Medicare Readmission Penalties
After 4 years of Medicare’s focused effort to reduce 30 day readmissions, 75% of hospitals have failed to meet goals and continue to be plagued with penalties. A high risk population for both hospital admissions and readmissions is seniors, as they are the highest consumers of our healthcare dollars.
Multiple chronic illnesses drive healthcare system use by seniors and are a greater risk factor for hospitalization than age. And rehospitalization occurs almost exclusively in seniors having multiple (not just a few) chronic illnesses.
So how do assisted living (AL) seniors compare to community dwelling seniors with respect to their risk for hospitalization? This is a question of immense importance for the assisted living industry, as the ability to objectively risk stratify seniors has significant financial and caregiving implications. Resident turnover in ALs is 54%, and over 90% of resident turnover is due to failing health that often includes a trip to the ER or a hospitalization that subsequently precludes the resident from returning to the AL.
Analytics are an invaluable tool that can lead healthcare management in assisted living. In this case, an innovative Acuity Index is developed that compares the hospitalization risk of assisted-living seniors to community dwelling seniors. This method uses a literature-based approach that relies primarily on the number of chronic health conditions and prescribed medicines taken by seniors in both settings.
The Figure below shows the extent to which the hospitalization risk for assisted-living seniors exceeds the risk of community dwelling seniors by the multiple shown above each red vertical bar (each bar is an individual resident).
(click on Figure to enlarge)
So as an example, the resident represented by the vertical bar on the far right of the Figure has 7.8 times the risk of being hospitalized in comparison to a community dwelling senior. In contrast, the resident represented by the vertical bar on the far left of the Figure has about the same hospitalization risk (0.8 times the risk) as a community dwelling senior.
The value of this analysis and data visualization is to give an AL manager an immediate appreciation of the hospitalization risk of every resident in his/her community so that healthcare resources can be efficiently deployed proactively (e.g. frequency of monitoring, doctor visits and follow-up, attention to control of high risk chronic illnesses, gap analysis, quality improvement initiatives, etc). The long term outcome will be stabilization of resident health, reduced resident turnover, and increased AL profitability.
This is exactly the kind of information that will appeal to referral networks, as it uniquely demonstrates a commitment to care excellence.
Please e-mail me to learn how your AL can benefit from analytics and the Acuity Index.
Dr. Steven Fuller is a triple board certified physician/entrepreneur who develops programs in support of an Integrated Care model of senior housing. This model includes 3 equal, interactive, and mutually supportive team members: real estate, hospitality, and healthcare. To reach Dr. Fuller, e-mail:
st**********@il*******************.com
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