The Ankota Healthcare Delivery Management Blog

The Future of Healthcare Tech - Interview by PracticeSuite.com

Posted by Jed Hammel on Jan 22, 2015 11:08:00 AM

Ankota Co-Founder, Ken Accardi, was recently interviewed by PracticeSuite.com about his thoughts on the future of healthcare and how technology can play a part.  The full article, entitled, Expert Interview with Ken Accardi About Healthcare Technology , can be found by clicking the link.

PracticeSuiteLogo-2

To get you started though, here are a couple of excerpts from the interview:

 

"Ultimately, healthcare technology will be the key to improving outcomes and reducing costs. Shared health records and care coordination technologies will reduce hospitalizations, reduce costs for redundant labs and diagnostics, and will enable focused and less expensive care to be delivered to the 5% of the population that account for half of healthcare costs."

Ankota_opportunity

"The biggest opportunity that we have to improve care and lower costs is to focus on the 5% of patients who consume close to 50% of the healthcare spend. This requires a trained expert (ideally a nurse case manager) to oversee the care of a group of patients."

Ken and everyone at Ankota is passionate about helping to improve healthcare.  If you'd like to learn more about Ankota's software for home care and care transitions, click here for a demo or click the following link to download our latest white paper,  "Why Care Transitions is the Next Big Thing for the Home Care Industry."

Why_Care_Transitions_is_the_next_big_thing_for_the_Home_Care_industry

Ankota provides software to improve the delivery of care outside the hospital, focusing on efficiency and care coordination. Ankota's primary focus is on Care Transitions for Readmission avoidance and on management of Private Duty non-medical home care. To learn more, please visit www.ankota.com or contact Ankota.

 

Topics: Home Care Blog, Private Duty Agency Software, Home Care Best Practices, Care Coordination, Aging in Place Technology, Home Care, Care Transitions, practicesuite.com

What Can Home Care Learn From a Pizza Shop In Singapore?

Posted by Ken Accardi on Jan 20, 2015 3:39:00 PM

Avi_LiranAround 10 years ago I traveled to Singapore for business and I met a gentleman from Israel named Avi Liran.  Since that time, Avi has started a company that provides consulting services and gives lectures about being happy.  Despite meeting him only the one time, he's been a great communicator.  He writes me on my birthday and I see some of his blog articles on LinkedIn. 

I saw a great blog post that he did last week entitled How to Chase Your Customers Away that I'd like to share with you.

I suggest that you read the full article, but the synopsis is that he and a friend went into a restaurant that was pretty empty, and sat down at a table for four, only to be told that he could only sit at a table for two.  After trying to rationalize that since the restaurant was empty he should be able to sit at the larger table, but the host wouldn't budge, so he left and hasn't been back (even though he was formerly a regular and liked the food). 

He named the restaurant and included their picture in the blog article - ouch.  Then he talks about a different restaurant called ZZAPI where he and a friend were able to sit anywhere they wanted and the staff was very accommodating on all accounts.

 Zappi-excellent-customer-serviceFor me, this is a reminder to all of us about the importance of good customer service.  As a software vendor, I plan to redouble my efforts to be accommodating of customer requests.  As a home care agency, what can you do to provide exceptional customer care?  Please leave a comment if you have best practices.  Perhaps we'll add your idea to our paper "7 Habits of Highly Effective Home Care Agencies."

If you would like to learn more home care best practices from highly effective home care agencies, just click the above link for a free download.  If you'd like a demo of Ankota's software, please let us know.

Increasing_Profitability_via_Care_Transitions

Ankota provides software to improve the delivery of care outside the hospital, focusing on efficiency and care coordination. Ankota's primary focus is on Care Transitions for Readmission avoidance and on management of Private Duty non-medical home care. To learn more, please visit www.ankota.com or contact Ankota.

 

Topics: Home Care Blog, Home Care Best Practices, Aging in Place Technology, home care marketing, Health Care Stories, the real nurse jackie

5 Tips for Providing Better Alzheimer's Care from Dr. Carson Benner

Posted by Ken Accardi on Jan 16, 2015 10:59:00 AM

A friend of mine recently sent me a humorous email about how what we consider success comes full circle from when we are children to when we are nearing the end of our lives.  Here is a a few lines from it:

As you go through life, your perspectives on almost everything will change. How you define success will change as well.  Things that you thought were important at the age of 35 will be useless when you’re 65.  You may not realize it now, but everything will shift. 

At age 4 success is not peeing in your pants. Ankota_kid
At age 12 success is having friends.  
At age 35 success is having money. 
At age 75 success is having friends. 

The punchline is that at age 80 our definition of success is the same as it is at age 4.  

The story reminded me that we face challenges at every stage of life, but keeping your sense of humor about things can help you to handle those challenges. 

Verna_Benner_CarsonIt also reminded me of an interesting Keynote address by Dr. Verna Carson Benner, who related this to dementia in a very serious way via her "Becoming an Alzheimer's Whisperer." training.  She describes a concept that they call the "Theory of Retrogenesis" which draws parallels between the way a child develops function and the way an Alzheimer's patient loses function. 

My original blog summary of Dr. Carson Benner's takeaways can be found by clicking this link, but here are the 5 Tips she outlined:

Five Tips for Providing Better Alzheimer's Care

  1. Don't Quiz, Argue or Reason
  2. If at first you don't succeed, wait five minutes*
  3. To combat repetition, find a "job" for the person you're caring for (such as folding towels or building with Legos(r))
  4. If a loved one complains "My mom didn't have breakfast", or "Nobody has been in to see my dad today", calmly explain that that "Your mom/dad can't remember, and fill them in"*
  5. Old photo albums and songs from the past are likely to connect with the patient because long-term memory lasts the longest.

Ankota is passionate about helping to improve healthcare.  If you'd like to learn more about Ankota's software for home care and care transitions, click here for a demo or click the following link to download our latest white paper,  "Why Care Transitions is the Next Big Thing for the Home Care Industry."

Why_Care_Transitions_is_the_next_big_thing_for_the_Home_Care_industry

Ankota provides software to improve the delivery of care outside the hospital, focusing on efficiency and care coordination. Ankota's primary focus is on Care Transitions for Readmission avoidance and on management of Private Duty non-medical home care. To learn more, please visit www.ankota.com or contact Ankota.

 

Topics: Home Care Blog, Private Duty Agency Software, Home Care Best Practices, Care Coordination, Aging in Place Technology, Home Care, Care Transitions

The Washington Post Says That Google and Apple Want to be Our Doctor

Posted by Ken Accardi on Jan 13, 2015 4:20:00 PM

washingtonpostActually, the Washington Post Article makes even a bolder statement than our title implies.  Their title is Google and Apple want to be your doctor, and that's a good thing.  In my case, Google has become my search engine, my browser, my email, my smart phone (Android) and more.  Apple has become my tablet, my music library, my way of seeing Netflix, and the laptops and phones used by my wife and kids.  Do I think they will become my doctor? Not really.  But their premise is compelling.

latest

Of course I encourage you to read the full article, but here's my synopsis:

  • Google and Apple are making technology that monitors our health on a regular basis (Google Fit and Apple Health Kit)
  • Measures can be weekly, daily, or perhaps hourly
  • If your measurements are trending in a bad direction, you can be alerted and take care of problems before they amount to anything
  • Google and Apple are also good at providing fast access to mass amounts of data.  It is implied that this level of big data analysis can become the basis of better diagnoses
  • Our smartphones have become a main way that we communicate (with email, texting, taking pictures, and social media,) so it will be natural for these to be our main health interface too.

What does this mean for home care?

My opinion is straightforward: Having Apple, Google, and many other innovators focus on health care will make health care easier and more accessible, but any idea of Google or Apple becoming our doctor is not credible, yet...

Apple-logo-e1381167393947

At Ankota, we are more of the mind that your nurse and home health aide are more likely to become your doctor than Google or Apple.  Nurses are trained health care experts who are hands on.  And Home Aides are able to see and assess patients regularly.  By connecting with the right patients (the 10% who spend 3/4ths ot the health dollars), home care professionals can become the new doctors in most circumstances, reducing hospitalizations and increasing quality of life.

If you'd like to learn more about Ankota's software for home care and care transitions, click here for a demo or click the following link to download our latest white paper,  "Why Care Transitions is the Next Big Thing for the Home Care Industry."

Why_Care_Transitions_is_the_next_big_thing_for_the_Home_Care_industry

 

Ankota provides software to improve the delivery of care outside the hospital, focusing on efficiency and care coordination. Ankota's primary focus is on Care Transitions for Readmission avoidance and on management of Private Duty non-medical home care. To learn more, please visit www.ankota.com or contact Ankota.

 

Topics: Home Care Blog, Private Duty Agency Software, Home Care Best Practices, Care Coordination, Aging in Place Technology, Home Care, Care Transitions, google, The Washington Post, apple

Navigating HealthCareLand - A Cool Slide from Disney's Chief Physician

Posted by Ken Accardi on Jan 9, 2015 11:37:00 AM

The biggest Health Care Technology organization and trade show is called HIMSS (Health Care Information and Management Systems Society).  It offers presentations covering many topics across the spectrum of Health IT.

One presentation I enjoyed was from the Chief Physician for Walt Disney World, Michael Hankins (MD, MPH).  In the Ankota blog we generally talk about home care, care transitions and related topics, whereas this topic covered managing care for Disney employees.

In classic Disney fashion, a slide was presented that made healthcare look like a theme park.  Here's the picture, "Navigating Healthcareland".  

HealthCareLand_Ankota_Healthcare_DeliveryWhat Do Some of These Definitions and Acronyms Mean?

I though it might be useful to share what a lot of these terms and acronyms stand for.  And away we go...

  • Billed Amount: Amount charged for care
  • CDHP: Consumer Driven Health Plan
  • COB: Coordination of Benefits - figuring out who pays when, for example, both husband and wife have insurance
  • Copay: An amount that a member pays (e.g., $30 out-of-pocket) when they see a doctor
  • CPT: Codes that are used for specific health care treatments (Current Procedural Terminology) 
  • Deductable: Out of pocket fee paid by the insured person before insurance kicks in
  • DRG: Diagnosis-Related Group - A code used describing treatment for billing
  • In Network: using a physician that has a contract with your health plan in your area (as opposed to a doctor not contracted with your insurance and at a higher rate.
  • EMR: Electronic Medical Record
  • EOB: Explanation of Benefits (a description of what's covered/paid for a claim)
  • ERISA: Employee Retirement Income Security Act (protects plan members)
  • FSA: Flexible Spending Account
  • Grievance: A complaint requiring review and resolution
  • HIPAA: Health Information Portability and Privacy Act - makes sure that personal health information is only shared with health providers who need to know it
  • HSA: Health Savings Account (savings for people with high deductible plans)
  • HMO: Health Maintenance Organization
  • NDC: National Drug Code System - codes used for drug billing
  • Out of Network: a physician or hospital who is not contracted to provide you care (you can generally get care from anyone, but will likely pay more)
  • PCP: Primary Care Physician
  • PDP: Prescription Drug Plan
  • PHR: Personal Health Record.  We highly recommend personal health records be maintained by patients as part of care transition services.
  • POS: Point of Service
  • PPO: Preferred Provider Organization (type of health plan)
  • Pre-Authorization: Some treatments require authorization (e.g., from Primary Care Physician) before seeing a specialist

Why Does this matter to Home Care Agencies?

As I mentioned in the intro, this post is off-topic for our usual home care audience, but I can see two reasons why this is relevant, as follows:

  1. Everyone needs health insurance and hopefully this post can help demystify some of it for you, and
  2. Home Care is poised to play a bigger role in health care, helping to provide ongoing care services and care transitions services to help avoid hospitalizations.

If you're interested in learning more about incorporating a Care Transitions program with your Home Care agency , please download our newest free white paper "Why Care Transitions is the Next Big Thing for the Home Care Industry."

Why_Care_Transitions_is_the_next_big_thing_for_the_Home_Care_industry

 

Ankota provides software to improve the delivery of care outside the hospital, focusing on efficiency and care coordination. Ankota's primary focus is on Care Transitions for Readmission avoidance and on management of Private Duty non-medical home care. To learn more, please visit www.ankota.com or contact Ankota.

 

Topics: Home Care Blog, Private Duty Agency Software, Home Care Best Practices, Care Coordination, Aging in Place Technology, Care Transitions

Health Care Spending and the Opportunity for Home Care

Posted by Ken Accardi on Jan 5, 2015 7:39:00 PM

It is said that "a picture paints a thousand words" and the picture below is a great one.  The story it tells for home care is profound (but I'll keep this to a couple hundred words).

Ginny_Kenyon_Home_Care_Consultant

 

 Let's start with the story that this tells in general:

  • 5% of the population accounts for half of health care spending
  • If you add the next 5% you're at 75% 
  • When you add the next 40% (those with chronic illnesses who are not it the top 10%, you're up to 97%
  • The health half of the population (the healthy people) spend very little

What Does This Mean for Home Care?

 Let's face it, home care is not the first thing that people think of when they think about the health care system, but I think that's good news because there's lots of potential for home care to go beyond ongoing personal care and 60-day episodes of home health.  Home care can play a bigger role in two key ways, as follows:

  1. Chronic Care Management Services: Here's the deal...  Physicians are starting to be incentivized (and penalized) for their performance with respect to their chronic patients, but there's a reimbursement associated with it.  The reimbursement is for patients with two or more chronic conditions in a practice with a certified EMR (Electronic Medical Record) system.  The reimbursement has two levels.  The first level, reimbursed at $42/month, requires a 20 minute check-in (e.g., on the phone) with the patient.  The second, reimbursed at almost $100, requires telehealth. Home care agencies can put a program in place where your best aides are paid $10 for a 20 minute check-in call.  If you charge $32 for this service (leaving a $10 margin for the referring practice) and allocate some of the revenue to your staff nurses and for software, you can provide a great service  and make a reasonable margin.
  2. Care Transitions Services: You can provide services to help transition patients from hospital to home.  Most hospitals are now being penalized for excessive readmissions (see our recent article Kaiser Shares That 2,610 Hospitals will be FIned $428MM for Readmissions).  These hospitals can use your help and there are many benefits to your agency.  We have a new white paper (click below) to teach you about the numerous benefits that your home care agency can achieve.

At Ankota, we love providing home care software, telephony, care plans, scheduling, billing, payroll and all the other basics, but we really love that we can enable your agency to play a broader role in the future oh health care.  We can make a difference together.  Please download our newest free white paper "Why Care Transitions is the Next Big Thing for the Home Care Industry."

Why_Care_Transitions_is_the_next_big_thing_for_the_Home_Care_industry

 

Ankota provides software to improve the delivery of care outside the hospital, focusing on efficiency and care coordination. Ankota's primary focus is on Care Transitions for Readmission avoidance and on management of Private Duty non-medical home care. To learn more, please visit www.ankota.com or contact Ankota.

 

Topics: Home Care Blog, Private Duty Agency Software, Home Care Best Practices, Health Care Reform, Care Coordination, Aging in Place Technology, Care Transitions

The Real Nurse Jackie Shares Life Lessons With Our Home Care Readers

Posted by Ken Accardi on Dec 29, 2014 4:03:00 PM

Ginny_Kenyon_Home_Care_Consultant

As anyone working in the various areas of the health care field probably knows, it tends to be a personal business.  That is, many of us get involved in health care because of our personal experiences with healthcare or the experiences we observed with that of a loved one.

To illustrate this point, we are reposting an article from the blog, Real Nurse Jackie, which is written by Jacqueline Vance, RNC, CDONA/LTC.

We have reposted the article below, but be sure to click the title link to follow The Real Nurse Jackie and her future posts.

With age comes wisdom ... and a sense of humor

Anyone who knows me well knows I idolize my dad. He's taught me so much that there is no way I could quantify it all.

I learned in first grade how to pronounce anesthesiologist (my dad's profession.) I learned from watching him that family is a priority. Dad waited until he finished school, finished his residency and established his specialty before having children because he wanted to spend time with us.

I learned almost every single fairy tale because Dad would act them out with my sisters and me. I learned that you never alter who you are to please people; and if they don't like you that's OK — you'll find someone who likes you just the way you are.

I learned that you are never allowed not to like someone because of their race, creed, religion, etc. After you meet someone and you don't like them, then that's OK. Dad taught use to respect all and that everyone deserves dignity.

Dad taught us things like its important to enunciate because it doesn't matter how smart you are, people won't listen if you don't speak well. Through Dad's eyes, I learned to be amazed at how the human body works and heals. And I learned that he has a heck of a sense of humor, albeit sometimes inappropriate.

My dad recently turned 90 and we had this surprise party. He was surrounded by family and friends who roasted and toasted him. It was heartwarming and validating to hear so many people say what they, too, have learned from my dad.

Then my dad stood up and gave an impromptu speech. He spoke about how much he has learned in this life. He began by declaring that a man is a measure of his friends and family and as you age, that becomes more important. He added that it is a wonderful thing to look back at your life and realize it is a gift — to recognize how delightful it is to be surrounded by family and friends. He continued in that vein until just about everyone had a tear in their eye (or a look of shock because my dad is not really “the sentimental guy”). 

And THEN he said the stuff I would expect from my dad, like, “I've learned that at the age of 90, you pee in Morse code. You just forget what the message is by the time you are done.” And, “When you're younger man, you need an adrenaline rush to feel alive. At this age, a good BM is a life validating experience!”

Yeah, that's my dad. So I keep learning from him, and now I learned that with age not only comes wisdom, but there also comes a wonderful sense of humor.

My dad was my hero and teacher when I was growing up and now he's my role model for growing older. In his unique way he teaches me how to deal with aging with grace and humor. I wish I could have 90 more years of him. I still have so much to learn.

Just keeping it real,

Nurse Jackie

The Real Nurse Jackie is written by Jacqueline Vance, RNC, CDONA/LTC, a 2012 APEX Award of Excellence winner for Blog Writing. Vance is a real life long-term care nurse. A nationally respected nurse educator and past national LTC Nurse Administrator of the Year, she also is an accomplished stand-up comedienne. She has not starred in her own national television series — yet. The opinions supplied here are her own and do not necessarily reflect those of her employer or her professional affiliates.

If you're interested in another personal story, this one from one of Ankota's founders, you can read this article from a few years ago, Founder's Passion for Health Care uncovered in Daughter's Essay.

If you're interested in recieving Ankota's paper on Home Care Best Practices, 7 Habits of Highly Effective Private Duty Home Care Agencies,  just click the link. 

Increasing_Profitability_via_Care_Transitions

 

Ankota provides software to improve the delivery of care outside the hospital, focusing on efficiency and care coordination. Ankota's primary focus is on Care Transitions for Readmission avoidance and on management of Private Duty non-medical home care. To learn more, please visit www.ankota.com or contact Ankota.

 

Topics: Home Care Blog, Home Care Best Practices, Aging in Place Technology, Health Care Stories, the real nurse jackie

6 Ways To Prep Your Home Care Agency for 2015 from Ginny Kenyon

Posted by Ken Accardi on Dec 22, 2014 2:17:00 PM

Ginny_Kenyon_Home_Care_Consultant2015 is almost here, and with the new year, some changes in the home care space that agencies should be ready to adadpt to.  Ginny Kenyon from Kenyon HomeCare Consulting, has written a forward-thinking article called 6 Ways Your Home Care Agency Startup Will Survive in 2015, that I highly reccommend that you read.

Here's a quick summary of her 6 points, but please read the full article for in-depth insight.

  1. Be Aggressive About Education
  1. Use Comprehensive Software Programs
  1. Establish a Learning Organization
  1. Utilize the “Lean” Theory of Operations
  1. Use Transformational Leadership
  1. Create Niche Services to Respond to Customer Needs

education_and_trainingAs I'm sure you noticed, Ginny suggests staying current, both through education and training of your team and with the software that you use to manage your business, as a way to survive and thrive.

If you're interested in recieving Ankota's paper on Home Care Best Practices, 7 Habits of Highly Effective Private Duty Home Care Agencies,  just click the link. 

Increasing_Profitability_via_Care_Transitions

 

Ankota provides software to improve the delivery of care outside the hospital, focusing on efficiency and care coordination. Ankota's primary focus is on Care Transitions for Readmission avoidance and on management of Private Duty non-medical home care. To learn more, please visit www.ankota.com or contact Ankota.

 

Topics: Home Care Entrepreneurship, Home Care Blog, Home Care Best Practices, Care Coordination, Aging in Place Technology, Care Transitions, Ginny Kenyon, home care marketing

Happy Holidays from Ankota!

Posted by Ken Accardi on Dec 19, 2014 2:47:00 PM

Ankota_Team_Christmas_Photo

 

This holiday season, as we gather with loved ones, we are reminded that every day an individual is at home surrounded by the people and things that they love, their quality of life is better, and their health care costs are lower.  This time of year reinforces Ankota's top goal - To make the delivery of care more efficient and easier to coordinate.

The Ankota Team would like to wish you, our readers and clients, Happy & Healthy Holidays!  We hope you had a wonderful 2014 and we wish you the very best in 2015! 

happy_holidays

 

 

 

 

 

Ankota provides software to improve the delivery of care outside the hospital, focusing on efficiency and care coordination. Ankota's primary focus is on Care Transitions for Readmission avoidance and on management of Private Duty non-medical home care. To learn more, please visit www.ankota.com or contact Ankota.

Topics: Private Duty Home Care Blogs, Private Duty Agency Software, Care Transitions, happy holidays

Kaiser Shares That 2,610 Hospitals Will Be Penalized $428MM for Readmissions

Posted by Ken Accardi on Dec 17, 2014 12:53:00 PM

Kaiser Health News has graciously allowed us to republish their article disclosing CMS Readmision Penalties for 2015.  Without further adieu, here's the article: 

Medicare Fines 2,610 Hospitals In Third Round Of Readmission Penalties

By Jordan Rau, Kaiser Health News

 Kaiser Health News (KHN) is a nonprofit national health policy news service. 

Medicare is fining a record number of hospitals – 2,610 – for having too many patients return within a month for additional treatments, federal records released Wednesday show. Even though the nation’s readmission rate is dropping, Medicare’s average fines will be higher, with 39 hospitals receiving the largest penalty allowed, including the nation’s oldest hospital, Pennsylvania Hospital in Philadelphia.

The federal government’s penalties, which begin their third year this month, are intended to jolt hospitals to pay attention to what happens to their patients after theyReadmission_Vicious_Circle leave. Around the country, many hospitals are replacing perfunctory discharge plans—such as giving patients paper instructions—with more active efforts, such as ensuring that outside doctors monitor their recoveries and giving supplies of medication to patients who may not be able to afford them. Others are still struggling to meet the new expectations. Before the program, some hospitals resisted such efforts because they weren’t paid for the services, and, in fact, benefited financially when a patient returned.

Last year, nearly 18 percent of Medicare patients who had been hospitalized were readmitted within a month. While that is lower than past years, roughly 2 million patients return a year, costing Medicare $26 billion. Officials estimate $17 billion of that comes from potentially avoidable readmissions.

Under the new fines, three-quarters of hospitals that are subject to the Hospital Readmissions Reduction Program are being penalized. That means that from Oct. 1 through next Sept. 30, they will receive lower payments for every Medicare patient stay —  not just for those patients who are readmitted. Over the course of the year, the fines will total about $428 million, Medicare estimates.

More than 1,400 hospitals are exempted from the penalties, including certain cancer hospitals and critical access hospitals, as well as facilities dedicated to specific services such as psychiatry or rehabilitation. Maryland hospitals are also excluded because the state has a unique payment arrangement with Medicare. The fines are based on readmissions from July 2010 through June 2013.

In New Jersey, every hospital but one will lose money this year. So will a majority of hospitals in 28 other states, including California, Florida, Georgia, Illinois, Massachusetts, New York, Ohio, Pennsylvania, Tennessee and Texas, as well as the District of Columbia, according to a Kaiser Health News analysis of the penalties.

Pay_fines

While some penalties are as small as a hundredth of a percent, hospitals with the highest readmission rates are losing 3 percent of each payment, an increase from a maximum punishment of 2 percent last year. The increase brings the top penalties to the full force authorized by the federal health law.

The 39 hospitals where payments will be lowered by 3 percent include a number of specialty surgical hospitals, small community hospitals and the Pennsylvania Hospital, a major teaching facility. The hospital, founded in 1751 by Benjamin Franklin and Dr. Thomas Bond, is part of Penn Medicine. Hospital officials did not immediately respond to a request for comment.

Another 496 hospitals will lose 1 percent or more of their Medicare payments. Those include Northwestern Memorial Hospital and Rush University Medical Center in Chicago, Beth Israel Medical Center in Manhattan, Tufts Medical Center in Boston, and a few satellite hospitals owned by well-respected systems, including the Mayo Clinic and Geisinger Health System.

Medicare levied penalties against 433 more hospitals than it did last year. The average penalty this year is 0.63 percent, up from 0.38 percent last year, according to the KHN analysis.

Two More Conditions Added

One reason for the higher and more widespread fines is that this year Medicare began evaluating readmissions of two new categories of patients—those initially admitted for elective knee or hip replacements, and those suffering lung ailments such as chronic bronchitis. Those patients were assessed along with the heart failure, heart attack and pneumonia patients Medicare has examined since the penalties began in October, 2012

Heart

A hospital was fined if it had higher than expected readmission rates in any category. Thus, a number of specialty hospitals that focus on hip and knee replacements received fines for theq first time because readmissions of those patients are now being assessed, the KHN analysis found. Fines increased for each condition where rates were above Medicare’s expectations. “Every time they add conditions, the penalties go up,” said Nancy Foster, a quality expert at the American Hospital Association.

Dr. Stephen Jencks, a consultant who was one of the first researchers to document the nation’s high readmission rates, said he was impressed overall by how much the fines have prompted hospitals to concentrate on their patients’ health after discharge. “This really fairly modest step” of penalties has “persuaded a lot of hospitals to talk in ways they simply were not talking 10 years ago,” he said.

Dr. Don Goldmann, chief medical and science officer at the Institute for Healthcare Improvement, a Massachusetts nonprofit, cautioned against attributing the drop in readmissions only to the penalties, since the government also has other, less punitive programs underway. “There’s so much at play,” Goldmann said. “I’d be careful about imputing the reduction to any one intervention.”

As the penalties have played out, an increasing number of prominent experts are voicing concerns that the punishments are too harsh and doled out unfairly. For one thing, Readmission_Arm_BandsMedicare lowers payments to hospitals even if they have reduced their readmission rates from the previous year—so long as their rate is still higher than what the government believes is appropriate for that hospital. Medicare uses the national readmission rate to help decide what appropriate rates for each hospital, so to reduce their fines from previous years or avoid them altogether, hospitals must not only reduce their readmission rates but do so better than the industry did overall.

“You have to run as fast as everyone else to just stay even,” Foster said. Only 129 hospitals that were fined last year avoided a fine in this new round, the KHN analysis found.

Medicare officials, however, consider the competition good motivation for hospitals to keep on tackling readmissions and not to become complacent with their improvements.

Another concern about the program is that safety-net hospitals that treat large numbers of low-income patients have been more likely to receive penalties, in part because poor patients face financial and logistical challenges that make them more likely to get sicker after discharge than others, even if the hospital is trying to oversee their recuperations.

Much of the formula that calculates the fines was written into the health law, and Medicare has maintained it cannot unilaterally change it. The Medicare Payment Advisory Commission, which makes recommendations to Congress, has urged that the government compare hospitals to similar ones—academic medical centers to each other, for instance—when assessing penalties.

bill

Experts convened by the National Quality Forum, a nonprofit that evaluates measures the government uses, also endorsed the idea of taking socio-economic status into account in creating many different health care metrics. The forum said it will test the approach. Meanwhile, bills are pending in both houses of Congress that would make Medicare consider socio-economic status of a hospital’s patients when calculating fines.

The Obama administration has raised concerns that assuming safety-net hospitals will do poorer in avoiding readmissions might encourage lower expectations for the quality of care for low-income patients. Some experts fear that hospitals with many readmissions are providing substandard care and should not be let off the hook.

“Low [socio-economic status] patients do often—but not always—have worse outcomes, and yet we know they are often exposed to lower quality of care, whether that’s the places that they go or the access to care that have,” said Dr. Susannah May Bernheim, director of quality measurement at the Yale School of Medicine’s Center for Outcomes Research and Evaluation, which created the method Medicare uses to count readmissions. However, she said, “it is important to understand that safety net providers both may be more vulnerable to payment penalties and may in fact need more than average resources to achieve good outcomes for their patients.”

‘It’s A Quagmire’

study published this month in The Joint Commission Journal on Quality and Patient Safety examined eight safety-net hospitals to see how they were handling readmissions. The researchers found that most of the hospitals’ leaders were concerned about the penalties, with one telling interviewers that they expected “the penalty will get bigger and bigger and then other payers [such as private insurance companies] are going to pick up on it.”

The program was popular among nurses and doctors, with one saying “we understand, we know the importance of it,” that “in order to get a response from administration, you have to penalize.”

The researchers, led by Dr. Karen Joynt and other current and former academics at Harvard’s school of public health and the medical school, discovered that one of the eight hospitals was not trying to cut readmissions because its financial stability would be undermined by fewer patients.  “It’s a quagmire,” an anonymous hospital official was quoted in the study as saying. “If you affect the population correctly, you will reduce both readmissions and overall admissions, which is good for the patient but financially bad for the hospital.”

Gina Kaurich, director of client-care services at the Cincinnati-based FirstLight HomeCare, one of many companies offering to help hospitals prevent readmissions, said she has seen hospitals take various approaches in light of the penalties. Some have tried to care for returning patients without readmitting them overnight so Medicare does not count their cases, she said. Others have assigned their own nurses to visit patients at home shortly after discharge to ensure the patients are properly taking care of themselves. Still others hire private companies like hers, which sends nurse assistants to homes.

“Before the penalties and the focus, I believe the hospitals were quite well aware of this, and a readmission almost was something that was expected,” Kaurich said. “It was [considered] part of the disease process.”

jrau@kff.org

Read more about this story’s methodology, view the average impact on each state, and download hospital data as a printable PDF or CSV spreadsheet.

This article was produced by Kaiser Health News with support from The SCAN Foundation. 

Increasing_Profitability_via_Care_Transitions

If you're interested in learning more about how your agency can benefit from a Care Transitions initiative, you can download our free White Paper, Increasing Profitability via CareTransitions. 

Ankota provides software to improve the delivery of care outside the hospital, focusing on efficiency and care coordination. Ankota's primary focus is on Care Transitions for Readmission avoidance and on management of Private Duty non-medical home care. To learn more, please visit www.ankota.com or contact Ankota.

Topics: Care Coordination Payments, Care Coordination, transitional care, Care Transitions, kaiser, medicare, readmission penalties

Subscribe to Email Updates

About Ankota

Ankota provides software to improve the delivery of care outside the hospital, focusing on efficiency and care coordination. Ankota's primary focus is on Care Transitions for Reeadmisison avoidance and on management of Private Duty non-medical home care. To learn more, please visit www.ankota.com or contact Ankota.

Follow Ankota on Twitter!

twitter bird white on blue

New Module

Add content here.

New Module

Add content here.