We would like to demonstrate to local hospitals and ACOs how our facility can help to prevent costly patient readmissions, which is critical to the survival of many acute providers and key to maintaining a steady stream of referrals and revenue.

Since UCN offers all private rooms, a 6:2 patient-to-staffing ratio, variety of specialty consultants and services specializing in taking the difficult to place isolations, extensive wound care and higher acuity patients, UCN as a specialized post-acute provider will play an integral role in helping acute hospital providers and insurers to reduce significantly preventable readmissions .

The Role of United Care Network in Reducing Readmissions

UCN is affected by a number of factors when it comes to hospitalizing a resident. These include but are not limited to:

• Resident and/or family preferences or requests

• Medi-Cal/HMO reimbursement policies across the healthcare spectrum

• Legal/regulatory concerns for managing acute conditions in a non-acute setting

• Ability to provide palliative and/or hospice care

• Pressure from Health Care Insurers to treat and discharge

Regardless of these factors, UCN continue playing an ongoing integral role in helping acute hospital providers meet the requirement to reduce preventable readmissions by 20%, which will save millions in costs, prevent readmissions, and reduce harm to patients by 40% resulting in fewer patient injuries and infections. 

UCN is continuing implementing the revised Readmission Reduction Program to increase effectiveness of care policies, programs, and procedures to monitor, manage and as a result avoid readmissions.

UCN recently initiated a quality improvement program designed to improve the early identification, assessment, documentation and communication about changes in the status of residents in UCN’s care facilities, and as a result to avoid readmissions.

The goal of the program is to improve care and reduce the frequency of potentially avoidable transfers to the acute hospital by:

• Preventing conditions from becoming severe enough to require hospitalization through early identification and assessment of changes in resident condition

• Managing some conditions in the nursing home without transfer when feasible and safe

• Improving advanced care planning and the use of palliative care plans when appropriate as an alternative to hospitalization

• More rapid identification and transfer of residents who do need hospital care

UCN management team looked back at the number of hospital transfers that occurred in the last three years to document and analyze the outcome of the transfer, as well as the hospital diagnosis for the ER visit or admission and created a unique and effective Readmission Prevention Program.

Conclusion

UCN can play a key role in helping to prevent costly patient readmission and can achieve this by incorporating the Readmission Prevention Program in coordination with all partnering hospitals and insurers.

Introduction

The Drivers Behind Reducing Hospital Readmissions

In 2011, nearly one-fifth of all Medicare and Medi-Cal recipients were hospitalized within 30 days of discharge. Nearly 90% of these hospitalizations were classified as unplanned resulting in a $17.4 billion cost to the Medicare program.

Due to the massive healthcare expenditures associated with re-hospitalizations, there is a tremendous amount of buzz around reducing 30-day hospital readmissions and the growing need to decrease the risk for them.

In 2013, one-quarter of Medicare residents in Long Term and Post-Acute Care were transferred back to hospitals for inpatient admissions annually, costing Medicare $14.3 billion.

Due to the associated resident risk and high costs, resident transfer and hospitalization rates have received the increasing scrutiny of government agencies, ACO’s and national associations.

Healthcare reform efforts targeted at reducing readmissions are here to stay, with significant penalties for preventable hospital readmissions, under Section 3025 of the Affordable Care Act, October 1, 2012.

At the same time CMS required to reduce payments to acute hospitals with excess readmissions under the new Hospital Readmissions Reduction Program, with 1 percent of a hospital’s entire Medicare billings, climbing to 2 percent in 2013 and 3 percent by 2014, and financial penalties for health care providers with excess readmissions starting in 2018.

Insurance companies and hospitals needing to reduce their statistics will start to increasingly depend on Acute-rehab and Post-Acute partners to affect reductions in rates and make these rates major criteria for partnerships moving forward.

United Care Network facilities have a proven track record of reducing the potential for readmissions to the acute care setting within the first 30 days of discharge.

UCN can help hospitals prevent costly patient readmission, which is critical to the survival of many acute providers.

Selecting the Team

Organizational leadership is in place at UCN to support the time necessary to fully implement the program and tools.

In addition, careful selection of the patient care team members is crucial.

The core team includes the Administrator Susan Duncan, Admission Coordinator and Social Worker Esabel Heredia, Director of Nursing Elizabeth Mason, Medical Director Dr. Sivalingam, as well as 24/7 team of Lead Floor Nurses (LVN) and Certified Nursing Aides (CNA).

Additional team members include Rehabilitation Therapists, Dietary, Activities, Housekeeping, and the Consulting Pharmacist,

in addition to contracted Pulmonologists, Nephrologists, Wound Care and Infusion Care specialists.

Cooperating with Local Hospitals

Since the changes in regulations by CMS and the ACA directly affect acute hospitals, these organizations are going to be actively seeking to optimize partnerships with downstream organizations that have Readmission Prevention programs and a proven track record of reducing the potential for readmissions to the acute care setting within the first 30 days of discharge.

UCN offers full cooperation with hospital administration and coordination with hospital’s case managers in planning and managing prevention of costly readmissions.