The U.S. Centers for Medicare and Medicaid Services (CMS) estimates that more than 2,500 hospitals in the U.S. (almost half the total number of 5,564 registered hospitals in the country) will face reduced Medicare reimbursement in FY 2018 under the Hospital Readmissions Reduction Program (HRRP). Under this program, CMS withholds up to three percent of regular reimbursements for providers if they have a higher-than-expected number of readmissions within 30 days of discharge.
Medicare uses an “all-cause” definition of readmission, meaning that hospital stays within 30 days of a discharge from an initial hospitalization are, in most cases, considered readmissions, regardless of the reason for the readmission. HRRP focuses on heart attacks, heart failures, pneumonia, chronic obstructive pulmonary disease, elective knee or hip replacement, and coronary artery bypass graft.
While provider reductions will amount to less than one percent of their Medicare inpatient payments, the amounts may be significant enough to impact the financial health and operations of most healthcare providers. Current estimates for FY 2017 put these reductions at more than $525 million, up more than $100 million from the previous year. And it is important to note that this increase is due mostly to more medical conditions being measured since the 30-day readmission rate been declining in recent years to its current level of approximately 18 percent.
Look Beyond the “Usual Suspects” for Solutions
The reduction in readmission rates since the implementation of HRRP suggests that providers have adopted new system-wide processes to address their readmission rates. These steps will, however, have an operational limit on how much they can reduce readmissions. At that point, providers will need to take a look at innovative, and perhaps even unconventional solutions to improving patient care before, during and after patient discharge to reduce the probability of readmission and HRRP penalties.
Two areas that are often overlooked as possible solutions are how much time physicians spend with patients and how effective this time is in enhancing treatment and treatment outcomes. Recent studies clearly indicate that while patients are generally satisfied with their physicians, only 11 percent report feeling they have “all the time they needed” with them. Physicians are also feeling this “time crunch,” with only 14 percent reporting they feel they get enough time with individual patients.
This lack of time is only bound to get worse given the operational and financial dynamics of today´s healthcare industry. Given the uncertainty of possible new regulations and the pressure to at least break even, providers will be further pressed to maximize the utilization of available resources – time being one of them. The risk for pressuring physicians to spend the minimal time possible with patients is perhaps highest in managed-care settings, both capitated and noncapitated. Some are already blaming managed care for further shortening patient visits.
In addition to reducing the amount of time that can be spent with patients reviewing their after-care programs, including follow-up doctor visits, shorter visit times have also been shown to have two other outcomes that can negatively impact a provider’s financial health. The first is that shorter patient-physician visit times have been shown to increase the number of prescriptions a patient receives from their healthcare provider, especially with the elderly. This can increase the possibility of new issues caused by the medications which can trigger a readmission. The second is that shorter visit times often result in a higher number of malpractice complaints or legal actions against a provider.
Better Communications Skills are the Answer
Studies continue to show that the dynamic and the quality of patient-physician communications impacts both patient health and treatment outcomes. These include, for example, visits based on a “participatory decision-making style” that encourages information gathering and questions on the part of the patient and better listening on the part of the physician. This can translate into better compliance with medication and follow-up visits.
In another study involving patient training, patients ended up spending more time on their health care (with all the benefits that brings) when they spend more time learning from their healthcare provider. The results of this study also suggested that not all of this training time needed to be with a physician.
For the patient, studies have clearly shown that the better educated and informed a patient is, the more productive their time with their healthcare provider. This education also helps them feel more confident in asking questions and partnering with their physician whether in a hospital or office setting.
For providers, learning how to take a more patient-centered approach also enhances treatment outcomes, especially when time is constrained. This includes setting an agenda for the patient visit, paying attention to a patient’s emotional cues, active listening, being clear and direct, and asking the patient questions. And better treatment outcomes generally translate into fewer readmissions.
As time becomes an increasingly precious resource for health providers and patients alike, learning how to maximize the value of time can translate into better patient treatment outcomes, reduced readmission rates, fewer CMS penalties and better provider financial health.