How to Improve Quality Care Levels Using Patient Data

How can your post-acute care facility stand out in a saturated and highly competitive healthcare market? By improving your quality care levels, you can make your organization more attractive to referring hospitals in your area. When they see that you have a lower readmission rate than competing facilities, they’ll put your name at the top of their referrals list.

Thanks to the changing reimbursement models, hospitals are feeling a lot more pressure from the Centers for Medicare & Medicaid Services (CMS) to lower their avoidable readmission rates. Readmission rates above a certain threshold will significantly reduce the revenue hospitals receive from Medicare reimbursements. Understandably, they’re re-evaluating how they choose their post-acute partners.

While big market shifts like this can be disruptive — and a little scary — they also present an opportunity. How can you stand out and show that your quality of care is better than the competition? First, you need to accurately track patient data.

According to a recent Rev Cycle Intelligence article, hospitals are now implementing utilization management programs, which “verify that patients are receiving the right care at the right time [ensuring] that hospitals are delivering appropriate, cost-efficient care.” Thanks to more accurate patient data tracking, these programs empower hospitals to improve care and reduce claims denials. Post-acute providers can use the same kind of data to improve quality care levels.

Know your readmission rate

When you have the right tools, you have the power to provide the right care at the right time, for better patient outcomes and higher quality care levels. Implementing an effective application to track hospital readmissions gives you a better view of your current performance. You can see where you are exceeding expectations and where you may have room for improvement.

Identify areas for quality care improvement

Better yet, when you can see condition-specific statistics, you can get a more complete view of your quality of care for all your patients. With these insights, you’ll see where you have a competitive advantage to target hospitals in your area that need post-acute care facilities like yours.

If you can identify areas where you excel and areas that need improvement, you can create an effective strategy to gain more referrals. Not only will you have the opportunity to continuously improve patient care, you’ll also likely increase your market share in the process.

Compare your quality care performance with your competitors

One of the most important metrics that referral partners evaluate is readmission rates. Tools like ABILITY INSIGHTTM Readmission Tracker use your patient data to benchmark your performance against your competitors. You can see where their quality care levels fall short, helping your organization stand out in the competitive post-acute care market.

How to Transition to PDPM Without Missing a Beat

The patient-driven payment model (PDPM) goes into effect in just a few months. Skilled nursing facilities (SNF) have until October 1 to make the transition. Is your facility ready?

Established by the Centers for Medicare and Medicaid Services (CMS), PDPM represents a shift from fee-for-service care to value-based care models. Successfully transitioning to PDPM will involve a three-pronged strategy for SNFs:

  • Optimizing efficiency in providing care
  • Enhancing patient experience
  • Improving patient outcomes

In a value-based care model such as PDPM, instead of billing patients based on the number of services you provide, you’ll bill them based on their outcomes. They key to maintaining revenue during this transition lies in capturing and managing data.

A deeper look into each step of the transition strategy, as well as how to best use the data you collect, can help your facility transition to PDPM without missing a beat.

Optimizing efficiency in providing care

When you optimize how you care for your residents, you may find untapped, justifiable reimbursement revenue that you would have otherwise left on the table.

With ABILITY CAREWATCH®, you can use the Resource Utilization Group (RUG) Potential tool to view RUG groups before you transmit your assessments. This will allow you to plan ahead for the next Minimum Data Set (MDS) assessment and ensure that you are properly reimbursed for each resident’s care and the services you provide.

Enhancing patient experience and improving outcomes

When your organization is reimbursed based on the quality of your patients’ experiences and outcomes, data becomes an indispensable tool. The right data applications help you keep track of where you stand on crucial quality measures. Tracking your Five-Star rating, for instance, allows you to clearly see how your facility compares with others, where you are succeeding and where you need to improve.

Another important metric to watch is acute care readmissions so you can identify at-risk residents. Data-driven applications offer SNFs the opportunity to pinpoint exactly where they need to improve for a seamless transition to PDPM.

Accurate MDS assessments for better reimbursements

Also, to improve patient experience and outcomes, SNFs must have the power to create enhanced care plans with accurate analysis of the MDS. With the right tools, you can catch MDS issues early and boost assessment accuracy for better care plans. With accurate MDS assessments, you’ll also be empowered to find more reimbursement opportunities, ensuring that you collect more of the revenue that you are owed.

Data-driven applications are crucial to easing your transition to PDPM and helping you improve patient outcomes.

For more resources on transitioning to PDPM, as well as other relevant industry info, visit the ABILITY resource center.

infection prevention

Skilled Nursing and Infection Prevention: 3 Strategies to Start Using Right Away

When did your facility last experience an infection outbreak? How many patients did it affect? In the United States, 1 in 3 million serious infections occur in long-term care facilities – and of those, 380,000 cases lead to death each year.

It’s a serious issue that can’t be ignored. But unfortunately, not all long-term care professionals know how to best prevent and control infection outbreaks. Regular cleaning and disinfecting, the use of disposable tools and even basic hygiene, such as flushing and hand-washing, is not enough. Caretakers need to do more to best ensure their residents’ well-being.

Here are three infection prevention strategies to start using right away.

1.    Record and monitor all infections

As much as you need to treat an infection, you should also be tracking every symptom and moment of intervention. This information is invaluable for better preventing similar infections in the future. It can help you identify the root cause of one patient’s infection as well as an outbreak.

But, how you record this data plays a critical role in how helpful it is. Paper files won’t get the job done. These are time-consuming to record, find and analyze. The easier, more efficient way to work is to digitally track all infection information with a tool like ABILITY InfectionWATCH™. Going digital gives you much more visibility to the infection trends affecting your organization. It simplifies how you track and treat each patient’s condition and how you prevent outbreaks from affecting all patients.

2.    Strengthen early detection efforts

One of the best ways to keep an infection from spreading is to identify it early on – either when an already existing infection enters your facility, or when a new infection occurs within the facility.


Some ways to improve the early detection of infection include:

  • Identify where an infection was acquired
  • Identify the prevalence of healthcare-associated infections (HAIs) and community-associated infections (CAIs)
  • Track cases of antimicrobial resistance
  • Record adverse drug effects
  • Utilize the information of previous outbreaks to identify high-risk trends

Early detection doesn’t just mean being aware of the potential for an infection outbreak in the future. It also means learning from past outbreaks to best minimize this risk.

3.    Prioritize your intervention plans

If one individual contracts an infection on Monday, and another is affected by a different, more serious infection on Tuesday, who do you need to see first on Wednesday?

Infections don’t happen exclusively. Depending on the size of your facility, it may not be that unusual to manage more than one outbreak – and many affected individuals – at a time. If you find yourself administering multiple intervention plans, you need to know how to prioritize them.

This way, there’s no question as to which patients need certain treatments and to what extent their infections should be tracked and monitored. To best prioritize your intervention plans, refer to the records you keep as symptoms arise and infections are identified. Then, continue to use these records to further enhance your infection prevention and control strategies long-term.

patient data

Continuing the Care Cycle: 3 Things You Can Learn from Tracking Patient Data

Patient care is an ongoing effort. Its success relies heavily on regular caretaker interventions, and it’s partially dependent on how invested a patient is in their well-being. Patient data also plays a role in the coordination and effectiveness of care.

When skilled nursing professionals are able to easily understand the recurring trends of their patients’ health, they can better focus their efforts. Over time, care efforts can shift from a reactive process of caring for the symptoms of serious conditions to a proactive approach that can prevent certain symptoms from affecting patients.

This can’t happen if patient data is sitting in silos. The data must be collected, compiled and analyzed for providers to utilize its full potential.

Wondering what you could accomplish with predictive analytics and insights?

Here are three things you can learn from tracking patient data.

1. Your biggest opportunities to improve care quality

Most providers assume they don’t need to track patient data because they already have a thorough understanding of each patient’s condition. This misconception causes them to miss out on the opportunity to greatly enhance the care quality levels of their entire organization.

By compiling the patient data of multiple people with similar conditions and treatments, providers can better understand how well they’re performing across the board. They can confirm which efforts work best and identify where their team has the most opportunities to improve.

Some providers may discover that assessment errors or lack of patient engagement have negatively affected treatment results. Others may be surprised to find that they’re performing below – or perhaps above – their state’s average star ratings. These are valuable pieces of information available via ABILITY CAREWATCH®, and they’re just scratching the surface of what utilizing comprehensive patient data can accomplish.

2. Why readmissions are occurring

Missed opportunities during treatment can lead to more serious conditions for patients and costly consequences for your organization. If you’ve seen a spike in readmissions, it’s time to take a closer look at what’s causing patients to leave your organization and return to a hospital. Assessing the data of a patient’s treatment from start to finish can help you find the turning point of their condition.

Analyzing patient data for a group of individuals, though, is what allows you to spot workflow trends in your organization that need to be improved. One benefits you on a case-by-case basis, while the other can significantly improve the results you’re able to provide all patients. By utilizing the data of all, you can reduce the risk of readmission for many.

3. How much revenue you’re not capturing

In addition to improving quality of care, patient data can boost financial performance. This occurs when you analyze the claims associated with a patient’s treatment records. If all the claims for a treatment haven’t been submitted, accepted and paid in full, revenue is slipping through the cracks.

There’s also a chance that you have untapped revenue in the form of claims that haven’t yet been created for services you’ve completed. This may happen because your billing staff is prioritizing other claims, or maybe, because they’ve overlooked the opportunity to bill for a service altogether. Another possibility is that the supporting documentation you currently have in place isn’t meeting payers’ requirements.

There are many additional reasons why a claim may not have been submitted or paid in full. But, you can’t leave money sitting on the table or allow conditions to worsen. With the right approach, a little bit of extra time spent analyzing patient data can lead to significantly stronger financial performance and more effective patient care efforts.

Tips on Introducing Value-Based Quality Care to the Day-to-Day Operations of Your Organization

As healthcare continues to embrace value-based care, it’s increasingly important for organization leaders to be on-trend.

Those who can quickly implement this way of thinking and operating will see an increase in patient engagement as a result of higher quality care. Those who struggle to embrace value-based care will fall behind as consumers turn to other, more attentive providers who can offer better results.

Here are three tips to help your organization succeed in its transition to providing value-based care as opposed to fee-for-service treatment.

1. Streamline front-end operations and payment processes

One of the biggest areas for opportunity with a value-based care model is front-of-house operations. Patients don’t like having to wait for their provider if they show up on time for their appointment. When being admitted into a hospital or skilled nursing facility, it’s not ideal to fill out piles of paperwork, either.

This means you must streamline your front-end operations, no matter the kind of organization you run. Make it easier for patients to provide their eligibility information, and help your staff verify eligibility by investing in the right software.

Advanced verification and claims management tools like ABILITY COMPLETE® can significantly speed up the entire billing process. They’ll provide your team with all the information they need to share with patients. To embrace value-based care even more, ask your team to clearly explain patient eligibility.

Patients who have a better understanding of their coverage and payment responsibilities will show higher levels of engagement. They’re also more likely to pay what they owe on time, especially if you have credit card processing capabilities on site. Other payment processes patients respond well to are online bill pay and automated payments.

2. Focus on comprehensive care and wellness

In addition to front-of-house improvements, you also need to change how you deliver patient care. A diagnosis and prescription won’t cut it anymore. Patients want a much deeper understanding of their health. They want a comprehensive approach to treatment – something that teaches them healthy behaviors they can continue after their treatment is over.

The desire for these long-term solutions is the result of the challenges today’s healthcare consumers face. It’s much harder for them to access care, and the cost of care is a big concern for patients as well. In fact, a recent study states 40% of Americans skipped a recommended medical test or treatment in the last 12 months due to cost.

Additionally, Americans fear the cost of treatment more than the potential illness. When they do seek care, they’re looking for the best, most well-rounded and effective treatment they can find in order to prevent future healthcare costs.

3. Boost revenue with CMS value-based initiatives

If patients avoid healthcare and only engage in comprehensive treatment, what does that mean for providers? CMS is aware that providers may be concerned about losing revenue, so they’re rolling out value-based initiatives to ensure both providers and patients benefit from this transition.

If providers can prove that they’re creating comprehensive health plans and focusing on the long-term well-being of their patients, they’ll receive payment. The qualifications and terms of each CMS plan is unique, but the opportunity is there (or on its way) for providers to increase the level of patient care they provide without hurting their revenue.

The shift toward offering higher-quality care in a more accessible manner has already begun. If your organization has yet to make the necessary adjustments to embrace value-based care, now is the time.

infection prevention

4 Infection Prevention and Control Tips to Use in Your Organization

There’s more to maintaining the health of your patients than treating them for their existing conditions. Providing a high level of quality care also means keeping them safe from additional health risks.

Health risks may include everything from a slip and fall to a flu outbreak to more serious matters like strep throat, UTIs and gastrointestinal infections.

If these or any other infection has recently affected your organization, it’s time to re-assess your infection prevention and control strategy. If no infections have occurred thus far, it’s best to keep building on the infection prevention practices you’re currently using.

The four tips listed below can help you lay the foundation for an infection-fighting strategy or improve the one you already have.

1.    Create a dedicated quality care and infection prevention team

Fighting harmful bacteria is the responsibility of all staff, so it makes sense to put employees from various departments in charge of infection prevention. A dedicated team can help ensure there are no gaps in your plan to prevent outbreaks. The combined knowledge and experience of each person will provide you with all the information you need to:

  • identify high-risk areas where an infection may occur
  • improve antibiotic treatment protocols
  • limit the transmission of antibiotic-resistant bacteria
  • expand infection surveillance capabilities

Additionally, a dedicated team can facilitate stronger communication and collaboration as staff works to keep infections at bay – and to control them in the event of an outbreak.

2.    Close the gaps across all department functions

Beyond your dedicated team, all staff members should be actively working to avoid an outbreak. Every employee needs to understand the critical importance of infection prevention and be committed to their role in it.

This begins with sharing the right information. Educate your whole team – not just those who work directly with patients – about infection control. Make sure food service individuals understand the best practices to use when preparing and distributing meals. Talk to housekeeping about the personal protective equipment they should use while they work. Explain infection prevention and control to your administrative staff, too.

Also remember to correct bad habits, even for seemingly simple prevention efforts like hand-washing and the use of gloves. These are two of the most commonly overlooked aspects of infection control, but they make a big difference.

3.    Streamline infection surveillance

Just as you must close the gaps between each team’s role in infection prevention, you need to also streamline surveillance. This is hard to do with incomplete documentation of outbreaks or a lack of adherence to evidence-based guidelines. However, having all the infection information you need in one place can do wonders for how well you prevent and control outbreaks.

Imagine if you could access infection records at the click of a few buttons instead of spending hours sifting through paper files. Or, if you had the option to track infections on a map or evaluate infection data in terms of category, type and culture organism. You’d have a much deeper understanding of the infections your organization commonly deals with, and you’d be in a better position to prevent future outbreaks.

You don’t need more time in the day or even extra staff to do this. You just need the right tools to help you keep your patients safe.

4.    Act fast and track everything

The faster you can identify an infection, the less risk it will present to your patients and staff. Streamlining surveillance will help you notice an outbreak, but you need to have an action plan in place. This is key to controlling an outbreak. A clearly-communicated, effective action plan can be the difference between a small, manageable outbreak and one that affects many patients.

But, the plan you have in place today doesn’t necessarily have to be the one you use tomorrow. Whenever an outbreak happens, gather all the data you can. Record patient interventions and identify clear categories to make sense of the data. Make graphs to reflect employee performance and create a full overview of how effective all infection control and treatment efforts were.

If you’re not currently dealing with an outbreak, you should be continuing the work to keep infections at bay. If an outbreak recently affected your organization, it’s worth trying a new approach to how you prevent and control the spread of harmful bacteria. Fortunately, the tips above can guide you in improving your organization’s performance when managing infections.

Patient Needs Are Changing: Here’s a Closer Look at the Impact

If you’re looking to attract new patients, you can’t rely on old tactics. Although there are some things that can stand the test of time, there’s no denying the need to adapt to ever-changing patient desires – especially as the largest population of American adults are coming of age.

Millennials have either recently come off their parents’ insurance plans or they’re about to. They’re learning how to open insurance policies and manage healthcare payments in a time when patient payment responsibility is growing and putting more pressure on consumers. This causes young adults to either not have any insurance or avoid seeking medical treatment even if they are insured.

As a medical provider, you can see this as a challenge or an opportunity. You can fight the change and keep wondering why patients aren’t coming in your doors, or you can learn how to better meet the needs of patients today.

The following is a closer look at three major shifts in how patients are taking care of themselves and the effects they have on medical providers.

More patients are taking preventive care into their own hands

Millennials who choose to go without insurance or primary care aren’t throwing their health out the window. Rather, they’re focusing on preventive care measures like working out and healthy eating to decrease their likelihood of needing medical services.

But, at one point or another, these health-focused individuals will still find themselves in need of a medical provider. And when they do go in for treatment, they want personal, attentive care. They want to be educated about what caused their condition and how to prevent it in the future.

This is your time to shine. It’s your opportunity to show these young adults why having a primary care doctor is so important, and to make them realize the value of being a patient of your organization as opposed to others. If you establish a relationship with these patients, they are more likely to return the next time they need care.

Convenience has transformed the consumer mindset

A recent study conducted by the Kaiser Family Foundation found that about 1/3 of American adults don’t have a primary care provider. Millennials comprised the majority of this population.

This is partially due to confusion around health insurance and increasing financial pressures, but the other reason primary care rates are dropping is convenience.

Patients are more concerned about how they feel in the present moment versus how they may feel in the future. This has shifted the patient mindset from “I need to have a regular primary care doctor I can rely on” to “I need a doctor (any doctor) to treat me right away.”

The result? More patients are going to walk-in clinics or bypassing primary care and going straight to a specialist. They expect to be seen immediately and they want fast solutions. Waiting a week for an appointment isn’t an option in their mind and having to come back for a follow-up visit isn’t ideal.

Connectivity is a must, not an option

How can providers keep up with the fast pace that a convenience-centered market demands? By implementing tech-savvy applications, such as an automated bill pay system, to help enhance your patients’ experience.

Simplify your communication process for setting appointments and receiving patients in the door. Your patients should be able to contact you with a quick online search and the click of a button – and they don’t want to show up for an appointment only to wait and fill out paperwork. Rather, it’s better to let them fill out forms ahead of time via a patient portal. After their visit, many patients prefer to pay online, especially if they have ongoing payments to make.

It isn’t necessary to completely transform your office’s workflow, but it is worth exploring what a few simple changes such as ABILITY SECUREPAY™ can do to better serve your market.

patient experience

4 Unique Ways to Enhance the Patient Experience in Your Organization

No matter how advanced medical tools and treatments become, human interactions will continue to play an integral role in healthcare. Patients will still need real people to provide eye exams, at-home care, mental health services and everything in between. Technology can make these things more accessible and easier to manage, but it can’t replace personal care.

This doesn’t mean pat­ient care will continue to be what it always has been, though. As new advancements make the role of medical professionals more efficient, it becomes the responsibility of providers to offer more than basic medical services. They now have to focus on enhancing the patient experience in every step of the care cycle.

Here are four things you can start doing within your organization to take the patient experience to the next level.

1. Treat people, not medical conditions

As much as patients want to find solutions to their medical problems, they also want to feel heard and empowered whenever they seek treatment. They’re taking ownership of their healing process, not looking for a band-aid solution.

This means your staff needs to make more time to listen and express genuine concern. Try to explain conditions and treatments a little more in-depth than you normally do and make it a point to show interest in patients beyond their health. Talk to them about their families and their hobbies. Remember their birthday and congratulate them on life accomplishments they may mention. Strive to be a friend and a medical professional, not just a signature on a prescription.

2. Give patients the maximum value for their healthcare dollars

Patients can Google one-size-fits-all answers. They’ve become accustomed to self-assessing their conditions and even treating certain health issues on their own without seeking any professional treatment.

When they do make a medical appointment, they’re looking for in-depth information. They want to know how to prevent the issue they’re currently dealing with from happening again. They want to get to the root of a problem to stay out of the doctor’s office as long as possible.

This may sound like it’s bad for business, but it would actually do you well to adjust to this shift in patient mentality. It can create better brand value and recognition for your organization and lead to more patient recommendations. And since more people are researching different providers before they make an appointment, it’s in your best interest to make a good name for yourself by going above and beyond standard care practices.

Such a strategy will help you capture new patients as they shop around for medical care and keep current ones coming back when they need more than at-home treatment.

3. Simplify patient payments

Patients have enough trouble understanding their insurance coverage; they don’t need to experience more financial stress when paying the fees they’re responsible for. Thankfully, you can make this payment process much easier on them by offering online bill pay options, like ABILITY SECUREPAY™. Instead of limiting patient payments to cash or check only, online methods give healthcare consumers the access they need to stay on top of payments. They allow people to conveniently pay for their medical services via a simple, easy-to-use portal. They also provide the option to save credit/debit card information for future payments and set up automatic payments.

4. Continue the conversation

Whether your patients come in regularly, every few months or sporadically, you should be continuing the conversation with them beyond one visit. Specifically, focus on providing better post-visit instructions in terms of medications to take and suggested lifestyle changes.

You can also use post-visit interactions to gain insight from your patients about what you can do better. A simple survey asking patients to rate your performance and provide feedback can do wonders for your organization. It helps you understand their needs/desires at a deeper level and catch things that may have slipped through the cracks in your workflow or staff training.

At the end of the day, the more you put into the patient experience, the more your organization benefits. It’s time to change the way you think about your duties as a medical provider and go beyond what you’ve ever done before.