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PointClickCare Tackling Readmissions from Long-Term and Post-Acute Care Facilities Head-On

Posted on January 12, 2018 I Written By

Colin Hung is the co-founder of the #hcldr (healthcare leadership) tweetchat one of the most popular and active healthcare social media communities on Twitter. Colin speaks, tweets and blogs regularly about healthcare, technology, marketing and leadership. He is currently an independent marketing consultant working with leading healthIT companies. Colin is a member of #TheWalkingGallery. His Twitter handle is: @Colin_Hung.

Transitioning from an acute care to a long-term/post-acute care (LTPAC) facility can be dangerous.

According to one study, nearly 23% of patients discharged from a hospital to a LTPAC facility had at least 1 readmission. Research indicates that the leading cause of readmission is harm caused by medication (called an adverse drug event). Studies have shown that as much as 56% of all medication errors happen at a transitional point of care.

By the year 2050 more than 27 million Americans will be using LTPAC services. The majority of these LTPAC patients will transition from an acute care facility at least once each year. With this many transitions, the number of medication errors each year would balloon into the millions. The impact on patients and on the healthcare system itself would be astronomical.

Thankfully there is a solution: medication reconciliation

The Agency for Healthcare Research and Quality (AHRQ) states: “Patients frequently receive new medications or have medications changed during hospitalizations. Lack of medication reconciliation results in the potential for inadvertent medication discrepancies and adverse drug events—particularly for patients with low health literacy, or those prescribed high-risk medications or complex medication regimens.”

Medication reconciliation is a process where an accurate list of medications a patient is taking is maintained at all times. That list is compared to admission, transfer and/or discharge orders at all transitional points both within a facility and between facilities. By seeing orders vs existing medications, clinicians and caregivers are able to prevent drug-interactions and complications due to omissions or dosage discrepancies.

What is surprising is the lack of progress in this area.

We have been talking about interoperability for years in HealthIT. Hundreds of vendors make announcements at the annual HIMSS conference about their ability to share data. Significant investments have been made in Health Information Exchanges (HIEs). Yet despite all of this, there has been relatively little progress made or coverage given to this problem of data exchange between hospitals and LTPAC facilities.

One company in the LTPAC space is working to change that. PointClickCare, one of the largest EHR providers to skilled nursing facilities, home care providers and senior living centers in North America, is dedicating resources and energy to overcoming the challenge of data sharing – specifically for medication reconciliation.

“We are tackling the interoperability problem head-on,” says Dave Wessinger, co-founder and Chief Operating Officer at PointClickCare. “The way we see it, there is absolutely no reason why it can take up to three days for an updated list of medications to arrive at our customer’s facility from a hospital. In that time patients are unnecessarily exposed to potential harm. That’s unacceptable and we are working with our customers and partners to address it.”

Over the past 12 months, the PointClickCare team has made significant progress integrating their platform with other players in the healthcare ecosystem – hospitals, pharmacies, HIEs, ACOs, physician practices and labs. According to Wessinger, PointClickCare is now at a point where they have “FHIR-ready” APIs and web-services.

“We believe that medication reconciliation is the key to getting everyone in the ecosystem to unlock their data,” continues Wessinger. “There is such a tremendous opportunity for all of us in the healthcare vendor community to work together to solve one of the biggest causes of hospital readmissions.”

Amie Downs, Senior Director ISTS Info & App Services at Good Samaritan Society, an organization that operates 165 skilled nursing facilities in 24 states and a PointClickCare customer, agrees strongly with Wessinger: “We have the opportunity to make medication reconciliation our first big interoperability win as an industry. We need a use-case that shows benefit. I can’t think of a better one than reducing harm to patients while simultaneously preventing costly readmissions. I think this can be the first domino so to speak.”

Having the technology infrastructure in place is just part of the challenge. Getting organizations to agree to share data is a significant hurdle and once you get organizations to sit down with each other, the challenge is resisting the temptation just to dump data to each other. Downs summed it up this way:

“What is really needed is for local acute care facilities to partner with local long-term and post-acute care facilities. We need to sit down together and pick the data that we each want/need to provide the best care for patients. We need to stop just sending everything to each other through a direct connection, on some sort of encrypted media that travels with the patient, via fax or physically printed on a piece of paper and then expecting the other party to sort it out.”

Downs goes on to explain how narrowing the scope of data exchange is beneficial: “I definitely see a strong future for CCDA data exchange to help in medication reconciliation. Right now medication information is just appended to the file we receive from acute care facilities. We need to agree on what medication information we really need. Right now, we get the entire medication history of the patient. What we really need is just the active medications that the patient is on.”

In addition to working on FHIR and APIs, BJ Boyle, Director of Product Management at PointClickCare, is also leading a data sharing initiative for those instances when there is no fellow EHR platform to connect to. “We are working towards something that is best described as a ‘Post-Acute Care Cloud’ or ‘PAC Cloud’,” explains Boyle. “We’re designing it so that hospital case managers can go to a single place and get all the information they need from the various SNFs they refer patients to. Today, when HL7 integration isn’t possible, case managers have to be given authorized access to the SNF’s system. That’s not ideal.”

PointClickCare has already taken an initial step towards this vision with an offering called eINTERACT. According to the company’s website eINTERACT allows for the “early identification of changes in condition…and the sooner a change in condition is identified, the quicker interventions can be implemented to prevent decline and avoid potential transfers” which is key to managing patient/resident health.

It’s worth noting that John Lynn blogged about LTPAC readmissions in 2014. Unfortunately at the macro/industry level, not much has changed. Dealing with readmissions from LTPAC facilities is not particularly exciting. Much of the attention remains with consumer-monitoring devices, apps and gadgets around the home.

Having said that, I do find it encouraging to see real progress being made by companies like PointClickCare and Good Samaritan Society. I hope to find more examples of practical interoperability that impacts patient care while touring the HIMSS18 exhibit floor in early March. In the meantime, I will be keeping my eye on PointClickCare and the LTPAC space to see how these interoperability initiatives progress.

Who Gets Paid for Reduced Hospital Readmissions and Who Can Solve It – The Disconnect

Posted on February 28, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

If it seems like I’ve been really interested in hospitals readmissions lately, it’s because I am. A hospital readmission is a complicated thing. What’s not complicated is we know that we don’t want hospital readmissions. They are expensive and costing healthcare a lot of money. What’s not as clear is who is responsible and how we can motivate them to reduce readmissions.

Most people believe that a primary care doctor is the key to reducing readmissions, but I broadened that discussion in my previous post about post-acute being the real cause of hospital readmissions. I’ll be really interested to work with people to discover what the real cause of hospital readmissions are in a hospital. Either way, I haven’t heard people making the argument that the hospital is the one that’s responsible for the hospital readmission. I guess there’s something to say about how quickly or slowly the hospital releases the patient from the hospital being a contributing factor, but I haven’t heard anyone argue that’s a significant contributor (I’d love to hear if someone has other info).

I think this is important to understand, because it could describe that the hospital who will get the financial benefit of reduced hospital readmissions isn’t the organization that can actually solve the problem. Does it make sense for us to be paying hospitals for reduced admissions when in fact it’s the primary care doctor or post-acute organizations that can really reduce the readmissions? Are we relying on hospitals to reach out to primary care docs and post-acute organizations in order to solve this problem?

Obviously, more and more hospitals are starting to get into ambulatory practices as well. In these cases, then the hospital can also be the primary care doctor. However, that’s still only a small portion of healthcare. What about the rest?

Of course, we shouldn’t cut the hospitals out of benefiting from reduced hospital readmissions. It’s hard for a primary care doctor to reduce the chance of a readmit if they don’t know that one of their patients was admitted. The hospital needs to be involved to let the primary care doctor know. Long term care and skilled nursing facilities likely can’t do it on their own either. For example, some don’t have the expertise to avoid the readmits. However, could they rely on the hospital experts on an as needed basis to get access to the skills they need?

The only way we’re going to really reduced hospital readmissions is by having all of these organizations (and the patient) get on the same page and rowing in the same direction. However, it seems the current reimbursement model only incentivizes the hospital to participate.

What’s the Real Cause of Hospital Readmissions?

Posted on February 24, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

To a person, I’m sure that every hospital has a detailed understanding of their hospital readmission number. Reimbursement depends on it and so every one or them knows that number well. However, how many of them really know the cause of their hospital readmissions?

As I consider the various companies working to reduce hospital readmissions, the vast majority (possibly all) of the ones I’ve seen and heard have focused on home health technologies. In theory, the idea makes sense. Someone is discharged from a hospital and so we need to provide them better home health technologies that can prevent them from returning to the hospital. This is the promise of home health technology and the media loves to cover it.

However, in a recent pre-HIMSS Google+ video briefing I did with Capsule, Stuart Long, their Chief Marketing and Sales Officer, made a comment about hospital readmissions that I’d never heard before. He said that the majority of readmits were coming from long term care and skilled nursing facilities and not from the home.

I found this to be a fascinating finding and one that made a lot of sense. However, I pressed him to know where he got the data for it. Since it was done from an internal survey, he offered me the following explanation of the finding:

Recently, Capsule surveyed the market to assess the level of financial pain that hospitals were feeling due to the Medicare penalties associated with 30 day readmissions coming from the patient’s home. We found that technology, although market buzz suggests otherwise, was not the main driver for hospitals mitigating the risk of penalty expenses associated with readmissions. To our surprise our survey of hospital CFO’s revealed that to date it has been the improvement of existing and newly deployed care processes that has had the most significant impact on the management of – in some cases even the reduction of – patient readmissions.

However, a consistent theme that was discovered across our survey was that the hospital readmission issues are not primarily coming from the home, but from long-term care (LTC) facilities and skilled nursing facilities (SNFs). Key points discovered include:

  • 60%-80% of readmits come from LTC & SNF
    • Mostly due to high co-morbidity (High number of simultaneous chronic diseases).
    • Discharges can vary to location based upon relationships with LTC’s and SNF. As high as 33% of patients to SNF, LTC and Home Health to “in network partners” where they have control through people and process.
      • 66% of discharges, however are “outside the network” to LTC and SNF where they have no insight to the patient.

This survey data supports the need for healthcare facilities to have a Remote Patient Monitoring (RPM) System & Clinical Decision Support solution for this population due to Accountable Care Organizations (ACO) and capitated reimbursement. To be able to effectively reduce readmissions and provide the best treatment of patients, much better care coordination is needed. For starters,

  • Data MUST be communicated to the primary physician. There is a driving need to send data to multiple caregivers.
  • There is a need to notify the primary physician or responsible caregiver in the event the patient show’s early signs of deterioration.

The additional challenge with the home is how to manage patient compliance. The current trend is to send an RN, Nurse Assistant, Case Manager or other outside company to the home for care.

Further to this point, a paper published by the Department of Health and Human Services OFFICE OF INSPECTOR GENERAL; “MEDICARE NURSING HOME RESIDENT HOSPITALIZATION RATES MERIT ADDITIONAL MONITORING” November, 2013 can be found here. This paper substantiates the problem with a specific disease condition that contributes to the high readmission rates from LTC and SNF’s.

In FY 2011, nursing homes transferred one quarter of their Medicare residents to hospitals for inpatient admissions, and Medicare spent an astonishing $14.3 billion on these hospitalizations. Nursing home residents went to hospitals for a wide range of conditions, with septicemia the most common.

I think this is a really important finding and I’d love to have it validated by readers of this site who have data from their hospital. Do you see the same thing happening with your hospital readmissions or something else?

If we assume that this finding is true, then the solution to the problem of hospital readmissions is very different than I previously thought. I think Capsule sees it as a tremendous opportunity for them to leverage their skills with connected devices in places like long term care and skilled nursing facilities.

As part of this strategy, Capsule just announced at HIMSS 2014 a new medical device information system that they’re developing. At first this sounded more like a device tracking system for medical devices. Is the device working properly? Where is the device? etc. Certainly it will have those features, but Capsule is looking at this medical device information system from a much larger perspective. They want the system to Connect, Monitor, Analyze, and Act. Connecting is what they’ve always done. Monitoring is the medical device management piece. However, Analyzing and Acting on the data those devices collects puts Capsule in a very new space.

I’ll be interested to see how deep Capsule goes with this and who they choose to partner with to put together the intelligence behind the “Analyze” and “Act” components. This will take some work and many will argue that this type of stuff should be done in the EHR. However, you have to remember that long term care and skilled nursing facilities were left out of the EHR incentive money and are way behind the rest of healthcare in IT adoption. Could these post-acute facilities put in a medical device information system from Capsule as a way to reduce hospital readmissions? Seems like an interesting and reasonable strategy to me. Plus, the hospital would be happy to pay for it if will indeed reduce their hospital readmissions.