As you may or may not be aware, Medicare’s Hospital Value-Based Purchasing program is set to add two new elements specific to joint replacement. Beginning in October, it is proposed that Medicare will publish data on readmission rate and complication rate after total knee and hip replacements. The data will be readily available on the Medicare website for all the world to see, and is also used on other websites, such as Healthgrades.com. In this day of consumerism in healthcare, poorer metrics are quickly spread across the internet and can have an impact not only on your Medicare payment, but also on patients who will consider whether or not to have their knee or hip replacement at your facility.
What can you do?
You may think there is not much that you can do. That might be true for all of the cases you have done up to now. However, with a little bit of work you can make sure that your readmission and complication rates are at among the market leaders going forward.
Patient optimization is critical to ensure patients are in the best medical condition—both physical and mental–for the rigors of the procedure and recovery thereafter. Optimizing patients means reducing their chances for complications and readmissions as well as improving their ability to handle pain, the rigors of surgery, and the expectations of them after surgery. This is accomplished through a more intensive history and physical evaluation, identified and patient-specific preoperative testing, and working to normalize as many medical issues prior to surgery as possible.
Complications lead to longer lengths of stay and more costly treatment. Using evidence-based care, hospitals can put processes in place to alleviate or manage complications. Conducting root cause analysis of the source for the most frequent complications will provide the insight necessary to eliminate or minimize the effect, providing for more effective treatment.
Throughout the patient stay and during the transition of care from discharge through recovery, the hospital needs to have established ‘touch points’ to ensure patients are progressing as planned. For example, a physician visit within two weeks post-surgery is appropriate for total hip and knee replacements. It is paramount that patients have a solid understanding of expected outcomes and symptoms that are cause for concern. Too often symptoms go unchecked, resulting in a readmission that could have been prevented through early treatment by a doctor. Likewise, unknowing patients may go back to the hospital for conditions that are normal to the healing process.