Case Managers Impact Hospital Readmissions

Case managers when utilized appropriately can reduce hospital readmissions and deliver more coordinated care in the emergency department, according to a newly published white paper from Huron Healthcare.


With Medexi, case managers now have the real-time ability to conduct alerts to transitional care teams while enhancing communications amongst the primary care physician and transitional care provider. More importantly, care teams are rallied around patients who face 30-day readmissions in real-time, while the patient is in the emergency department – before the readmission takes place!

More than ever, primary care physicians are relying upon the emergency department to evaluate their patients. Hospital readmissions have increased by 17 percent over the past seven years, which is a symptom of information gaps that exists with the disconnect between hospital encounters and community physicians.

A Merritt Hawkins report found primary care doctors generate more revenue for their hospitals than specialists — $1.57 million vs $1.42 million, respectively. Thus, the RAND report recommends that hospital administrators, policymakers, payers and federal research agencies understand the role of the emergency department as it relates to care coordination.

With Medexi Inform, the entire circle of care is notified upon a patients entrance into the emergency department. Our patent-pending algorithm identifies high-risk 30-day readmissions so that transitional care teams may be rallied prior to admission. Medexi Care delivers real-time patient data to the primary care physician such as: HPI, Labs, Radiographic Findings, Prescriptions, Discharge Instructions and communication from the transitional care team through Medexi Bridge.

Rather than relying upon retrospective data, Medexi Reporter allows for real-time metrics and predictive modeling to better future outcomes. Track readmissions, admissions avoided, diagnosis, provider involvement and much more!

To learn how Medexi can deliver care coordination to your facility, call 1-800-325-7103 today.

The ROI of the Medexi Suite

The ability to measure the impact of your investment is vital when investing in a new solution. The CMS Readmissions Reduction Program was legislated under the Affordable Care Act. This program launched in October 2012 and the 1% penalty on 30-day readmissions suddenly became a powerful pain point. In total, 2,217 hospitals will receive penalties ranging from .01% to 1% of total Medicare reimbursement generated during 2012. That percent will increase in the years 2013 and 2014.


Looking Under the Hood

The readmission penalty is complex. Let us provide you with a sample scenario:

  • Total Licensed Beds: 500
  • Annual Medicare Admissions: 10,000
  • AMI, CHF and Pneumonia Medicare Admissions: 1,000
  • AMI, CHF, Pneumonia 30-day Readmissions 230, Expected 200
  • Payment Rate per Readmission: $10,000
  • Cost Related to Excess Readmissions: $300,000
  • Penalty (1 / national readmission rate): 5
  • Annual Penalty: $1,5000,000


These penalties will recoup CMS $280 million alone in the year 2013. The penalties will increase over the next two years and the scope of diagnosis are set to expand to include COPD, Orthopedic Surgeries, etc.


What differentiates Medexi from other companies? We’re high tech, high touch! While our software serves as an early warning system for high-risk readmission, we also bridge with patients into their home within 24 hours of discharge. Our Transitional Care Providers visit with the patients in-home to provide eduction, compliance and follow up. If your hospital already has a transitional care team in place, then Medexi is the intelligence you need to rally those teams around patients who meet transitional criteria.


The Medexi ROI

When you redirect 30 readmissions you’ve paid for Medexi for an entire year! To put this number into perspective, last month our transitional care providers reduced a facilities readmission rate by 28%, thus the Medexi ROI was completed within 30 days. Furthermore, hospital systems receive enormous return in network referral revenue, decreased administrative costs, decreased faxing, less test redundancy and improved operation efficiency.


The Bottom Line

Healthcare systems in the future will be judged and penalized based on care coordination and patient satisfaction scores. Medexi 360 is completely vendor-neutral which has the ability to work with all systems and requires no installation within the hospital. To learn more about how Medexi can help your organization, contact us for a free demo.