West Corporation

Posted on March 3, 2016 by West Corporation 



Avoiding CMS Penalties—and Capturing New Revenue Streams—Through Proactive Patient Outreach

By Chuck Hayes

Thousands of hospitals across the United States are feeling the financial pressures of the Centers for Medicare & Medicaid Services’ (CMS) Hospital Readmissions Reduction Program. Up to three percent of Medicare reimbursement is on the line when patients are readmitted to hospitals within 30 days of discharge for a set of diagnoses specified by CMS.

This year, 2,601 of the 3,400 hospitals subject to the program will have to pay penalties to CMS.

Needless to say, preventing readmissions is top of mind for hospital executives — and improving transitions of care through proactive patient outreach is a key strategy in achieving this goal.

Engaging Patients through Early Outreach

Research shows that early outreach is key to ensuring that discharged patients understand their care plan and receive the follow-up care they need. That’s one reason why CMS’ transitional care management guidelines require communication with the patient within two business days of discharge.

One Pennsylvania hospital recently proved how effective a simple outreach intervention can be in reducing readmissions. They piloted a program where they sent simple reminders via text message to patients and their caregivers—one message the day after discharge verifying patients had picked up their medications and scheduled their follow-up appointment, and one reminder message the day before the follow-up appointment. The result was astounding: Readmissions in the pilot group were 25 percent lower than in the control group!

Making Money through Patient Outreach

What this hospital—and others—have found is that not only does outreach help them avoid penalties, it also helps them make money. Through CMS’ Transitional Care Management (TCM) program, hospitals can earn between $160 and $230 per patient simply by fulfilling TCM requirements. In fact, because of this program, the Pennsylvania hospital expects a 300 percent ROI from their patient outreach initiative.

To learn more about how to easily and efficiently take advantage of CMS’ program, join us for a free webinar: Six Communication Best Practices for Reducing Readmissions and Capturing TCM Revenue—on HISTalk, March 22. To learn more and register, visit

Chuck Hayes serves as Vice President of Product Management for West, where his areas of focus include working with healthcare organizations of all sizes to better understand how they can leverage technology applications to solve their daily challenges and goals.

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