As part of the healthcare profession, most likely you are aware of measuring rehospitalization outcomes as a result of the relatively new Medicare rehospitalization guidelines. But maybe you don’t quite understand what those guidelines are, how they affect your organization, or why you should pay close attention to them. And if your rehospitalization outcomes need improvement, how do you make these changes?
Rehospitalization Outcomes and Medicare: Why it Matters
Medicare is tightening its leash on reimbursements for hospital stays, rehab and home health and hospice episodes. Consequently, knowing your rehospitalization rates, the rates of your hospital partners and making their prevention a top priority is essential.
The Effect on Hospitals
What’s all the buzz about surrounding hospital readmissions? According to CMS, unacceptable readmissions with the same diagnosis occur thirty days or less from a patient’s discharge. To give you an idea of the scale of this issue, fewer than 800 hospitals—out of a total of 3,400 subject to the Hospital Readmissions Reduction Program—met Medicare’s requirements to avoid penalties in fiscal 2015. As for the others not meeting the requirements? They are suffering from up to a three percent cut in reimbursements from Medicare.
The Effect on Home Health and Hospice
The fallout doesn’t stop with hospitals, and they aren’t the only healthcare organizations required to measure their hospital/rehospitalization outcomes. Reporting specific outcomes is required if you run a home health or hospice agency.
How do these outcomes affect your bottom line? If the rehospitalization outcomes you report are consistently poor—or if you fail to report required outcomes to CMS—then your reimbursement rates for the following fiscal year are lowered. For home health organizations, these outcomes include emergency room visits as well as acute hospitalizations.
Additionally, the home health, hospital and SNF outcomes reported to CMS currently are posted online for consumers to view. Plans are in the works to have Hospice Compare results online in the spring/summer of 2017. As a result, any potential clients, their families and medical professionals can search your outcomes. Then, using this outcome information, they determine whether or not to choose your agency to provide client care. If your outcomes aren’t considered acceptable, you may lose business.
The Effect on Clients
Needless to say, all private pay and Medicare clients want to remain in their homes. This is one of the primary reasons homecare services are retained. Trips to the emergency room and hospitalizations disrupt lives, making clients frustrated with the level of care they’re receiving from your organization.
Addressing the Issue of Rehospitalization Outcomes: Education for Aides
Although preventing hospitalizations seems daunting, negative rehospitalization outcomes can be easily overcome. Homecare agencies can provide the best care possible for clients, secure their reputation within the community, and ensure good relationships with referral sources by providing advanced chronic disease education for aides.
Chronic disease education gives aides the knowledge and experience they need to provide top-notch care to clients suffering from long-term conditions. Often these elderly clients are not able to do the basic tasks necessary for improving their quality of life—such as managing multiple medications, maintaining personal hygiene, and preparing healthy meals.
Therefore,with advanced chronic disease education, aides are able to help you improve rehospitalization outcomes by:
- Understanding how to care for clients after they leave the hospital;
- Knowing the warning signs of condition deterioration;
- Having knowledge of common symptoms of various chronic diseases;
- Comprehending when to call for help.