You can find hundreds of companies looking to “disrupt” the healthcare industry with “game changing” technology. Most of those companies are heavy on tech and light on empathy.
Enter Genus Connect
Genus Connect is all about getting caregivers on the same page — and caregivers doesn’t just mean doctors. When a person comes home from an encounter with the healthcare system, their family and friends play a big role in whether that person stays healthy — whether they adhere to their medications, go to their follow-up appointments, eat right, and more.
One of the small-but-powerful features that Genus Connect uses to empower families and friends is the ability to record the discharge conversation on a mobile app. Providers deliver so much information in such a short time, it’s virtually impossible to keep all the information straight. With Genus Connect, family members can record the discharge conversation and then share it with everyone who will be involved in keeping that patient healthy after discharge.
It’s one thing to have empathy for patients and their families. It’s quite another to have empathy for hospitals and healthcare systems.
Yet Joe and his team aren’t knocking on doors saying “pay for this app — patients and their families love it”. Instead, through a partnership with Henry Ford Hospital, they showed that the app actually improved patient outcomes — readmissions and patient experience scores — outcomes the federal government ties financial incentives to.
That got me wondering: if Genus Connect can help hospitals win in the Medicare pay for performance programs, which Michigan hospitals need the most help?
Quick review: CMS Pay for Performance Programs put 6% of hospitals’ Medicare reimbursement at risk
When Congress passed the Affordable Care Act in 2010, the law included “hospital pay-for-performance” programs to incentivize hospitals to improve quality — but mostly tocontain cost.
The Hospital Readmissions Reduction Program ties a hospital’s reimbursement to their readmissions rates for the six conditions and procedures Medicare pays the most for: heart attack, heart failure, pneumonia, chronic obstructive pulmonary disease, hip and knee replacement surgery, and coronary artery bypass surgery. The Readmissions program puts up to 3% of a hospital’s Medicare reimbursement at risk.
- Whether the patient believed their doctors and nurses communicated clearly and listened to them
- Whether the patient understood what medications they were supposed to be taking and what the purpose of each medication was
- Whether the patient believed they were effectively transitioned to the next phase of their care
The Value Based Purchasing program puts up to 2% of a hospital’s Medicare reimbursement at risk.
Combined with the Readmissions program (3%) and the Hospital Acquired Conditions program (1% — and out of scope for this post) that puts 6% of Medicare inpatient reimbursement at risk.
In a business where 6% margins are fairly healthy, these programs can put poorly-performing hospitals out of business.
Back to Genus Connect.
According to Joe Gleason, hospitals buy the app and the app pays for itself by reducing readmissions and improving patients’ experience around doctor communication, communication about medicines, and communication about care transitions.
Let’s see who needs the help.
The nine Michigan hospitals leaving the most money on the table, and why
DISCLAIMER: These programs, and the reporting for these programs, lag behind real life. This analysis comes from the most recent data available. The most recently reported readmission results are from patients discharged between 2013 and 2016. The most recently reported patient experience results are from patients discharged in calendar year 2016.
To compile these numbers, I combined data from three sources:
- My calculation of base hospital reimbursement came from the IPPS impact file.
- My calculation of the Readmission penalty came from the HRRP Supplemental Data File.
- My calculation of Patient experience came from the HVBP HCAHPS data sets on data.medicare.gov
Nine Michigan hospitals are leaving $1 million+ on the table in the Readmissions program and the Patient Experience portion of Value Based Purchasing.
We can see WHO is leaving money on the table. What we can’t see is WHY. What is happening to the patients at these hospitals?
- If patients are triggering the Readmissions penalty by returning to the hospital, what condition were the hospitals TRYING to treat?
- If patients had a poor opinion of their care, what were they dissatisfied with?
Let’s go one level deeper…
Starting with readmissions:
- The heaviest Readmission penalties are associated with poor performance in multiple service lines. The three most penalized hospitals saw 2-3 different patient populations returning to the hospital 10-20% more frequently than at comparable hospitals.
- If it’s not multiple service lines, it’s one really bad service line. The next group of hospitals paying heavy Readmissions penalties were characterized by a single patient population returning to the hospital 25-28% more frequently than at comparable hospitals.
In the Patient Experience categories of interest:
- Hospitals are doing a poor job helping patients understand and manage their medications. Eight of the nine hospitals were rated worse than top hospitals in “Communication about medicines”. Patients at four of the nine were more than 20% less likely to report that they “always” understood what medicine they were taking, the purpose of taking it, and what side effects they might expect (than patients at top hospitals).
- Hospitals aren’t effective at helping patients transition to the next phase of care. All nine hospitals were rated worse than top hospitals in “Transitions of care”. Patients at five of the nine were more than 15% less likely to report they “strongly agreed” hospital staff took their family’s wishes into account as they planned for the next phase of care and that patients understood how to manage their health after discharge (than patients at top hospitals).
Going into this analysis, I expected to see that the biggest penalties were associated with poor performance in readmissions after surgery (because hip/knee replacements and open heart bypass surgeries are so expensive — and the Readmissions program weights them more heavily).
Instead, I found that a hospital with a lot of relatively-inexpensive readmissions can still rack up a sizable penalty.
I expected to see the most money left on the table in “Transitions of care” (because CMS added those questions to the survey more recently).
Instead, I found that patients and their families seem to struggle the most with medication reconciliation.
Given what I know about Joe Gleason and Genus Connect’s mission, I can’t help but be optimistic for patients in 2019. Patients whose families are using the app will stand a better chance of staying on top of medications.
And if patients find it easier, that’s good for hospitals, too. Patients who manage their medications better return to the hospital less often. And more satisfied patients give higher marks on the all-important surveys.