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Midas+, a Xerox subsidiary, has developed a data-driven solution that estimates excessive readmission rates and the associated financial penalties for two fiscal years in the future.
The Midas+ Readmission Penalty Forecaster’s near-real-time measurements include patients who are readmitted within 30 days to a different hospital.
The announcement comes as hospitals with high Medicare patient readmission rates have just under six months to ramp up their reduction efforts and avoid stiffer financial penalties for patient readmissions.
To avoid penalties, hospitals must prevent excessive readmissions in six clinical areas for Medicare patients discharged from July 2012 through June 2015.
“In addition to readmission penalties, health care organizations are tasked with meeting and implementing new federal regulations and initiatives that set expectations for quality, coding, reimbursement and overall care delivery,” Justin Lanning, senior vice president and managing director of Xerox Healthcare Provider Solutions, told eWEEK. “Regulations such as ICD-10, HITECH/Meaningful Use and the Affordable Care Act, designed to improve care and efficiency, require time, money and resources.”
In addition to the Forecaster offering two years lead time to improve performance, it also provides ongoing focused and targeted information to deploy a hospital’s resources that are crucial to the success of health care organizations in the world of value based care, Lanning said.
To make predictions, the Forecaster crunches five years of Medicare data and links it to a patient’s record in the Midas+ analytics and workflow software platform.
With machine learning technology, the system delivers up-to-date insights on patient admissions by leveraging real-time data on every aspect of the clinical care cycle from more than 1,900 hospitals.
“The Forecaster is one offering within our comprehensive machine learning and analytics services that provides hospitals with actionable data to improve their overall efficiency,” Lanning said. “We are focused on applying national best practices while delivering customized process improvement programs to help hospitals improve transitions of care and prevent readmissions. In addition, Midas+ continually enhances our offerings to stay ahead of regulation and the health care analytics marketplace.”
The Centers for Medicare and Medicaid Services (CMS) reduces hospital payments for Medicare beneficiaries if it deems rates of unnecessary and unplanned 30-day readmissions excessive.
In 2014, hospitals faced $175 million in penalties, but that figure is expected to reach $424 million in 2015 as the maximum penalty recently increased 1 percent.
“Replicating government risk models, the platform estimates excess readmission ratios with as much as 99 percent accuracy, allowing hospitals to plan and prepare for the financial impact, as much as two years in advance of the reports that CMS provides to hospitals,” he said. “In addition, on-site consultation enables hospitals to respond to areas of concern and implement strategies that help reduce readmissions, and ultimately, improve the quality of patient care.”