Author: Brittany Hagedorn, US Healthcare Lead at SIMUL8 Corporation Reducing 30-day patient readmissions is increasingly important due to a combination of factors.  Of course, it has always been important to hospitals, clinicians, and patient advocates because of the impact on patient health and wellbeing.  But now that there are financial incentives as well, the issue is finally getting the attention that advocates have long been working for. Financial incentives come primarily from CMS’s VBP program, which withholds money on all Medicare payments for poor performance on measures including 30-day readmissions, patient satisfaction, risk-adjusted mortality rates, and a variety of clinical process measures.

As this program has gone into effect, other insurance companies, patient advocates, and public reporting/ranking organizations have taken notice and brought the spotlight to the issue. In an effort to keep up, hospital systems are rapidly implementing interventions, often without solid evidence of their efficacy or adequate measurement systems in place to track the results.  Interventions have a wide range, including ideas such as:

• Hiring additional case managers
• Automated follow-up calls after discharge
• Coordination with public social services
• Scheduling of follow-up primary care appointments
• Extra patient education prior to patient discharge
• Additional ED triage to divert potential readmissions to lower acuity settings
• Extended holding in the ED for observation prior to admission

The challenge of course is how to fund the additional staff time, IT resources, and limited follow-up capacity to get the most return on investment (ROI).  The key is to identify which interventions will work best for a specific organization, given their goals and constraints.  There are many factors to consider including:

• Available staff and financial resources
• Prevalence of chronic conditions
• Social and economic influences
• Financial incentives from CMS and others
• Current clinical outcomes, relative to peers and literature

Simulation is the only tool that can factor in all of these complexities, estimate both financial and clinical outcomes, and project into the future as demographics evolve.  This enables you to quickly play with “What If” scenarios and make the best investment possible – for both the bottom line and for patients. If you are interested to learn more about how simulation has been used in population health, please check out some of our case studies below or visit our section on Population Health.

• Improving Emergency Care Systems with Simulation Whitepaper
• Bowel Cancer Treatment Research
• Evidence on the effectiveness of screening for prostate cancer
• Modeling Out of Hours Demand for NHS Grampian
• Simulating future service needs for dementia care