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Hospitals Use BI To Stanch Revenue Losses

With Medicare set to stop paying for preventable hospital readmissions in October, healthcare organizations are turning to business intelligence tools to reduce the risk.

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With Medicare about to stop paying for some preventable hospital readmissions, the care management industry is starting to come up with ways to help healthcare providers avoid complications that can lead to such needless readmissions.

The latest entrant into this underserved field is Phytel, a Dallas-based vendor of population management tools for healthcare. Last week, Phytel introduced Phytel Hospital Readmission Management a product that aggregates data from other systems, helps case managers analyze information, and then supports outreach to patients.

Beginning in October, the start of fiscal year 2012 for the federal government, Medicare Part A will no longer pay for preventable readmissions within 30 days of discharge from a hospital for treatment of certain conditions, including heart attack, congestive heart failure, and pneumonia. The U.S. Department of Health and Human Services is supporting other programs aimed at reducing readmission rates, too. According to Phytel, nearly 20% of Medicare patients who are hospitalized are readmitted within 30 days.

Thanks in no small part to greater emphasis on care coordination and the threat of lower reimbursements for poor outcomes, Olsen noted that many Phytel clients are moving toward more integrated models, via integrated delivery networks, closer physician-hospital affiliations, and accountable care organizations. The latter is a centerpiece of the Obama administration's healthcare reform plan.

Phytel, which has been around since 1997, historically has focused on patient engagement and population management services, mostly for large physician practices, but now is looking at a new market segment. "This new direction we're going in now is taking our current platform and expanding it to hospitals," Russell Olsen, VP of product management, told InformationWeek Healthcare .

Phytel Hospital Readmission Management is built on the company's existing management platform, which includes a registry of more than 20 million patients, according to Olsen. It doesn't replace an electronic medical record (EMR) or a discharge management system. "It identifies patients that are at risk," Olsen said.

Within 72 hours of discharge, the Phytel system initiates an automated telephone survey to patients that meet the hospital's criteria for follow-up. The call includes a patient-satisfaction survey, questions about whether the individual understood discharge instructions, and the option to speak to a real person at a nurse help desk or call center for additional counseling. "The results are fed back to the hospital for them to take appropriate action if needed," Olsen explains.

Since the Hospital Readmission Management application is built on the same platform as Phytel's ambulatory management system, hospitals can send the survey results to care management records at primary care practices, the company said.

Patients who don't respond to the survey get flagged in the Phytel system so the hospital can have a clinician or care manager call back. The rules engine also flags patients if they fail to schedule a follow-up appointment with their primary care physicians or take other recommended actions, all in hopes of mitigating risk.

"Using automation is really one way to reach out to thousands and thousands of patients and identify gaps [in care]," Olsen said.

Find out how health IT leaders are dealing with the industry's pain points, from allowing unfettered patient data access to sharing electronic records. Also in the new, all-digital issue of InformationWeek Healthcare: There needs to be better e-communication between technologists and clinicians. Download the issue now. (Free registration required.)

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