Achieving interoperability key to reducing readmissions
As penalties for too many readmissions loom over hospitals, it is clear that many have not done enough to stave off Medicare payment reductions and that coordinated care efforts may require more interoperable tools to achieve results, according to Dominick Bizzarro, RPh, who spoke during a Jan. 10 webinar hosted by the Health Information Management and Systems Society.
“Value-based business models are going to depend on timely access to data and making good decisions in a risk-sharing environment,” said Bizzarro, global business manager for the healthcare division of InterSystems, a software company headquartered in Cambridge, Mass. “Leading information systems provide more comprehensive solutions, but there are often hundreds of applications to deal with. In a world demanding more cooperation, it’s ever more important to address the gaps between those applications and who’s using them.”
Interoperability issues have forced many healthcare organizations to implement core clinical information systems that don’t allow flexibility for plug-and-play health IT applications. To allow for additional functionality and enhanced communication, dozens or hundreds of interfaces must be built both within and outside of an organization, according to Bizzarro. While this approach may have worked well enough in the fee-for-service era, new value-based reimbursement models will require higher degrees of interoperability.
The Centers for Medicare & Medicaid Services’ readmission reduction program begins in fiscal year 2013. Established by the Patient Protection and Affordable Care Act, the program reduces payments to hospitals with too many readmissions for acute myocardial infarction, heart failure and pneumonia within 30 days. These conditions often are preventable, yet they cause 20 percent of Medicare hospitalizations and cost an estimated $17 billion annually, according to Bizzarro. When the program begins, hospitals responsible for too many readmissions face reductions in Medicare payments of up to 1 percent, a rate that will increase in future years, based on the calculation of excess readmissions for a 3-year period from July 2008 to June 2011.
Some have estimated that approximately two-thirds of hospitals will face Medicare payment reductions because of the PPACA provision, according to Bizzarro. However, some hospitals have implemented coordinated care programs to successfully bring down readmissions. For instance, the care transitions program launched by the University of Colorado School of Medicine reduced readmissions by 30 percent and costs by 17 percent per patient; and another transitional model launched by the University of Pennsylvania helped reduce readmissions by 36 percent and costs by 29 percent per patient.
“When you look at the components of best practices associated with different models, you see they have a lot in common,” Bizzarro said. These programs employ a battery of strategies including coordinated care plans, care managers, home visits, follow-up phone calls, patient education and social services to ensure patients stay safe, healthy and out of the hospital. “You wonder why they haven’t been use more in other parts of the country.”
These programs rely heavily on an ability to coordinate patients, providers, caregivers and administrators, and that means a variety of health IT devices and information systems must be able to communicate with each other, from primary care provider and specialist EHRs to home healthcare devices and hospital billing systems. This is where interoperability platforms come in, according to Bizzarro. They not only enable clear communications and access to real-time information for all members of a large care team, they also enable analytics to identify patients at-risk for readmission. Employing many flexible approaches to meet them where they are is key,” Bizzarro said. “Versatile product platforms are the future.”
While there are technical and organizational challenges to achieving the results demonstrated by the University of Colorado’s care transitions program, for instance, it is becoming clear that healthcare organizations will need to address these challenges head on to survive in the era of health reform. Implementing an information system that fulfills basic requirements and taking a patchwork approach to clinical integration is no longer enough. Full interoperability is necessary to achieve the degree of communication and the analytical capabilities to make the improvements in care quality now required by law.