimated that poor care coordination and communication gaps resulting in complications and readmissions cost up to $45 billion in wasteful spending.
What Do These Conditions Have In Common?
Advancements in the treatment of all of these conditions have been made, but they continue to be a problem. CHF affects nearly 5 million Americans, with around 550,000 new cases diagnosed each year. That’s a lot of people who could be readmitted. COPD claims more than 120,000 lives a year. More than 12 million have been diagnosed, and another 12 million are likely to have COPD and don’t know it. Adults living with heart failure increased to 6.5 million (2011-2014), according to the American Heart Association’s 2017 Heart Disease and Stroke Statistics Update. And lastly, pneumonia resulted in an average of 3 million cases reported each year and 60,000 related deaths. So what do we have here? We have a mix of sudden and long-term conditions, affecting a broad range of Americans in the millions. These conditions have a high risk of death, cost a lot to treat, and often result in admissions to the hospital.But what is happening in that 30-day window after discharge that leads to these patients readmitting? CMS, NQF, and many others have agreed, a lack in coordination of care and communication is a key factor.
Solving The Communication Issue
Many organizations spend a good deal of time trying to understand which of their admitted patients are at risk for readmission. But what to do with that data? Some institutions hire a full-time employee to make follow-up phone calls, but many have opted for the more modern-day solution of secure texting. Patient communication apps allow providers to stay connected with their patients when they are at the greatest risk of readmission, normally the time period between discharge and an in-office follow-up appointment. Providers can address common concerns such as symptoms the patient is having, complications, questions about medications, and appointment reminders. Your organization may even have a disease specific “champion” (ex: Heart Failure Coordinator) who is responsible for monitoring and follow-up. But do they have the tools necessary to do their job efficiently? They do if they’re using secure texting.Discharge education provided to the patient is not enough to solve the problem. You may think the EHR is the natural solution, but the EHR is built to support billing, not the full cycle of patient care. When the visit or account is closed, the channel of communication and documentation is turned off. But the conversations need to continue.A secure texting app allows you to have “conversations” with caregivers, specialists, and the patients themselves long after they’ve left the hospital. Texting apps with EHR integration capability allow that conversation to flow back to the source of truth, the EHR, documenting the care and concerns, even between visits.
Consider this scenario:
Ms. Smith has a heart attack and goes to the ER. She gets a stent in the cath lab and receives post op care, education, and is discharged. While at home she struggles with her new normal. She attempts to understand the lifestyle changes she needs to make, but there are quite a few. She changes everything, diet, exercise, stress management, and tries to stick to a complex medication schedule. Ms. Smith tries her best, but she lives alone and has limited resources. All of the change leads to her missing her follow-up appointment, but she reschedules another two weeks out. On day 28, she experiences chest pain. Does she take the Nitro or was that only if there was shortness of breath, too? Is this just anxiety caused by all the change in her life? How can she know? Should she just go to the ER to be safe? Ms. Smith goes to the ER and is re-admitted for chest pain.
Now let’s reimagine it in a world where Ms. Smith has clinical resources at her fingertips:
Post discharge, Ms. Smith receives a text message letting her know her prescriptions are ready. Questions about her new meds are answered by the nurse practitioner that works with her new cardiologist. On day seven, Ms. Smith receives a friendly text with the “Top 3 Things You Can Do To Reduce Your Risk of Another Heart Attack.” The article is timely, helpful, and includes a link to a patient forum where she can meet others in her situation. On day 13, Ms. Smith confirms her follow-up appointment after receiving an appointment reminder. The appointment goes well, and Ms. Smith's’ condition continues to get better. Without the stress she experienced in the first scenario, Ms. Smith doesn’t experience anymore chest pain. Ms. Smith now knows she can talk to her cardiologist via secure texting before heading to an ER in fear.
We Are Ready, Are You?
Some might say that lowering readmissions is simple. We know it takes a team approach. Improving collaboration and communication can only happen when people have the tools to do it. You may already be using standard SMS messaging to communicate about your patients. You know the communication can be critical, but it isn’t a compliant way to share or transmit PHI. Secure texting is here. It is now. Alleviate the concerns of PHI breach by implementing secure texting today. Let us show you how. Contact us today to learn more.
