Last month, Medicare reduced reimbursement rates to 2,592 hospitals due to their high number of 30-day readmissions. The reductions came as part of the Hospital Readmissions Reduction Program, which aims to prevent patients from returning to the hospital within 30 days of discharge for certain conditions. Since the fines began in 2011, national readmission rates have dropped; however nearly one in five Medicare patients who are admitted with a diagnosis of heart attack, heart failure, pneumonia, chronic lung problems or elective hip or knee replacements return to the hospital within a month. With nearly half of the nation’s hospitals getting penalized for readmissions, many are looking for ways to improve their numbers. A study from Loyola University Medical Center showed that adding a nurse practitioner (NP) or physician assistant (PA) to a medical or surgical department can improve patient discharges, reduce unnecessary readmissions through the ED, and save hospitals money. In this role, the NP or PA essentially acts as the discharge coordinator, making sure patients and their families are equipped to manage their care outside the hospital and checking in with patients after they have gone home. The study breaks this role into a three-step process.
1. Ensuring patients have the resources they need
The NP or PA first established a relationship with the patient and identifies any medical needs he or she may have. For example, if the patient doesn’t have a car to get to a follow up appointment, the NP or PA can coordinate with a social worker who makes arrangements for the patient’s transportation. The NP or PA can also evaluate whether the patient requires physical therapy or other follow up care that will ensure the patient continues to recover outside the hospital.
2. Educating patients and family members
For some patients, it may take several hours of instruction over several days to effectively communicate the post-discharge instructions. It is time most physicians do not have. NPs and PAs are better equipped than physicians and have more time to properly educate patients on the basic self-care instructions that will keep them well. Although the physician should still be involved at a higher level discussions about the discharge process and answer any questions, more detailed discussions about dressing changes or how to it is important to have a safe path to the restroom can be handled by the NP or PA.
3. Communicating with patients post-discharge
The Loyola study credits post-discharge communication as the factor that most likely led to their decrease in readmissions. The NP or PA routinely calls patients to check on their progress and troubleshoot problems. NPs and PAs can prescribe certain medications without having to involve the physician or arrange for the patient to visit an outpatient clinic if they are experiencing non-emergent symptoms. There, the NP or PA can evaluate the patient and make informed treatment decisions because he or she is familiar with the patient’s case. This frees up the hospital’s emergency department for more life-threatening cases and also saves money for the hospital and the taxpayers.
Adding an NP or PA to Your Team
The study recommends one NP or PA per every three to four physicians. Organizations should be sure to keep caseloads manageable to ensure the NPs and PAs are able to spend the time required to properly coordinate discharge planning. At Barton Associates we have a deep pool of NPs and PAs in our database who are ready to work at your organization. We can provide the staffing you need to implement this model at your facility and reduce your readmissions today. Learn more on our Hospitals, Practices & Companies page. When you’re ready, you can fill out a form on our site or call 877.341.9606 to speak with one of our staffing specialists!
