Patient Care: The Heart of the Clinical Pathway

Improving patient care means better outcomes for patients and their families, higher satisfaction for therapy staff, and better operational and financial results for the facility.

Patient care is the heart of the 5 C’s, (Care, Census, Cash, Compliance and Customer Service), the core areas that, if done well, will keep your facility strong and effective. Comprehensive care through clinical pathways results in patients improving more rapidly and experiencing fewer post-discharge set-backs, not to mention avoiding readmissions. This approach focuses on providing the highest level of coordinated care, in the shortest amount of time, and restoring the patient to their independence as soon as possible.

Under bundled payment programs such as Value-Based Purchasing and CJR, the focus on readmission risk is viewed by CMS as a major cost reduction opportunity. Under these payment programs, both hospitals and SNF’s can face reduced revenues due to penalties for high readmission rates. SNFs that have not proactively reduced their readmission risk will lose referrals and income to facilities that have. This is a significant incentive to take clinical pathways to the next level.

What does it look like to have effective clinical pathways in place to improve patient care?

Having much closer communication and structured treatment coordination with hospitals, doctors, and care staff “upstream,” and home health care and other “downstream” post-acute care providers

·        Having a process in place to establish each patient’s pre-hospital and post-hospital abilities

·        Utilizing a specialized protocol to achieve specific performance on a targeted timeline

·        Integrating into the patient’s care plan any conditions or co-morbidities that impact both treatment and patient outcome

Putting It In To Practice

An Ohio-based customer of Concept Rehab’s partnered with a community hospital (owned by a nationally-recognized hospital system) to review the quality of patient care and improve outcomes. The partnership started with collaboration on a QAPI (Quality Assurance Performance Improvement) program. It soon became evident that patients in the CJR bundled payment model would benefit greatly from an advanced clinical pathway.

With Concept Rehab’s guidance, a comprehensive pathway incorporating the therapy team with nursing, social services and dietary was put into place. Daily, each patient’s care was discussed by members of this interdisciplinary team (IDT) to determine the current progress and make sure the patient was on target for the recommended discharge date. In addition, on a weekly basis, a physician and a case manager from the hospital would meet with IDT members from the SNF to discuss each CJR patient’s care. The results were that patients improved more rapidly and displayed fewer post-discharge setbacks.

Improving patient care by employing Advanced Clinical Pathways can benefit everyone involved in the therapeutic setting, starting with the patient and extending to the therapy team, partners, and operational staff.

Having a therapy services provider who has the experience to put these pathways in place is critical. Plus, your therapy services provider can undoubtedly make or break your facility by how well they deliver on each of these 5 C’s: Care, Census, Cash Management, Compliance and Customer Service. Focusing on and improving these fundamentals will put your facility on a strong strategic path for success. For more about the 5 C’s, download the latest issue of RehabOps: The 5 C’s.