The term ‘care coordination’ has become increasingly popular due to Accountable Care Organizations (ACOs), value-based purchasing, and patient-driven payment model (PDPM), which are driving the collaboration of acute and long-term post-acute care for reimbursements. These handoffs between care providers and settings come in many forms. For example, a patient can shift from a hospital to a skilled nursing facility. Then, there’s also the transition that occurs when a patient is discharged from a care setting to the home. Organizations have discovered that inadequately managed care transitions can negatively affect care quality and increase costs for the healthcare organization.
In fact, researchers have estimated that inadequate care coordination, including inadequate management of care transitions, was responsible for $25 to $45 billion in wasteful spending in 2011 through avoidable complications and unnecessary hospital readmissions. This is a huge cost to every person involved, but through careful collaboration this can be avoidable for the facility and the patient.
Below are a few ways that care coordination teams can influence and improve care transitions in their care settings.
Increase data interoperability. With differences in IT systems between health systems, it’s often difficult to transmit medical records between hospitals and physician practices. Luckily, there are standards that are in place by the ONC (Office of National Coordinator for Health Information Technology) that every organization should explore and implement.
Communicate between internal teams and patients. In addition to external communication, care settings must also place importance on the communication with patients and between care providers inside the facility. Patients especially must be able to trust that the team members are all vested in their overall well-being.
Efficient processes and procedures. Finally, automating some of the information exchanged during the handoffs can really reduce errors and minimize the miscommunication. Utilizing your EHR and interoperability solutions to its full potential can help staff track patient health effectively, which in turn helps keep costs down and provides quality care.
One major way to avoid a patient’s critical health important records from getting lost in transition is to use technology. When a long-term care facility uses a referral portal to gain access to prospective residents from referring hospitals, all that patient data is readily accessible. The long-term care facility is then able to make the most educated decision on whether that individual will be a good fit for their particular facility. What’s more is that if that facility is chosen, all the healthcare records are there for clinical staff, there’s no longer risk of something getting lost in the mix.
Referral Portal by Cantata Health streamlines care coordination, reducing the amount of time it takes for clinical liaisons to screen and accept new residents from hospitals. A unified view into candidates’ care profiles gives SNFs the speed they need to win referrals, plus the insight to select ideal residents for their facilities. Learn more, or to speak to an expert on how Referral Portal can help your facility increase bed count, improve care quality, and more.
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