Delivering more than simple financial insights to predict areas of potential loss related to clinical and/or operational activities. This means that hospitals can proactively protect their revenues while improving the health of their patients
Readmission events are not isolated. They are the result of a confluence of factors, many of which are exogenous to the patient and his/her clinical care. Things like access to a pharmacy, access to a car, having food in the pantry. All of these external elements impact if, when, and why a patient is readmitted to the hospital.
Jvion's Cognitive Clinical Success Machine looks at readmission events within all of the clinical and external context that drive risk. We don't view these events in isolation or as a separate moment within an episode of care. Instead, our tool accounts for the holistic patient and delivers a high-definition view into the future state of a patient's health including his/her risk of returning to the hospital. This view also includes action pathways that will reduce the likelihood of a readmission to help clinicians apply the most effective intervention based on the individual.
This approach, and the cognitive engine driving it, deliver a highly precise view into who within a patient population is at risk and the exact actions to take. In a recent stress test, Jvion's machine correctly identified patients at high-risk of a readmission 96% of the time. We call this capability "patient verity": the machine isn't simply accurate, it delivers a view into the future that is complete and true. This power is helping our clients drastically lower readmission rates and ensures that each patient is given the most effective intervention and support to drive the best possible outcome.
Reducing avoidable readmissions is a key goal for the Centers for Medicare & Medicaid (CMS). There are good reasons why:
The Hospital Readmission Program, part of the Affordable Care Act (ACA), requires CMS to reduce payments to hospitals that have demonstrated “excess readmissions.” This program is effective for discharges beginning on October 1, 2012 and are outlined in subpart I of 42 CFR part 412.
Hospital risk standardized readmission measures are included for:
These initial conditions have been updated to include:
So what's the hit?
This year, hospitals can lose up to three percent of their Medicare payments under the penalty. Based on a hospital's 30-day readmissions performance on the five conditions listed under the program, a penalty is determined. For each penalized hospital, CMS will reduce payments for patient stays between October 2014 and September 2015. This penalty applies to any condition. For example, Kaiser Health News provided the following scenario:
“(I)f Medicare would normally pay a hospital $15,000 for a kidney failure patient, with a 1.5 percent penalty Medicare would deduct $225 and pay $14,775.”
** Currently, 2,597 hospitals (more than half of all hospitals in the United States) face fines. You can access the full list here.
For more information on the Readmissions Reduction Program, visit the CMS.gov.
Find out how Jvion's solution can help you reduce readmissions and protect your revenues. Contact us at firstname.lastname@example.org.
- Medicare's Readmission Penalties Hit New High. Kaiser Health News; Rau. August 2. 2016; http://khn.org/news/more-than-half-of-hospitals-to-be-penalized-for-excess-readmissions/
- MN Community Measurement Hospital Readmission and Potentially Avoidable Admissions Impact and Recommendation Document; Update May
- Impact of a Comprehensive Heart Failure Management Program on Hospital Readmission and Functional Status of Patients With Advanced Heart Failure http://content.onlinejacc.org/article.aspx?articleid=1124146
- A Guide To Medicare's Readmissions Penalties And Data; http://khn.org/news/a-guide-to-medicare-readmissions-penalties-and-data/