It’s a hospital administrator’s dream: reduce readmissions while providing the best patient experience. But that dream may seem out of reach with the new Medicare 30-day readmission policy in place. It doesn’t have to be.
Take these stories from innovative hospitals. They reduced readmissions by 60 percent by doing what most hospitals don’t: Going outside the hospital.
Your hospital can see the same success, you just have to think outside your own walls.
Examine Your Community
What made the programs at one hospital system such a success was that it introduced “patient navigators.” These navigators would conduct patient follow-ups, ensure they were connected with local care services if they needed them and schedule any necessary doctor’s appointments. This was crucial in an area where patients might not have timely access to a physician, which can result in their return to the hospital with complications. By assisting patients in receiving follow-up care, the navigators also reduced non-emergency uses of the ER by 43 percent—another huge cost savings.
Take a look at your community’s demographics. Is it in a rural area? Can residents afford to travel to and from appointments? Are there physicians’ offices within a reasonable distance? If you answer “no” to any of these questions, you might consider implementing a program—like the patient navigators—that helps patients find and get to follow-up appointments.
Go Where the Patients Are
Valley Hospital in New Jersey reduced readmission rates by sending a medical team comprised of a paramedic, an EMT and a nurse to patients’ homes who were previously hospitalized for heart failure. The team from Valley examined the patient, answered questions, reinforced any discharge instructions and made sure the patient had made a follow-up appointment.
Similarly, a hospital system in Minnesota sends a team of paramedics on home visits to make sure patients who frequently visit the ER are getting the care they need outside a hospital setting.
If after examining your community data or your ER admission data, you find the populations you serve are rural or frequent users of the ER, consider creating and dispatching a team of mobile health workers. The team and the visits they make can cost a fraction of that which your hospital would incur for non-emergent ER visits.
Try Transitional Care
Community Care of North Carolina implemented a transitional care program that involves intensive patient follow-up and monitoring; it resulted in a 20 percent drop in readmission rate. The hospital sent nurses and social workers to check on patients to make sure they were adhering to their medication schedules.
Once a patient leaves your facility you have little control over whether he or she adheres to instructions, makes follow-up appointments or takes medications. Statistically, a large portion of them won’t, but by following the most at-risk patients out of the hospital, your facility can reduce readmission rates from preventable causes. All it takes is looking closer at the community your hospital serves.
