The Truven Health Blog

The latest healthcare topics from a trusted, proven, and unbiased source.

Hospital Readmission: A Marker for Better Transitions of Care

By Ray Fabius/Wednesday, January 30, 2013
Ray Fabius imageThe Medicare penalty is causing hospital systems to pay greater attention to complex patients who are at risk of re-admission.  As one who has focused a tremendous amount of time and energy on population health issues, I can tell you this more intense focus is a great step forward.  To execute this Medicare penalty with fairness, the severity of the population served needs to be considered.  Fortunately, organizations like Truven Health Analytics have developed tools to adjust for the illness burden of the patients treated and can evaluate actual performance against what should occur or can be predicted.  By doing this adjustment, hospitals that treat the poorest and sickest people should not be unfairly penalized.  And no institution or doctor should feel pressured to not re-admit someone in need.

From a population health standpoint, a hospital admission identifies someone in the community who needs more health care and support.  A re-admission is even a greater indication.  Our country cannot have a health care system where nearly 20% of its senior citizens who are hospitalized, return for re-admission within 30 days.  It demonstrates a need for our delivery system to adjust, and transitions of care are an obvious focus for change. 

Most often the physicians and other providers who care for a patient inside the hospital are not the same as those who take over outside the hospital.  The handoff between them needs to be coordinated better, with more complete information integrated in the process. Often as well, the patient has limited resources – physical or financial – to assist in their recovery.  The hospitalization itself, particularly for the elderly, is debilitating.  In some cases, skilled nursing facilities and rehabilitation units need to be better leveraged.  Certainly home care services for many of these vulnerable patients needs to be deployed.  By focusing on a more comprehensive transition of care process for their patients who are most at risk for readmission, hospitals can reduce readmissions and at the same time provide appropriate support for their communities of patients and providers.

Ray Fabius MD
Chief Medical Officer

Readmission Prevention

By Bill Bithoney/Tuesday, January 29, 2013
Bill Bithoney imageCMS has recently imposed penalties of up to 1% of all CMS revenues for hospitals that have higher-than-expected 30 day readmission rates for three diagnoses: congestive heart failure, pneumonia and acute myocardial infarction. Over the next three years multiple other diagnoses will be included. The expectation is that by 2016 all diagnoses will be included in these analyses.

The Truven clinical team has done an extensive review of the medical literature on this topic and has compiled a list of proven interventions can help prevent 30 day hospital readmissions. Key techniques for readmission prevention include:

1.     Employ a discharge advocate/patient navigator that can guide the post hospitalization care the patient will require.
2.     Educate patients about their diagnosis during the hospital stay.
3.     Ensure that high risk patients have a follow-up appointment within seven days of discharge.
4.     Use IT and clinical decision support to expedite care transitions especially by digital transmission of discharge summaries and operative notes to primary care physicians, nursing homes and all clinicians involved in patient follow up care.
5.     Confirm medication plan and reconcile all discharge medications.
6.     For patients who do not speak English, ensure the availability of adequate translators.
7.     Consider affiliation with a patient centered medical home to provide follow up primary care for the sickest patients.
Based on our extensive experience in this area, we have devised successful readmission prevention programs, as well as a readmission risk assessment tool to help focus on types of patients who are most likely to be readmitted. While hospitals can ill-afford the penalties that CMS plans, neither can they afford to deploy all possible resources for all patients.

Funding for Health Insurance Exchanges - Just One Step Toward Better Care

By Ray Fabius/Monday, January 28, 2013
Ray Fabius imageHealth Insurance Exchanges are an important next step required under the ACA. These virtual marketplaces will provide individuals an opportunity to "shop" for the best coverage for their dollar spent. Theoretically, enough buyers will purchase policies through these exchanges that price competition will prevail and health insurance for individuals will be more affordable than it is today.

With affordable options, the individual mandate requiring coverage, and the expansion of Medicaid for low wage earners, our country can approach near universal access to healthcare. Next we must create a health care system with a strong primary care base to support this transition in coverage. The promise of care improvement and care efficiencies is based not only on coverage of all but also timely access to care.

Ray Fabius MD
Chief Medical Officer

Comparing the Quality of Care in Medicare Options and All Plans: A Difficult Task Worth Doing

By Ray Fabius/Thursday, January 24, 2013
Ray Fabius imageAs Dr. Reinhardt has mentioned there is a dearth of evidence in the literature to clearly demonstrate that managed care models are consistently out-performing traditional Medicare models.  Differences in model type (HMO, PPO, POS), in network access (broad versus narrow), and in regional influences and illness burden greatly complicate this effort.  However, from a theoretical standpoint managed care should be superior to unmanaged care.

The pursuit of patient satisfaction surveys and quality and efficiency metrics should be encouraged and required for all health plans regardless of model type.  Those that outperform should be recognized with additional compensation – as noted by my colleague Dr Bithoney, happily this is happening today albeit on a limited basis – and promoted broadly to expand their membership. 

AHRQ, NQF, NCQA and others have worked diligently over a few decades to create measures that can be calculated with administrative data.  With the growing availability of real-time lab and pharmacy data newer metrics are being enhanced.  And as physicians convert from paper records to electronic platforms the task of evaluating the health status of populations over time and against predicted trends will be possible and should be encouraged – particularly by Medicare.  Through the greater use of data including that from diverse and non-traditional sources or ‘big data’ we should be able to determine the best health plans and optimal delivery models, and secure the financial future of this most important program. 

Ray Fabius MD
Chief Medical Officer

Advice to Young Males: See Your Healthcare Provider!

By Ray Fabius/Thursday, January 24, 2013
Ray Fabius imageWhen evaluating the relationship that various cohorts of our population have with health care, it is the young adult male who is often unengaged or even disenfranchised. Young women establish a connection during the reproductive years with family physicians, gynecologists, and obstetricians. As a consequence their health care needs are met and their bonds with trusted clinicians can be leveraged to meet any medical challenge throughout their lives.

Young men, on the other hand, often do not interact with the health care system unless they are quite ill and then often access emergency rooms. This approach limits their ability to take advantage of preventive health services and causes them to receive less guided care when sick. Efforts to change this, whether through provisions of the Affordable Care Act or through ongoing community outreach or employer-based programs can have profound effects on population health and cost containment.

Ray Fabius MD
Chief Medical Officer