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How Post-Hospitalists Decrease Health Care Spending

how post-hospitalists decrease health care spending

The benefits of post-hospitalists cannot be overstated. These specialized physicians have proven to enhance the quality of care, make facilities compliant with ever-changing regulations and decrease health care spending.

How does one type of skilled physician decrease health care spending?

Being dedicated to post-acute and long-term care facilities

Many physicians divide their time between hospitals, post-acute facilities and private practices. With their available time spread thin, patients within long-term and post-acute care (LTPAC) facilities may go days or even weeks without seeing a physician. Traditionally operating LTPAC facilities allow new patients to wait 72 hours before seeing the facility’s physician.

Post-hospitalists see all new patients within 24 hours. They focus solely on LTPAC facilities, provide regular office hours and are readily available for patients. In-house physicians ensure patients receive care more quickly, medication discrepancies are reduced and communication effectiveness is enhanced, all of which will decrease health care spending for facilities and insurance companies. Having an on-site physician also reduces the need to transport patients to other facilities, which requires transportation costs and can cause additional health issues due to the stress.

Establishing proactive treatment plans enhance patient care

Reactive care accounts for 75% of all health care spending in the U.S., according to Modern Healthcare, and has been the typical care approach for far too long.

Proactive care plans help prevent many medical issues from occurring at all. These plans clearly define each individual’s care and medical needs, and medication requirements. The plan’s progress and standards are communicated regularly with the patient, the patient’s family and post-hospitalist staff members.

Lowering hospital readmission rates

From January to November in 2011, hospitals spent $41.3 billion treating patients that were readmitted within 30 days of discharge, according to the Agency for Healthcare Research and Quality. Each year, Medicare alone incurs $26 billion in hospital readmission expenses, $17 billion of which could be avoided.

How do you avoid hospital readmissions? Provide better quality of care. Not all readmissions are avoidable, but by providing an enhanced level of care, only patients that are scheduled for a follow up or encounter an emergency return to the hospital. General Medicine’s ER usage reduction is as much as 33% less than the national average, and our readmission rates stand at just 4.7%, according to the 2013 Quality and Resource Use Report (QRUR), compiled by the Centers for Medicare and Medicaid Services (CMS). This results in a 70% reduction in readmission spending for post-acute facilities, MCOs and ACOs partnered with General Medicine.

For years hospitals and LTPAC facilities have been fairly exempt from readmission expenses, but that is no longer the case. Currently, CMS’s fees are affecting MCOs, ACOs and PCPs that work with post-hospital organizations. For 2015, more than 2,600 hospitals will be penalized as much as 3% of CMS reimbursements for high readmission rates. These hospital penalties are expected to reach $428 million in FY 2015.

Long-term and post-acute facilities are not safe from penalties, either. In 2017, as part of the Hospital Readmission Reduction Program (HRRP), CMS will start penalizing post-acute care facilities for unnecessarily high readmission rates.

Preparing for and complying with industry regulations

Health care regulations are always changing and evolving. If your facility isn’t keeping up with these changes, you could find yourself out of compliance and down a long road of penalties. Over the last few years alone, the Affordable Care Act, Hospital Readmission Reduction Program and the Protecting Access to Medicare Act of 2014 and the Nursing Home Five-Star Rating System were all put into effect.

Over the next few years, major changes will continue impacting the industry. Health care facilities are transitioning to a value-based reimbursement model and readmission penalties will continue expanding as the final regulation of the Hospital Readmission Reduction Program occurs in 2017.

The post-hospitalists of General Medicine, The Post-Hospitalist Company, are dedicated to enhancing the care and compliance of your facility. By specializing in post-acute and long-term care, and continuously identifying new regulations and areas for improvement, our team is your partner to decrease health care spending and improve quality of care for all.

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Tom Prose