How hospitals can make big data pay big

March 21, 2014 in Medical Technology

Hospital executives are faced with numerous challenges related to healthcare reform in general and the Affordable Care Act  in particular. Strategic decisions about how to address these challenges will significantly impact not only the financial and clinical performance of hospitals, but the perception of executive leadership itself.

Even though optimizing workflows and other processes are the main avenues available to executives to address these issues, it’s critical to understand the role that advanced information technology has in bringing these efforts to fruition.

Reduced payments to hospitals for avoidable readmissions began in 2012 under the ACA’s Hospital Readmissions Reductions Program, and the program is expanding in future years by increasing the level of payment reductions and expanding the scope of illnesses covered.

[See also: Health IT not keeping pace with big data.]

By 2015, under the ACA’s Hospital Readmissions Reductions Program, a penalty of up to 3 percent of regular reimbursements will be levied against hospitals that have had too many patient readmissions within 30 days of discharge for conditions such as heart attack, heart failure and pneumonia.

Compounding these factors are estimates from the American Heart Association that the number of people in the U.S. with heart failure could rise 46 percent, from 5 million in 2012 to 8 million in 2030, while the costs required to treat the condition could rise from $31 billion to $71 billion over the same timeframe.

Big data software applications represent the single most effective solution to addressing the myriad cost pressures facing hospitals, including the reduction of avoidable hospital readmissions. With each passing year, these technology investment decisions will become increasingly pivotal as a variety of cost pressures continue to rise.

Cost/benefit analysis will help reduce risks

While payment reductions constitute a significant financial risk for hospitals, there are additional risks related to the Centers for Medicare Medicaid Services publicly reporting hospitals’ 30-day readmission rates and other healthcare quality measures online at “Hospital Compare” and other venues. As healthcare consumers and employers become increasingly aware of the available date, they will begin to more readily use that information to make decisions about where and how to engage service providers for healthcare.

However, all of these developments provide great opportunities for hospitals and health systems; not only to maximize payment capture from CMS, but also to bolster hospital marketing programs that promote achievements in key quality measures. With the right strategy for health information technology, hospitals and health systems can reduce avoidable readmissions, avoid reimbursement adjustments, and gain new market leadership in the healthcare reform environment.

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