The Truven Health Blog

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

 

Need More Evidence that Patient Education Can Reduce Readmissions? Start Here.

By Truven Staff
Arti Bhavsar imageAs healthcare practitioners and administrators, we are keenly aware of the complexities associated with preventing readmissions. Common questions that come to mind when tackling the readmissions dilemma include: What patient care and education interventions can we implement? Do we have a solid transition of care program? What is the cost impact to my organization, from direct costs to loss in reimbursement? Most importantly, how can we embed sustainable programs to avoid readmissions? 

Take for example the impact of medication management related issues as a factor for readmissions. In an evaluation conducted by Feignbaum, et al. at Kaiser Permanente, researchers studied factors contributing to readmissions within 18 hospitals (1).  Medication management issues impacted 28 percent of preventable readmissions and were identified as one of the top five areas for to prioritize for organizational intervention programs. Upon interviewing 189 patients and caregivers, researchers found that 32 percent of patients indicated they would have liked to have received more communication regarding their medications, and of these, 73 percent of caregivers indicated that lack of information was one of the components that lead to a readmission (1). This data, coupled with a recently published article by Mixon, et al. focusing on post-discharge medication errors, highlights a significant area of opportunity to prevent medication management related issues. The study indicates that medication errors ranging from omissions, commissions, and misunderstanding in indication, dose, and frequency were found in 50 percent of patients after hospital discharge (2). The groups most impacted were those with low health literacy and numeracy scores (2). These statistics are sobering and should make us want to re-evaluate our current approach towards medication-related patient education in order to improve our practices to reduce the risk for patient harm and eliminate avoidable readmissions. 

When creating a strategic approach to reduce medication management related readmissions and errors, organizations should consider the following areas of improvement:
  • Integrate medication handouts into Electronic Health Records (EHR) to optimize clinician work flow and enhance the patient discharge process
  • Provide patient education handouts that adhere to health literacy standards to improve patient comprehension and retention of medication management related topics with tools designed for those with greatest risk of non-compliance (low health literacy and numeracy)
  • Embed a “Teach-back Process” to validate patient and/or caregiver comprehension of the medication management related information provided
  • Provide low-literacy aids to augment learning with tools such as pill-boxes, text messages, and/or daily medication schedules
These interventions are not only meaningful for the clinical outcome improvement results they can provide, but they are also aligned with safety, regulatory standards, and compliance standards that lead to higher reimbursement payments. These incented standards range from reduction in readmissions related to medication management events, to attestation for Meaningful Use Stage II criteria for integrated patient education and improving patient satisfaction scores as evaluated by the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. 

Pharmacists, physicians and nurses, it’s time to ask yourself how your organization is approaching medication-related patient education. Has your organization mobilized the medication-related experts who impact care decisions at the point of care? Do you have the opportunity to improve your work flow to make time for caregivers to exercise best practices in education on discharge? Do you know how many patients you are discharging with medication errors? These questions can help you on the journey to reduce your medication management related risk and improve your organizational approach.

Arti Bhavsar, Pharm.D.
Consulting Manager

Are Doctors Learning From Hospitals?

By Truven Staff
Michael R. Udwin imageAs suggested in the recent article from Kaiser Health News, in collaboration with The Washington Post, “Medicare Announces Plans To Accelerate Linking Doctor Pay To Quality,” physicians will soon be confronted with a reality that hospitals have already experienced. With reimbursement currently at risk for readmissions, perhaps doctors can learn from hospitals as they adjust to a new world.

Hospital reactions to pay for performance have varied dramatically, from denial to indifference to dread. Those that have fared best recognized the importance of data and understanding their unique position within the care continuum. They began by asking the right questions. If heart failure readmissions were too high, they posited the “why.”  They were not afraid to pursue the follow-up questions, including “What populations are at higher risk?”, “Is this related to process or provider-related?” and “What needs to change within our control and outside our walls?”

Although doctors often pride themselves on the desire to deliver top quality care, in the office much of the focus for many has been on establishing an efficient, sustainable practice. Through hospital employment and other alignment strategies, physicians of late have begun to view their role as team member within an organization. As co-management of patients takes hold and process measures begin to meld with outcomes, this team approach will become even more important.

For some this will be a new way of viewing performance in the outpatient space.  Quality does count, as suggested in the article. And now more than ever, doctors can learn from hospitals, as they leverage data and ask the right questions to ensure the best for their patients.

Michael R. Udwin, MD, FACOG
National Medical Director

What Financial & Operational Topics Were Top-of-Mind at HFMA's ANI?

By Truven Staff
For many of us, the Healthcare Financial Management Association's (HFMA) Annual National Institute is the best meeting of the year. In addition to hearing excellent general session and breakout speakers, it’s an opportunity to visit with long-standing friends and to engage with new colleagues. It’s always impressive to hear their thoughtful opinions on current and future challenges, and this year was no different. Here’s what I heard this year in Orlando, Florida:

  • Hospitals and health systems continue to identify creative processes to address cost and productivity. But they still question whether their efforts will be sufficient, if anticipated reductions in reimbursement occur.
  • Reimbursement is key. With dismal returns on investment income and sharp declines in contributions, the emphasis on revenue cycle has never been more acute.
  • Many organizations estimate that if Medicare and Medicaid payments are reduced, additional cost reductions could be in the range of 15% - 25% of current operating expense. 
Becker's Hospital Review also spoke with 10 experts about the biggest issues impacting hospital CFOs today, and my thoughts are included there too.

Phil Gaughan
Senior Director of Operational Improvement

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