According to the Robert Wood Johnson Foundation, one in five patients wind up back in the hospital within 30 days of leaving, creating a “revolving-door” affect. The readmission of Medicare patients alone amounts to $26 billion annually, $17 billion of which is spent on return trips—surely some of those incidences wouldn’t occur if the patient received the care they needed to begin with. The Centers for Medicare & Medicaid Services (CMS) calls avoidable readmissions one of the leading problems facing the U.S. health care system, and in an effort to turn things around the CMS is now penalizing hospitals with high rates of readmissions for patients with certain conditions (there is talk that the CMS will eventually create a penalty system for all conditions). The quality of care a patient receives depends in part on the person who is providing them with that care. Continuing care professionals must strive to hire individuals who are going to provide higher levels of care in order to reduce hospital readmission rates.
The Department of Health and Human Services (HHS) has included the Medicare Payment Advisory Commission’s (MedPAC) report to the Congress on Medicare Payment Policy in its 2014 budget proposal. This proposal would reduce payments by up to 3 percent for skilled nursing facilities with high rates of preventable and care-sensitive hospital readmissions. The new penalties are part of a plan to save $2.2 billion in Medicare over 10 years by promoting responsible, high-quality care. Currently, about 40 percent of Medicare patients are admitted to a skilled nursing facility or rehab community after being discharged from a hospital. In 2012, hospital readmissions averaged 24.7 percent—but in many individual settings the numbers rise higher, 30 percent or more, according to the HHC. Those rehospitalizations are time and cost-intensive and many are preventable with proper care and safety protocols in place.
Reducing hospital transfers
The INTERACT Program with the Centers for Medicare & Medicaid Services and the Administration on Aging found that skilled nursing communities can reduce hospital transfers by:
- Preventing conditions from becoming severe enough for hospitalization by regularly assessing residents’ conditions and identifying potential problems
- Improving advance care planning and palliative care
- When safe, effective, and feasible, managing conditions in the nursing home without hospital transfer
But that can be easy to say and hard to do; how does your average long term care or post-acute care organization manage these conditions and mitigate hospital readmissions in real and measurable ways? The answer could lie in your staff.
How can you influence readmissions?
A great deal of research has linked the mitigation of hospital readmissions to follow-up care, proper rehabilitation, dedicated staff positions for managing patient transition, and positive work environments for long term care providers. For example, research published in a 2011 edition of Professional Case Management found that nurse case management protocols and follow-up provider visits, when implemented properly, decreased readmissions from 30 percent to 11.32 percent over 6 months. In another case, a study published in Medical Care found significant readmission reductions in nursing communities that implemented targeted programs to improve the work experience by increasing nurse-to-resident ratios, improving the work environment, and expanding the proportion of nurses holding a BSN degree. Implementing the long-term planning and integrated care necessary to reduce readmission rates (and avoid penalties) requires a staff with the right clinical training, compassion, dedication, flexibility, and strong communication skills. But finding an employee with all of these qualifications can be hard. Especially in long term care, where the nature of the job is difficult and turnover is known to be high. Melissa Koehn, Human Resources Director at Newton Presbyterian Manor said: “We want people who don’t just ‘talk the talk’ but who actually ‘walk the walk.’ Just because you get certified to be a CNA doesn’t mean you’re a good CNA for us. When we’re interviewing people, we want to evaluate their soft skills, too.” By assessing your candidates for their inherent behavioral competencies with behavioral assessment software, recruiters and hiring managers are better able to identify candidates who are likely to provide higher quality care. Behavioral assessments can help long term care professionals with validating a candidate’s abilities and measure difficult-to-quantify variables, like compassion and willingness to learn. By scientifically assessing how they handled previous situations, long term care organizations will be able to effectively measure the abilities of potential employees. When you’re able to assess the behavioral competencies of your employees and hire for fit, you’re setting yourself up for success with a professional staff who are competent, compassionate, and ready to go the extra mile for your patients and residents. By using behavioral assessments during the application process, you’re also providing a positive experience for job seekers. Jared Wright, Recruiter at Silverado At Home’s Dallas branch said: “Candidate’s often say that the questions really make them think about themselves and their behaviors more carefully. Those individuals frequently turn out to be the best applicants.”
Interested in learning about how the hiring process can impact your organization’s culture and impact employee satisfaction? View this webinar replay to see how Episcopal Ministries to the Aging (EMA) Communities inspired meaningful living for residents and employees by improving their hiring process. This article was originally published at the HealthcareSource Long-Term Care Blog