Dayton Business Journal
Alternate Solutions Healthcare Systems Inc. has invested in technology it hopes will improve patient care and cut down on preventable re-hospitalizations.
The Kettering-based home health care provider will use a computer program — which analyzes patient history and medications — to determine which patients are most likely to revert back into the hospital system without more attention.
Alternate Solutions, the first company nationwide to sign on to use the program, hopes to reduce its re-hospitalization rate by a few percentage points, which would help retain clients and further boost its reputation among hospitals, on which the agency relies for patient referrals.
Local hospitals could reap ancillary perks. Medicare this year plans to penalize hospitals nationwide with too many Medicare recipients readmitted with the same diagnosis in a short time. Improved care following patient discharge could prevent some re-hospitalizations.
Nashville, Tenn.-based Medalogix developed the software — a proprietary predictive modeling tool — that takes into account two main factors: patient medication and OASIS-C information, required by the Centers for Medicare & Medicaid Services for home health providers to collect for all adult patients who receive Medicare and Medicaid reimbursements. OASIS, an acronym for Outcome and Assessment Information Set, measures care quality and includes patient information, such as demographics, environment, health status and nearly 1,800 other variables.
An algorithm analyzes the patient information and produces a ranking for each patient in the home health care agency from most to least likely to return to the hospital.
In the three years the program has been in development, it has accurately predicted patient risk about 75 percent of the time, Medalogix says.
Dan Hogan, President and CEO and co-founder of Medalogix, formerly owned and operated a home health care agency in Tennessee. Program results do not recommend patient care, but Hogan said it could expose at-risk patients who otherwise would have flown under the radar.
“For the bulk of patients, they’re already doing everything they can,” Hogan said. “The value is in the identification of patients who may not appear to be on the face as at-risk as they are.”
Tessie Ganzsarto, president and co-founder of Alternate Solutions, said the information would help identify which patients need heightened care. That could include more frequent visits and phone calls from nurses, earlier appointments with doctors or therapy not initially recommended.
Ganzsarto said Alternate Solutions has a 9 percent to 10 percent re-hospitalization rate and she hopes to cut that down at least a few percentage points, which would make a solid impact on its active patient base of 1,500 to 1,700.
Alternate Solutions has 11 locations in four states, including two in Dayton with 200 employees locally and 450 total. The company pulled in $31.92 million in revenue 2010 — 8 percent more than in 2009.
Medicare patients older than 65 are admitted to hospitals more than nine million times annually, and nearly one in five are re-hospitalized within a month, statistics show.
A recent report by Dartmouth Atlas on post-acute care for Medicare recipients shows roughly 12 percent to 13 percent of patients are readmitted in the Dayton region within 30 days of surgical discharge. In addition, about 22 percent to 25 percent visit a primary care clinician within 14 days of surgical discharge to home, which could indicate a disconnect in care.
The Centers for Medicare and Medicaid Services estimate avoidable readmissions cost more than $17 billion annually. To help prevent as many re-hospitalizations, Medicare in 2013 plans to impose a penalty of 1 percent of hospitals’ Medicare billings, if an excessive number of patients are readmitted.
The penalty increases to 2 percent in fiscal year 2014 and 3 percent in 2015.
Fewer admissions back into hospitals would allow home health care agencies to care for patients longer and look better to hospitals, which refer patients to home health care providers and look to prevent re-hospitalizations.
Nearly all of Alternate Solutions’ patients are Medicare beneficiaries, and about 8 percent to 10 percent are referred to the agency by hospitals, Ganzsarto said. The rest come from assisted living and skilled care homes, physicians groups and long-term acute care hospitals.
“We’re working with hospitals every day to show that we’re trying to be proactive rather than reactive,” Ganzsarto said.