Healthcare Breakfast Club

Free Startup Idea: Discharge Planning

Thu, 01 Sep 2011 04:46:00 -0700

Medicare and private insurers are increasingly going to stop paying hospitals for readmissions. But reducing readmissions requires dedicated staff with skills that hospitals don’t currently have. Great systems like UCLA can grow such skills in-house, but everyone else requires help – and that’s where you come in.

Here’s the pitch – for a per-case fee, your staff helps hospitals plan discharge. Your social workers sort out outpatient dialysis, home health equipment, and home nursing. Your coordinators call all the outpatient docs and get them the Discharge Summary and info they need. Your nurses perform medication reconciliation and teach the patients about their follow-up plans. Your call center serves as the point of contact for patients, which is easier for them than trying to call the hospital (ever called a hospital?). This combination of pre- and post-discharge care coordination reduces readmissions.

The sale shouldn’t be hard. Hospitals faced with looming unreimbursed readmissions – now a cost at $5,000-$15,000 a night – will find your rates reasonable in comparison. In addition, you’ll be lightening the burden on their clinical staff, freeing them to do the clinical work they’d rather do. Because you have dedicated skills and local relationships, you can do this faster and at lower cost than the hospital. Because you have cost accounting skills the hospital doesn’t, you’ll be assured of forecasting your rates accurately. Also, as a third party you’ll be entrusted with data that payors are reluctant to give hospitals. This knowledge advantage will allow you to offer to take a pay cut when patients are readmitted, thus proving to hospital clients that you have skin in the game.

Costs are modest. You hire staff at reasonable rates from hospitals, where the work is too intense, and insurers and disease management companies, where it’s too hands-off. Otherwise you’re asset-light – no inventory, no plant, no specialized technology. You get to know all the SNFs, rehabs, home health companies, and dialysis units in the region, creating barriers to entry for competitors. Billing is easy – you go straight to hospitals and not payors. No special coding needed. Patients should like it, since your job is to help them stay healthy, understand their health, and connect them with their docs. Policymakers should get behind you, too.

I might be biased but I believe it’s do-able and it would be good for patients. It’s yours free of charge – good luck. [Disclosure: I work for the UCLA Health System.]

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