Healthcare organizations face growing pressures and penalties in relation to hospital readmissions, especially in light of value-based reimbursement models. As these challenges combine with an aging population, healthcare organizations are starting to recognize the important role that post-acute care providers have on their bottom line – from regulatory, patient experience and reimbursement perspectives.
Before readmission penalties, improvement toward acute care outcome initiatives focused on patient care within the four walls of the hospital. However, the advent of readmission penalties has increased the need to ensure appropriate care and patient compliance with therapy and discharge instructions after leaving the hospital. Although referrals to post-acute care have been part of the discharge process in the past, formal referral networks and strategic partnerships are becoming more critical than ever.
Even outside a formal collaboration, such as an Accountable Care Organization (ACO), performance expectations are more clearly defined upfront by acute care, and post-acute providers are able to demonstrate their positive impact on outcomes with detailed data and evidence-based care plans.
Post-acute care providers are becoming an important component of acute care’s continuum, but healthcare organizations must choose their post-acute partners carefully, as they are an extension of the healthcare organization’s brand. Partners that enhance the patient experience are essential to maintaining high patient satisfaction ratings, positive community reputation and strong physician referral relationships.
Even when post-acute caregivers identify themselves by their organization’s name, most patients assume they are a continuation of hospital care. The referral partnership is not unlike one friend recommending a restaurant to another friend. If the dining experience is unpleasant, doubt arises about the friend’s ability to judge quality and credibility for future recommendations.
Acute care providers can ensure a successful relationship with a post-acute care provider by taking these steps:
1. Select providers with modern technology that enables real-time data exchange.
Although ACOs routinely ask for specific patient data, other acute care providers should also expect patient progress and outcome information from the post-acute provider. The exchange of this information should take place electronically with standard integration interfaces to improve timeliness and accuracy of data as opposed to telephone, fax or manual data entry.
2. Partner with post-acute organizations that deliver services efficiently.
Particularly for chronic disease patients, compliance with therapy increases when clinical services, equipment and supplies are provided in a timely and consistent manner, immediately following discharge. Look carefully at the provider’s admission processes and care plan enforcement capabilities. Providers who can demonstrate consistent execution against care plans and monitoring of patient outcomes are more likely to be aligned with the financial goals of the health system. Modern technology that can enforce guidelines and facilitate creative, collaborative care approaches are critical foundations for a successful partnership.
3. Expect data to evaluate performance.
Not only should the exchanged data enable real-time visibility into the care that an acute care facility’s patients are receiving, but the post-acute care provider should evaluate this data to determine the reasons for readmission in order to improve interventions. Reviewing trends and identifying causes of readmissions, or inability to reach therapy goals, on a regular basis is a critical component of the acute care-post-acute collaboration. Working together to address patient needs in both care environments leads to better overall patient care and fewer financial penalties.
4. Choose providers with critical expertise.
An effective model of an acute care/post-acute care network may require multiple post-acute providers to access different expertise needed for hospital populations that are most at risk for readmission. Metrics and a description of chronic disease management strategies that provide guidance to clinicians and educators to prevent unnecessary readmissions, reassure acute care providers that the post-acute provider is well-prepared to care for specific populations. For example, a home medical equipment company with respiratory therapists on staff to provide education and ensure compliance with oxygen therapy will report better outcomes than a provider who just delivers supplies.
5. Pick organizations with similar goals and philosophies.
While evaluating other attributes of local post-acute providers, don’t forget the importance of similar goals, mission, philosophy and culture. No matter how successful each individual organization is in the community, a culture clash in a partnership will not work. For example, a hospital that is extremely cost conscious will not work well with a post-acute provider that is extremely care conscious. Both organizations must have the same expectations from the start of the partnership because the reputation, quality of care and lives of patients are at stake.
Selecting the right post-acute partners is only the beginning of a sustainable relationship. Innovative organizations support the collaborative process with monthly meetings that include post-acute providers along with acute care representatives from key clinical areas and discharge planning. By discussing the case load, reviewing outcome reports, and sharing ideas for improvement, the partnership becomes a sustainable effort, strengthening patient care and the bottom line.
As healthcare continues the transition to value-based reimbursement models, acute and post-acute care collaboration that benefits both organizations – financially and clinically – is the future of patient care. By taking steps now to partner with the forward-thinking post-acute providers, healthcare leaders can strengthen financial strategy and ensure success in preparation for this transition, leading to such things as reduced hospital readmissions penalties, improved patient satisfaction and higher quality of care.