Why Do Care Transitions Remain a Black Hole in Healthcare?

Care transitions between acute and post-acute organizations remains fraught with challenges. They can be inefficient, highly manual, and prone to errors. This has been known for years, yet remains an area that receives little attention and funding. Why is that?

This was the central question in a Healthcare IT Today panel discussion (recording available) featuring:

  • Mary Kay Thalken, RN, MBA, Chief Clinical Officer at Ensocare
  • Patrick Yee, Chief Technology Officer at Ensocare
  • Mark Kestner, Chief Medical Officer at TractManager

Current state of care transitions

“Patient transitions today are very bumpy, at best,” stated Thalken. “The process for the staff handling transitions is largely manual. They are still using telephones, fax machines, and copiers. There are about 40 steps from the point where a case manager receives an order to find placement to that patient actually being placed in a post-acute care facility.”

Thalken estimates that today almost 50% of a case manager’s time is spent on non-value-added clerical aspects of patient transitions. This is very surprising given the pervasive use of EHRs at acute care institutions. With most patient information stored electronically, shouldn’t it be a fairly simple task to transfer that information to a post-acute partner? Not so, explained Kestner.

“One of the great fallacies was that the EHR would solve many of healthcare’s problems,” said Kestner. “EHRs are a repository of clinical information. You still need people to do all the tasks like care transitions. The EHR did nothing to improve the workflow or make it easier for case managers to find a place for those patients.”

Impact of poor care transitions

When care transitions are not handled smoothly, there are negative impacts for everyone involved. For patients, extended stays in a hospital can result in higher costs, especially if they have high-deductible insurance plans. Extended stays can also can delay their recovery. Plus, it goes without saying, that no one likes waiting in a hospital bed, so any transition delay leads to a sub-par patient experience too.

Of particular concern is the potential risk to patients when care transitions are handled manually. When clinical information cannot flow electronically between the acute care facility and their post-acute partner, deadly errors can occur. If a case manager has to print/fax a patient’s record, pages can go missing or the record can be incomplete.

This is especially dangerous for things like medication lists. If the printed record isn’t up-to-date, dosages may be incorrect or medications that are no longer required may still be listed. A 2017 study found that 26% of ER admissions were potentially attributable to preventable medication-related issues.

For the hospital, delays and bottlenecks in placing patients with a post-acute provider can have a significant financial impact. While that patient is waiting to be transitioned, the hospital is unable to accept a new patient to that same bed. The metric used to track this is “avoidable patient days”.

When avoidable patient days creep up, a hospital is more likely to reach capacity – forcing it to potentially turn patients away which can lead to higher costs for patients (and payers) who have to be diverted to other facilities. A hospital that isn’t using this metric may come to the erroneous conclusion that more bed capacity is needed and embark on a costly temporary or permanent expansion.

During the panel discussion, Yee brought up a potential issue that many organizations do not consider – the validity of fax numbers.

“You have to stay on top of your network of post-acute providers, including when they go out of business,” implored Yee. “Because when you are faxing out clinical information, and that provider is no longer in business, there is a chance that fax number has been recycled and could now belong to a Subway sandwich shop.”

Why are care transitions still a black hole in healthcare?

With so many potential problems that can happen during care transitions and the severe impact that delays or errors can have – why does this area of healthcare remain ignored?

“Historically, hospitals were not disincentivized from readmissions,” Dr. Kestner said. “I could be a little sloppy in discharging a patient because, if they came back, that was okay.”

In Dr. Kestner’s opinion it’s only because of the implementation of penalties for readmissions that organizations are turning their attention to care transitions.

“I think one of the big contributors is fragmentation in healthcare,” stated Thalken.

This is especially true in the post-acute world where there are multiple providers of varying sizes – from small mom and pop operations to multi-site, multi-state organizations. The lack of standardization for information exchange is also a contributing factor, according to Thalken.

Who should pay to fix the problem of care transitions?

Dr. Kestner believes payers have the right incentive, are positioned at the right spot in the healthcare ecosystem and have the financial means to pay to fix the issues in care transitions.

Payers have the incentive to move patients to the appropriate level of care to ensure they recover and remain healthy. Getting a patient out of an expensive hospital bed and into a lower cost SNF where they can receive more of the care they need (ie: physiotherapy) is in both the payer’s and patient’s best interest.

Payers also have an incentive to ensure the transition to the chosen facility is as smooth as possible. Eliminating potential errors means patients will remain healthier and have fewer complications.

In theory, payers could fund the implementation of electronic tools that make:

  • Maintaining a trusted list of post-acute partners easier
  • Matching patients to the most appropriate post-acute partner faster
  • Transferring all the latest clinical information (especially medication lists) between organizations smoother
  • Communication between case managers, care teams and post-acute providers seamless

Tools exist

Thankfully, there are already platforms that have these features. Ensocare, the sponsor of the panel discussion, is one of them. Their platform automates every step of the patient care transition process – reducing and eliminating many of the clerical tasks that bog down case managers.

The net effect is that avoidable patient days are reduced, cost of care is reduced, and satisfaction rises for both patients as well as staff. You can find out more about Ensocare by visiting their website: https://www.ensocare.com/

Great panel discussion

To view the entire panel discussion, visit this page. You’ll learn:

  • Why solving care transitions will become more important in the years ahead as health plans become more homogenous.
  • Why asking the patient to be responsible for their own transition is a bad strategy
  • How ignoring workflow inefficiency will lead to staffing issues in the future
  • What a patient or caregiver can do to help ensure a smooth and safe care transition
  • The advantage SNFs and post-acute care providers can realize by making care transitions with their facilities as smooth as possible

About the author

Colin Hung

Colin Hung

Colin Hung is the co-founder of the #hcldr (healthcare leadership) tweetchat one of the most popular and active healthcare social media communities on Twitter. Colin speaks, tweets and blogs regularly about healthcare, technology, marketing and leadership. He is currently an independent marketing consultant working with leading healthIT companies. Colin is a member of #TheWalkingGallery. His Twitter handle is: @Colin_Hung.