Page 9 - SOUTH FLORIDA HOPSITAL NEWS JUNE 2021

Hospitals Can Slash When It Comes to Patient Care

Medicare Readmissions - First Who, Then What

Better Data Analysis, Modeling, Ever ask your team an obvious question and
get vacant stares as a response? Like they either
and Discharge Planning never thought you would ask, or even scarier,
never truly asked themselves?
Fiscal Year 2021 is a difficult year for hospital Medicare As large states like Texas, Florida and
reimbursement. Medicare “will cut payments to 83% of California are predicting huge shortages in
the 3,080 hospitals evaluated” under the Hospital nurses in the years to come, the debate contin-
1
Readmissions Reduction Program. Reimbursement ues why this is happening. Some point to a tem-
2
reductions “from 0.01% to the maximum of 3.0%” will porary drop in program enrollments during the
compound the financial challenges emanating from the pandemic. Others say the pandemic itself is per-
COVID pandemic. manently frightening off would be medical pro-
Research shows on average “patients discharged to fessionals. What is agreed is the lack of nurses
home healthcare had a 5.6% higher 30-day readmission the country is facing over the next decade is BY JAY JUFFRE
rate than similar patients discharged to a skilled nursing real and will have a dramatic negative impact
3
facility (SNF). on patient care.
• For the patient, there is no mortality or functional So, knowing all this is coming, here is the obvious question to ask your
BY RICHARD KLASS outcomes differences between the two groups. team, “what is our organization doing differently to develop, hire and retain
4
• For Medicare and Medicare Advantage plans, home nurses?” Unfortunately, many are doing the same thing they have always
health care is significantly less expensive; “an average savings of $4,514 in total done, but somehow expecting different results. Others however are getting
5
Medicare payments in the 60 days after the first hospital admission.” proactive quickly. They are going on offense by offering scholarships for
• For hospitals, Michelle Marsh of Forma Advisors, Inc. notes that payors want high school seniors who enroll in nursing programs, summer internships
patients directed to the lowest cost of care option. “For hospitals, the challenge is for nursing students, aggressive recruiting tactics, signing bonuses and
identifying the patients at discharge where constant 24/7 monitoring prevents com- unique long-term employment benefits. These organizations are also play-
plications or where a more intensive treatment protocol will avoid an unnecessary ing better defense by enhancing employee engagement programs and devel-
inpatient admission.” oping better strategies to keep the nurses they currently have on their team.
A proactive and analytical approach to post-acute care referrals may significantly So again, ask your team, ‘what are we doing differently?’ The term shortage
improve upon hospital readmission rates, and support cost saving related conversa- is relative. If it is true, Texas would have been short 16,000 nurses in the
tions with managed care organizations. For example, using Medicare data, hospitals year 2020. The question is which organizations are going to put the work
can redirect home health referrals to levels of care with lower hospital risk adjusted in to be 100% staffed and which will be caught trying desperately to fill
readmission rates. Michael Kubica of Applied Quantitative Sciences, Inc. opines vacancies in their hospital, office or surgical center. The patient will never
“readmission rate differentials are significant enough to make it worthwhile for hos- be happier than the people taking care of them, which begs obvious ques-
pitals to understand the best options and influence post-acute care choice where they tion number two, “what if we have no one there to care for patients?” It is
can. Related analysis should include specific comorbidities, severity level psychoso- always first who, then what. Start thinking about the future employees you
cial support and other key factors. Much of the data necessary to perform such an will need.
analysis are collected by Medicare.” Jay Juffre is Executive Vice President, ImageFIRST. For more information on
Kubica suggests “hospitals should study the patients discharged to home health ImageFIRST, call 1-800-932-7472 or visit www.imagefirst.com.
care to understand the attributes leading to a successful post-acute care treatment
outcome versus a hospital readmission. Data analytics and a predictive model of read-
mission risk can be a valuable tool to
advance a hospital’s Medicare reim-
bursement position.”
Emphasizing the opportunity to
reduce hospital readmissions, the data
shows:
• Nationally, 17 million Medicare fee-
for-service beneficiaries were dis-
charged to post-acute care between
2010 and 2016; 39% were referred to
7
home health and 61% to a SNF.
• Analysis by Bill Sampsel of Health
Metrics shows Medicare fee-for-service
covered about 786,510 hospital discharges in Florida in 2020 (27.2% of total dis-
charges). Of this total, 153,770 or 19.6% were discharges to a skilled nursing facility.
Assuming the national proportion is a good approximation, about 306,740 Medicare
discharges were to Florida home health agencies. The number of home health refer-
rals better suited for discharge to a SNF requires study at the hospital level.

Richard Klass, President, 2CY, Inc., can be reached at rklass@2cy4u.com. Bill Sampsel of
Health Metrics can be reached at bsampsel@hscope.com. Michael Kubica, president,
Applied Quantitative Sciences, can be reached at mkubica@aqs-us.com. Michelle Marsh,
President, Forma Advisors, Inc., can be reached at michelle@formaadvisors.com.

(1) Ayla Ellison (Twitter) [November 3rd, 2020], 39 hospitals face maximum Medicare readmission
penalties. Found at: https://www.beckershospitalreview.com/finance/39-hospitals-face-maximum-
medicare-readmissions-penalties.html
(2) Ibid
(3) R. Werner, B. Coe, M. Qi, R. Konetzka [March 11, 2019], JAMA Internal Medicine, Patient Outcomes
After Hospital Discharge to Home with Home Health Care vs to a Skilled Nursing Facility, Home health
care leads to savings despite increasing hospital readmissioncs. Found at:
https://ldi.upenn.edu/brief/patient-outcomes-after-hospital-discharge-home-home-health-care-vs-skilled-
nursing-facility
(4) Ibid
(5) Ibid
(6) CMS, 2017 Data. For calculation of the risk adjustment measure, see
https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-
Programs/SNF-VBP/Downloads/SNFRM-TechReportSupp-2019-.pdf
(7) Ibid

Visit us on the web at

www.southfloridahospitalnews.com
www.southfloridahospitalnews.com

South Florida Hospital News southfloridahospitalnews.com June 2021 9