‘Patient Alignment’… It may not be sexy, but it’s better.
Hospitals are assessed costly financial penalties when their discharged patients are un-necessarily re-admitted within 30 days of discharge. Skilled nursing facilities are soon expected to encounter similar penalties. And who’s next to get the axe and join the ‘penalty club’…Home Health? Hospice? Long term acute care hospitals? Inpatient rehab facilities?
But wait a minute…isn’t this all backwards? Shouldn’t we change ‘Re-admissions’ to ‘Never admitted in the first place?’
Re-admissions – the problem is real, and many successful programs are now available for hospitals. And a unique new program is also available for assisted living communities as well.
But the name “Re-admissions” conveys the heart of the problem – a reactive and faulty mindset: to admit again. No sooner have you gotten home, then for 1 out of 5 Medicare patients things fall apart, and it’s time to get admitted again!
This re-active, victim-oriented mindset is geared to fixing a problem after it occurs. Instead, we should cultivate a pro-active and savvy patient-oriented mindset determined to prevent problems from happening!
A lasting solution to re-admissions demands a change in mindset – changing our thinking to a pro-active approach that encourages realigning our interventions on high risk patients before they become ill and while they’re still home. The goal would be to prevent the index hospitalization whenever possible.
The good news is that it doesn’t cost anything to change your thinking. In fact – it will probably cost a lot less in the long run.
Think about it…
Patients who suffer a re-admission don’t just appear “out of the blue.” Most of them are already in the healthcare system long before they ever require a hospitalization. They already have doctors and often have multiple other care providers as well. They are known, their medical histories are known, their medications are known, and many of their social and demographic characteristics are known.
Enough already!
We already have more than enough information that’s needed to pro-actively identify and risk stratify patients. So why have we ignored all this information and waited for admissions and re-admissions to occur BEFORE doing something about it? Why do we spend all of our time and resources cleaning up after a bomb explodes rather than preventing the explosion to begin with?
I believe the solution is easier than we imagine, even though we may have convinced ourselves that the only remedy surely must be complex.
Our mindset needs to be pro-active and pre-emptive – we need to derive solutions for problems BEFORE they occur, or at the very worst, at the very earliest onset of symptoms so that interventions can be rapidly deployed long before hospitalization would ever be required.
Here’s a solution that may help. What’s your suggestion?
The starting place for solutions is the doctor’s office, since this is the primary repository of patient health information. The doctor’s Electronic Health Record should contain algorithms that risk-stratify every patient (low/medium/high risk). The patient’s risk level should be color coded and prominently displayed on the doctor’s viewing screen. Risk reduction strategies should be developed, and suggestions for specific action steps should “pop up” in the viewing screen and be available for the doctor to click and implement before he ends the patient visit.
As an example, the doctor would implement an entirely different plan of action for each the following 2 patients:
- Joyce is a 85 year old woman with 3 chronic health conditions, who takes 2 different prescription medicines, and who has a loving and supportive family and friends with whom she spends much of her time.
- Mary is an 75 year old woman of modest means with 8 chronic health conditions, who takes 10 different prescription medicines, whose husband has dementia, and whose family lives in a different state. Mary rarely socializes – she just doesn’t have the time or energy and can’t afford the out-of-state travel to see her family who are also very busy.
Today’s reactive approach by most providers is to deal with the acute problem that precipitated the office visits, and then to send these patients on their way. But with new, pro-active thinking that focuses on patient alignment, the follow-up plans for these 2 patients would be totally different.
- For Joyce (risk level Green), routine evidence-based care would be provided with attention to education about her chronic health conditions and medicines as well as the importance of routine follow-up visits.
- But for Mary (risk level Red), in addition to evidence-based care, a host of social and healthcare support services would be employed, and close regular follow-up visits would occur with her doctor for close monitoring and rapid response to changes in condition.
This approach exemplifies Mary’s alignment with her doctor and healthcare support system and is our best chance for reducing costly hospitalizations and re-admissions.
So, what’s my suggestion for “Re-naming Re-admissions?”
I suggest “Patient Alignment.”
OK…”Patient Alignment” isn’t sexy. But this change in name might prod our thinking so that we focus on keeping our patients aligned with our community-based healthcare team rather than letting patients fall through the cracks and end up getting hospitalized and then readmitted.
“Patient Alignment” may not be as sexy as “Re-admissions.” But sex isn’t everything, and I believe that proactively keeping patients aligned is better than reactively trying to fix them after allowing a problem to un-necessarily spin out of control.
What’s your suggestion for re-naming re-admissions?
Dr. Steven Fuller
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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