CMS has made it very clear that reducing needless hospital readmissions is a priority, with or without healthcare reform. The long anticipated financial penalties took effect in September 2012 and will become increasingly severe for those hospitals that do not improve and meet published benchmarks. Thes first round of penalties is scheduled to double next October and then reach 3% of the hospital's total medicare reimbursements by October 2015.
The problem is significant: 1 in 5 Medicare patients are readmitted within 30 days of discharge, and 30% are readmitted within 60 days -- for conditions that are widely considered avoidable. This translates to a burden on the Medicare system that exceeds $25 BILLION per year.
Every hospital in the nation faces these new performance & quality requirements, which are measured by readmission rates for the most prevalent and costly of chronic conditions. Without exception, it is the number one issue facing hospitals today. Further, it is not enough to satisfy CMS's requirements today to avoid penalties because the both the requirements and the penalties continue to escalate. The entire system is being forced to continuously improve and reduce costs, which is a well-developed cornerstone of performance management models long used in other industries. Stiff penalties assure that hospitals take them seriously by taking responsibility for coordinating follow up care that helps patients recover and thrive outside of the hospitals. These settings include the patients' homes, assisted living facilities, and skilled nursing facilities. Clearly, more care will be delivered in homes and other residences and the complexity of that care will continue to increase. This presents a tremendous growth opportunity for the ecosystem of post acute care providers.
From the November 26, 2012 New York Times article "Hospitals Face Pressure to Avert Readmissions," In a common example, Barnes-Jewish Hospital in St. Louis, will lose $2 million this year. Dr. John Lynch, the chief medical officer, said Barnes-Jewish could absorb that loss this year, but “over time, if the penalties accumulate, it will probably take resources away from other key patient programs.”
"The readmission penalties will recoup about $300 million this year. But the goal is to pressure hospitals to pay attention to what happens to their patients after they leave. The penalties have captured the attention of hospitals, and many are trying to improve their supervision of discharged patients’ recoveries." This will require new technologies and processes to coordinate care from hospital to home, an area where Ankota is squarely focused.
A few doctors have long advocated such a model, including Dr. Eric Coleman, a professor at the University of Colorado Anschutz Medical Campus who has devised proven approaches to reduce hospitalizations. These methods focus on helping elderly patients by caring for them more proactively and encouraging cooperation among primary care physicians, home care, physical therapy providers and those delivering equipment and supplies, for example. This is also the right model to help patients recover at home when events do force a hospitalization.
Even with the development of protocols to better manage care, like those of Dr. Eric Coleman, these protocols generally exist only on paper. There is a fundamental lack of technology in place to connect providers to support these programs of care. Ankota's Healthcare Delivery Management (HDM) platform provides web based, secure technology through which providers are able to manage Care Transitions as well as models like Dr. Coleman's and others.