BRG will conduct pilot projects at select hospitals using 3M's Potentially Preventable Complication (PPC) and Potentially Preventable Readmission (PPR) software, as well as advanced patient classification systems that connect with hospital claims data. These tools will identify process and performance issues that contribute to post-admission complications and patient readmissions.
"Under the provisions of the health reform bill of 2010, hospitals bear a greater responsibility for improving patient outcomes, which will ultimately bend the cost curve down," Donna Kinzer, director at BRG, told InformationWeek Healthcare. "By combining BRG's expertise in clinical economics and 3M's clinical classification tools, we want to uncover those instances where hospitals were responsible for an illness that occurred while a patient was in their care so that hospitals can take action to prevent these medical complications."
According to Kinzer, by using 3M's PPC software, hospitals can, for example, examine claims data to identify patients that contracted an infection during their hospital stay. That may spur hospitals to install hand sanitizing dispensers in hospital rooms or insist that nurses remove or replace catheters as soon as possible. That should ultimately result in a shorter length of stay and a reduction in hospital costs.
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BRG will also use 3M's PPR software to identify all hospital readmissions, including those considered potentially preventable. The clinical logic determines whether a readmission is related to a previous admission and allows hospitals to target areas for improvement.
Kinzer cited the example of a patient that's been hospitalized for chronic heart failure and is discharged with many different medications, becomes confused, doesn't follow medication instructions, and has to be readmitted. "In this case, hospitals have to put in place measures that ensure physician follow-up and home care in order to avoid the expense of a hospital readmission."
According to estimates from the U.S. Department of Health and Human Services, readmissions cost Medicare $26 billion each year. Under the Patient Protection and Affordable Care Act (PPACA), Medicare payments to hospitals will be more closely tied to a set of quality measures that have been linked to improved clinical processes of care and patient satisfaction. They will pay special attention to the 30-day readmissions rates for three conditions: pneumonia, heart attack, and heart failure.
For hospitals that have excessive readmissions, the health reform law allows the Centers for Medicare & Medicaid Services (CMS) to withhold 1% of a hospital's total Medicare billing starting in 2013. The penalty will rise to 2% in 2014 and 3% in 2015.
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