Let me introduce you to Tom Andrews*.
He’s a business analyst for Granite Community Hospital, a 112-bed facility that’s part of the Southern New Hampshire Health Network. The hospital also owns physician practices: four primary care and three specialty care. Like many rural and community hospitals, the majority of Granite’s payer contracts are fee-for-service. During the next two years, Granite Hospital will be preparing for a successful transition to value-based care arrangements.
Tom wears many hats at Granite. He reports to the chief information officer and under his direction Tom regularly collaborates with the financial and clinical quality departments. Tom supports the medical management team, a group of hospital leaders and stakeholders from the Southern New Hampshire Health Network tasked with identifying opportunities to strengthen revenue and quality, and developing strategies to act on those opportunities.
Strengthening Revenue: Managing Readmissions
A primary focus of the medical management team is readmissions. The hospital has been losing revenue to readmission-related penalties on the Medicare population, and when Granite moves into value-based contracts, revenue on the commercial population will be adversely impacted as well.
Let me show you how Tom uses the Theon® Platform for Analytics and Reporting (Theon® Analytics & Reporting) to generate actionable cost, quality and utilization reports for the medical management team. He starts with examining all-cause readmissions.
First, he reviews the population metrics in this report. These measures help him understand high-level, aggregated details about the hospital’s population, such as:
- There are 693 individuals who had an inpatient hospital stay in the past 12 months. Of these individuals, 65 patients were readmitted, leading to a readmission rate of nearly 11 percent.
- The average length of stay is 6.5 days with an average cost of $1,453 a day, totaling nearly 650 readmission days and a total readmission cost of $942,000.
Then, Tom reviews the dashboard that allows him to compare readmissions by payer type. Granite’s Medicare and Medicaid patients have the highest readmission rates. Tom knows these populations are an important source of revenue for the hospital.
So he dives deeper.
The Link Between Congestive Heart Failure and Readmissions
Tom reviews the top diagnostic categories for initial admissions and sees congestive heart failure (CHF) accounts for nearly 63 percent of readmissions. For the medical management meeting, he wants to focus on the patients who have CHF and have been readmitted to the hospital within the last 30 days. Tom pulls a number of reports, at summary and detail levels, that provide insight into the cost and utilization patterns among patients with CHF who have readmissions at GCH.
By closely examining the patterns of readmissions, the medical management team is able to make informed decisions about the best way to reduce potentially avoidable and costly readmissions among patients with CHF. As a result of the insights in the reports Tom has generated, the hospital agrees with the medical management team’s recommendations and decides to:
- Create a transition-of-care program for all CHF patients discharged by repurposing one of the existing registered nurses to provide telephonic outreach post-discharge, perform medication reconciliation, identify any barriers to care, schedule a follow-up visit with the patient’s primary care physician or cardiologist, and provide critical education to patients to closely manage and coordinate care for at least 30 days following discharge from Granite Hospital. An additional benefit to this change is the opportunity to build closer relationships with the patients the hospital serves while improving the overall patient experience.
- Extend hours at ambulatory primary care sites before and after the normal working hours of 9 AM to 5 PM to mimic a “walk-in clinic”, giving patients a more cost-effective and accessible alternative to the emergency department.
In the weeks and months ahead, Tom will continue to use Theon® Analytics and Reporting to monitor the effectiveness of the hospital’s initiatives to reduce readmissions among CHF and strengthen revenue.
ICYMI, check out my last blog, 10 Ways Small Hospitals Can Realize Value from an Analytics and Reporting Solution.
*Tom’s experience is an illustrative example based upon the actual experience of a Geneia client. This information is provided for illustrative purposes only. Tom is fictional and not intended to represent any specific person. Any direct similarities to any real person are purely coincidental and unintentional.