Just recently, I’ve been looking back at some statistics of particular interest, as many of us head off to HIMSS12 in Las Vegas next week. One data-driven report that came out in late September 2011 strikes me now as especially worthy of comment. On Sep. 28, the folks at the Lebanon, N.H.-based Dartmouth Atlas Project released a report showing that little progress was made during the five-year period from 2004 through 2009 in the area of working to reduce hospital readmissions.
Examining records on 10.7 million discharges for Medicare patients, the Dartmouth Atlas researchers found “striking variation in 30-day readmission rates across regions and academic medical centers.” What’s more, the researchers found that more than half of Medicare patients discharged to home do not see a primary care clinician within two weeks of discharge, one of the key steps required to avert readmission; and that the same hospitals and regions with particularly high medical utilization were also those with high readmission rates. In fact, they found, readmission rates for medical conditions rose slightly from 15.9 percent in 2004 to 16.1 percent in 2009.
The Dartmouth Atlas report was released in the context of awareness that the Affordable Care Act has mandated that hospitals receiving Medicare payments begin soon to reduce avoidable readmissions (and of course, CMS will have to determine which types of readmissions are avoidable). And, as perhaps as many as 31,000 people flock to HIMSS in Las Vegas for nearly a week’s worth of educational sessions, discussions, vendor exhibits and demonstrations, receptions, and other events, I’m pondering what I’ve been hearing from leaders at pioneering organizations now doing readmissions work.
Not surprisingly, they’re telling me that it’s hard work—that goes without saying, I suppose. But how is it hard? Well, it’s difficult for a number of reasons. First, none of the processes around collecting and analyzing data, around using analyzed data to improve performance, or around optimizing discharge and follow-up processes, have been standardized or made better, in most hospitals. That’s very, very big. Second, there isn’t yet even a real consensus on what an avoidable admission is, or around which conditions should most closely be looked at. And third, the underlying information systems have not yet either been put in place or harmonized so that they can be brought to bear on the problem. Without a fully robust EHR, including excellent physician and nurse documentation, medication reconciliation, and improved discharge management components, not to mention a very strong data warehouse and top-flight report writing and disseminating capabilities, none of this work will get very far.
And CIOs, CMIOs, and vice presidents of clinical informatics, and everyone who works for those leaders, will have to become deeply involved in all this work, shoulder to shoulder with clinician leaders and front-line clinicians, at very granular levels, before the industry really begins to make progress in averting readmissions that can in fact be prevented. And of course, mapping workflows and analyzing processes will be a major part of this work as well.
In any case, the readmissions mandate coming out of federal healthcare reform is just one of numerous important policy mandates and other requirements that will necessarily be on the minds of HIMSS attendees this year. Some in the industry have been complaining that the combination of the meaningful use process, healthcare reform, the transition to ICD-10, and other mandates, taken all together, are simply too burdensome for patient care organizations to all accomplish in the allotted amount of time. Yet others are relieved by the increased clarity in the policy sphere, and indeed, when one compares the atmosphere leading up to HIMSS this year with that of, say, 20 years ago, the contrast is striking.
So thousands of attendees will soon be wending their way towards Las Vegas for HIMSS12. It will be fascinating to share in the hallway conversations and to hear what other attendees are seeing, hearing, and talking about. But make no mistake: this year’s conference participants have more real, grounded reasons to learn things at the HIMSS Conference than perhaps at any time in memory. For when it comes to addressing and mastering a challenge like the avoidable readmissions challenge, we’re talking about real lives—and, let’s face it, real dollars—being at stake, in real time. I’d call that an atmosphere of focused learning, I’d say.