Transitions—when patients move from one care setting to another—represent a state of vulnerability for both the patient and the healthcare organization. Patients need referrals to the most appropriate provider in a timely, seamless fashion so they get the level of care they need. If patients leave the network, it could result in revenue leakage for the provider organization. I’ve heard healthcare leaders estimate that between 20-30% of their patients ultimately leave their network during a transition of care. This renders the care team less able to ensure patients get the best possible care—and less able to track patient progress and monitor follow-up. Plus, it means missed revenue opportunities. When patients see out-of-network ambulatory or post-acute providers, healthcare networks are unable to capture the revenue that would otherwise be associated with patient care. There are downstream financial effects, too. When patients […]


The Path to Reduce Readmissions

Hospitals are wrestling with readmission rates, some as high as 25-30%. They’re eager to help patients avoid returning soon after being discharged. There is also a financial impact. Some estimate Medicare annual readmission costs as high as $17 billion. As Medicare cuts payments for readmissions, hospitals have financial incentives to reduce readmissions. Strategies to help prevent hospital readmission How many readmissions are avoidable? No one knows for sure. But improving the discharge process could help. There are various approaches to solve this problem, according to Steve Blau, senior director of case management and patient logistics at Medstar Good Samaritan Hospital in Maryland. The top two strategies are improving case management and better care transitions management. In a recent webinar, Blau outlines the components of successful readmission reduction program. He examines specific approaches hospitals are taking – such as focusing on […]

Just in case you missed Sunday’s New York Times article, “Hospitals Aren’t Waiting for Verdict on Health Care Law,” be sure to read how 701-bed Maimonides Medical Center in New York City is preparing for the Supreme Court’s verdict on President Obama’s health reform law.  As the Times put it, “like hospitals across the country, Maimonides is not waiting for the verdict. Win, lose or draw in court, administrators said, the policies driving the federal health care law are already embedded in big cuts and new payment formulas that hospitals ignore at their peril. And even if the law is repealed after the next election, the economic pressure to care differently for more people at lower cost is irreversible.” Buried within the Times article is a revealing set of facts.  Maimonides (which uses Allscripts Sunrise Clinical Manager EHR, the Allscripts ED […]

Many observers, including the analyst firm IDC Health Insights, have noted the critical role of care management software in accountable care organizations (ACOs). For a closer look at how one health system has used care management technology to create the foundation for an ACO, we recently read this excellent peer-reviewed article (requires download fee or subscription to Professional Case Management) by Linda Stutz, BSN, MBA, Senior Director for Case Management at Banner Health. In the article (“Case Management as a Foundation for an Accountable Care Organization”), Stutz describes how Banner, one of the largest, nonprofit health care systems in the country, implemented “a Case Management Model that demonstrates a strong return on investment for the hospitals in the system and creates the foundation for success under health care reform.” Just what ROI did Banner produce under the new model? An 8-percent […]