Friday, December 7, 2012

Black Monday, the Day CMS Readmission Reduction Program became effective

Stay away, we don’t want you!

That‘s what hospitals are telling their patients as they get discharged.
Readmissions to the hospital for certain conditions are becoming  
very expensive. Under the Affordable Care Act, hospitals are now getting 
penalized for readmission for heart failure, heart attacks or pneumonia, 

with more conditions being added in future years. 

This year 2,217 hospitals will be penalized resulting in $280 million 
dollars being returned to Medicare. That doesn’t include any state 
penalties they might incur.

Again – why? The federal government found out that nearly one in five 
Medicare patients return to hospitals within a month of discharge and it 
cost the government an extra $17.5 billion in 2010.
That’s right, billion with a “B”!
To help reduce readmissions, hospitals are becoming more pro-active
after discharge by implementing outreach programs to ensure patients  
get follow up appointments, take their medications regularly after  
returning home and sending nurses to visit patients at home.
But, while hospitals are trying many different approaches with varying  
degrees of success, one area often over looked is the discharge process 
itself and the paperwork that accompanies the patient home. If you or 
family member has had a hospital stay, you have seen various flavors of 
discharge instructions. 
While we here at NEPS cannot follow a patient home and help with 
medications (we’d like to, but we don’t have the skills or license), we use 
our expertise in clear communications and information design to make 
documents easier for people to understand and follow. The result is not 
only better for the patients and caregivers, but for hospitals too. Simple 
instructions may help lower the cost of the post-discharge follow-up 
Here are two examples:
First, the following is a section from a seven-page discharge form that 
tells the patient about the blood clot medicine they are taking home. At 
quick glance, it looks like four bullets, but the fourth bullet (10 lines) 
includes the time and place of your next test and the name of your  
physician. The text all runs together with no visual separation and is the 
same font and same point size, making it hard to read and more crucially, 
find important information. The testing/contact information is lost.

before discharge sample
Think about a patient as they are being discharge from the facility and 
with a nurse who is going over seven pages of information. The
patient may still be suffering from the effects of the procedure 
medication and might not be fully aware. Maybe there is a family 
also in that meeting. But that family member might not be 
with the
patient 2, 3 or 4 days after when the patient needs to refer 
to the
discharge papers. It will be difficult trying to weed through 
seven highly
illegible pages.
Now look at the revised sample.
nwh patient care sample
Notice the use of different types of fonts– bold and light – to distinguish
information and allow the eye to find relevant groups of content. In
addition, the proper use of white space creates separation so the eye can
focus on each group and quickly and easily find the appropriate 
information. Here too, a larger font size is used, making readability easier 
even for olderor visually impaired patients. This is all accomplished while 
taking up lessspace on a page thus giving the patient fewer pages to read. 
Together, all these factors can help improve the chances of success in 
keeping patients from being readmitted.
Equally as critical in this type of document is the order in which 
informationis provided. We recently reviewed a card sent home with a 
chemotherapypatient to help them understand and manage the after 
effects. The first item on the 5 ½ x 8 ½ sized card was:
“How it is given: Into the vein”
This information is entirely irrelevant in this context and yet it is given the
most prominent position on the card. What is relevant is what side effects
can be expected, a list of symptoms that should prompt a call to your 
doctor, and a list of recommended behavior or things to avoid. Fully half of 
this information was on the back of the card, including all the information 
about when you should call your doctor. The very last bullet on the back 
side of the card was a warning about avoiding the use of “aspirin or aspirin 
containing products”. Since this is a common OTC medication that many 
use without thinking, and taking it can lead to complications for some, 
this warning should be much more prominent.
Ultimately, we designed the card to look like this with all information on 
one side and the most critical having the most prominence.
Although the penalties are capped at 1% this year, they will go up to 2% 
next year and 3% the following year. Hospitals must do whatever they can 
to minimize the penalties, but also improve healthcare and reduce medical 
errors. While outreach programs and personal visits and phone calls can 
prove effective in preventing readmissions, they are expensive and not 
always available at the exact time they are needed. Why rely solely on 
multiple people and processes as a costly band-aid (pun intended!) on the 
post-discharge end when clear communications can result in increased 
understanding of and adherence to follow-up activities?
In our own way, we are playing an important role in making information 
clearer, readable and easier to understand for all involved, while cutting 
down on preventable post-hospitalization complications.