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The Affordable Care Act (ACA) has changed all aspects of health care, and it is now a strategic imperative for health systems to make process improvements to achieve performance expectations. Using focused clinical programs to achieve strategic initiatives, health systems can better understand and manage processes to achieve these expected outcomes.The goals of the ACA are to improve the quality and efficiency of health care; prevent chronic disease; .jpg)
improve public health; provide transparency and program integrity; and improve access to innovative medical therapies. When these goals are met, patients are expected to be provided with better care and have improved outcomes at a lower cost; the Tax Foundation estimates that approximately $940 billion will be saved.
improve public health; provide transparency and program integrity; and improve access to innovative medical therapies. When these goals are met, patients are expected to be provided with better care and have improved outcomes at a lower cost; the Tax Foundation estimates that approximately $940 billion will be saved.Using heart failure patients as an example, in 2013, 1 million heart failure patients were hospitalized at a cost of $32 billion. Twenty to 25 percent of those patients were readmitted to hospitals within 30 days of discharge at a cost of $17 to $18 billion. Under the ACA, hospitals that exceed the expected number of readmissions are subject to penalties, which will result in the Centers for Medicare & Medicaid Services taking back $8.2 billion over seven years when the ACA is fully implemented. While most penalties have been relatively small to date, (135 Florida hospitals receiving a .35 percent average penalty), it is imperative that health systems improve before the penalties are raised for poor performance.
While most health care applications largely focus on the appropriateness of service level, cost management, patient satisfaction and clinical outcomes, in order to reduce readmission rates, the following principals should be followed:
• Define the problem, goals and customer requirements
• Measure current defect rate and process ineffectiveness
• Analyze process capability, identify sub-process owners, assess potential for improvement and availability of resources
• Improve the process to remove/reduce defects
• Control process performance and continuously assess for defect recurrence and new defects
Process analysis is key to reducing readmission rates, but requires leadership, resources and accountability.
