by Dr. Lincoln Godfrey
It’s no secret that healthcare regulations have increased, and continue to increase both in number and complexity. Compliance is now where healthcare organizations spend the lion’s share of their focus. And it is a lot of work and overhead.
The challenge is in how you look at it. You can comply with regulations to check a box, or you can look at the intent behind the regulations and use that intent to get creative and make a difference.
Because there is so much work, organizations run the risk of structuring their processes to check off the regulatory boxes while not actually achieving the intended benefit of the regulations. In this article, I want to share ways in which I have seen regulations drive innovation and mutual benefit beyond just achieving compliance.
Leveraging the Goal of Low Readmissions
The readmission rate of patients to a hospital is an important number if you want to get paid for your services. In the current reimbursement model, you are judged on the outcome of a patient regardless if they cooperate in their treatment or not. It may be frustrating to realize that there is little responsibility or accountability placed on the patient in this model, but this is reality. Whether you like it or not, the challenge is squarely in the hospital’s arena to make sure a patient gets better and stays better.
Assuming your delivery of service is where it needs to be, you are left asking yourself, “What else can we do to make our readmission rate better?”
The answer starts with looking at your data.
Data Driven Insights
For us, the first step in reducing readmissions was seeing the readmission picture clearly.
It’s tempting to think that you already have a good idea about the procedures and patient profiles which most lead to readmissions, and who is abusing the system. I thought so too.
But once we reviewed the data from our EHR, we realized many of the issues we thought we had were actually small or had minimal impact and did not need an aggressive solution. On the other hand, we identified areas that we weren’t aware of and found them to be important contributing factors.
This awareness meant that we were able to clearly see not just the patients we knew about, but the ones who were falling through the cracks and needed our help.
Using Data to Create Meaningful Solutions
Now, by combining our big picture insights with the information captured in the clinical documentation process during the initial physician/patient encounter, we are able to identify high-risk readmission patients and adjust our treatment plans in a variety of ways to improve their success rate.
Some of the issues we see that lead to readmissions are that patients don’t follow treatment plans, they don’t have an at-home support network to encourage them to get better, and/or they don’t have access to transportation for follow-up visits.
Based on the situation, a physician may decide to keep a high-risk patient longer post-op if it means they will require less at-home care and will ultimately have a higher success rate. Another option we have introduced is using a high-touch, post-procedure follow-up plan that includes routine calls to the patient and visits to a patient’s home to ensure their treatment is followed and managed.
We have also started to leverage a transportation network to pick up patients for their follow-up visits. By offering services that cost us up-front, like a transportation service, we actually save money because we are able to keep patients out of an ambulance and out of the ER down the road.
The beauty of solutions like these is that they are completely needs-based, and at the discretion of you, the provider. Regulations are not dictating to us how to treat our patients, only that we must meet certain performance goals. Although the environment of compliance isn’t one that outwardly encourages innovation, it is also not precluding it either.
While the healthcare industry is still going through growing pains of implementing EHR systems and increasing staff to handle the new systems and new regulations, there is a payoff. And that payoff is having real data on your population that can be used to create innovative care solutions that do impact lives, as well as increase revenue.