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How to Become a Preferred Provider

As we recently discussed, interoperability is the key to greatly improving long-term, post-acute care (LTPAC). By removing the friction associated with access to health records, caregivers are able to incorporate the most up-to-date and accurate data to inform next steps.

While patient care is the most important outcome of interoperability, there is also a business benefit: becoming a preferred provider. In recent years, hospitals have begun narrowing their network of referral partners, and as a result, they choose partners based on more scrutinized criteria — and data is at the heart of those choices. The sharing of data, for many healthcare providers, has become a non-negotiable prerequisite.

For example, penalties for readmission is a prominent financial risk for many hospitals and accountable care organizations. According to a recent study published in the American Journal of Accountable Care, one in five Medicare patients are readmitted within 30 days of discharge at a cost of approximately $17 billion per year. As a result, it is in a hospital’s best interest to only refer patients to LTPAC and Skilled Nursing Facilities (SNF) with a history of providing a level of care that reduces the probability of readmission. Therefore, facilities that are not using the most innovative systems to limit readmissions are not reaching preferred status.

So what does it mean to be a preferred provider?
Hospitals are demanding that preferred SNF and LTPAC partners use the interoperability enhancing necessary to quickly and accurately share patient data, thus enabling exceptional, value-based care.

Characteristics of a preferred partner include:

Facility metrics
For hospitals to make the best decisions for patients, they need more than just the baseline information about a facility’s performance. Preferred partner network managers need to view performance metrics for facilities in or out of their network using a single application.

These performance indicators include:

  • Admission logs: A view of all resident transfers to the hospital with the ability to filter for trends.
  • Transfer logs: A view of all outcomes for 30-day readmission rate, transfers resulting in admission, transfers resulting in emergency department visit only, and transfers resulting in observation stay only.
  • Trend tracking: Plotting of various trends for pattern identification, including admissions/transfers by hospital, practitioner, outcome, reason, day-of-week, and time-of-day.

Automated, accurate patient information transfer
The likelihood of readmission increases when technology-based barriers disrupt communication between hospitals and care facilities. It is critical to enable the transfer of a patient’s information on or before admission to a SNF. For example, facilities that can only accept transfer documents via traditional communicative technology such as a fax machine, can increase the risk of data transfer failure should a technical glitch occur.

Up-to-date patient progress reports: To help reduce the probability of readmission, hospital staff should be able to receive updates on how the patient’s care is proceeding and offer insight to the facility should they detect an anomaly with care. Access to patient information via APIs (or other tools) and notifications on patient clinical or insight change should be available in seconds.

Such data includes:

  • Changes in condition: Length of time between identification of change of condition and transfer from hospital, new or worsening signs and symptoms, abnormal findings from the lab, and by diagnosis or presumed diagnosis.
  • Actions taken: Tools used to evaluate change in condition, medical evaluations, medical and nursing interventions, advanced care planning tools, and types of directives in place.
  • Improvement opportunities: Information related to progress patient is making under the facility’s care and updates on possible discharge.

Hospitals must make smarter, more educated referral choices to reduce readmission rates. As a result, it is necessary for SNF and LTPAC providers to position themselves as a preferred partner. In today’s healthcare environment, interoperability is the gold standard, and having the necessary tools to send and receive critical data is paramount, not only to improving care, but ensuring a robust, ever-expanding referral network.

Learn more about how PointClickCare can simplify the task of interoperability.

October 1, 2018