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February 23, 2020

How to Curb Rising Readmission Rates

What do you do when the standard approach to readmission reductions isn’t moving the dial on penalties? Your organization has implemented post-discharge calls and a data warehouse, yet you’re still looking at a 20% readmission rate. Perhaps it is time to consider a fresh and innovative look at how to positively impact readmission scores. A proven best practice for doing this is by examining complex clinical pathways, such as Congestive Heart Failure (CHF).

congestive heart failure readmissions

The economic burden of CHF continues to impose a staggering challenge to all segments of the healthcare system.  On average, twenty percent of CHF patients will be readmitted within 30 days of their initial admission.1 This has a costly impact on healthcare organizations in the current era of tightening budgets, diminishing reimbursements, quality of care mandates, and government regulation, all with a rapidly aging population and shortage of caregivers.

Hospitals are compelled to develop more strategic, cost-reducing clinical pathways and protocols, with evidence-based care, to become more successful and competitive in the healthcare market place.

It’s time to work differently and leverage forward-thinking workflow automation software, a solution that performs the critical data gathering, risk calculations, exception alerts and more, all in one view.  By implementing an automated approach to clinical pathway workflows, organizations can quickly qualify heart failure DRGs, and keep up with constant changes in the diagnosis.  Even better, clinicians and executives gain visibility into negative variations of processes and have the power to improve them in real-time.  Using business intelligence to calculate risk scores drives the ability to focus on accessible, visible, critical, actionable tasks that trigger discharge determinations and better clinical outcomes.

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Challenge #1 - Determining CHF Patients

What comes in conjunction with a CHF diagnosis is typically other comorbidities that often make the CHF DRG codes a moving target.  Nurse Navigators and Managers often do manual work to confirm their patient populations are, in fact, truly CHF patients.


CLARIFIRE®, the workflow automation application that complements any EMR, prevents expensive penalties for coding errors by providing immediate diagnosis visibility. It is the first technology that alerts the physicians in daily rounding with a “Working DRG” for heart failure patients, which translates into an entirely new level of awareness of DRG variability. This is big because the DRG drives the expected length of stay and defines the patient quality measures. True value is demonstrated through software process innovation happening before our eyes.

As an example, a CHF Physician is going in to round on patient Johnson to discuss his CHF discharge status.  Fortunately, the rounding slip generated by CLARIFIRE reads as “Patient Johnson’s DRG = COPD.”  The doctor is immediately alerted that the patient condition needs to be further researched to reconcile the appropriate DRG within the clinical system (EMR) and mitigates making discharge decisions without the necessary physician consult. The impact is improved quality and validation of auditable results.

Challenge #2 - Visibility into Data/Pathway Workflow

Traditional solutions for reducing readmissions focus around hospitals acquiring EMR systems to have access to static data. However, merely having access to data isn’t enough. Busy physicians today do not have time to data-mine. Guiding physicians with important, relevant information is a clinical necessity in a digital world with an over-abundance of data, regulatory burdens, and overbuilt EMR systems. CMO, Dr. Jeffery Jensen, said it best with, “I don’t have time in my day to go into clinical documentation systems to slice and dice data; give me one view where I can see where my problems are.”

During the physician rounds, multiple consults are reviewed with numerous labs and assessments to take into consideration. The physicians need to know where the alerts are, in one view, as well as see if the clinical pathways protocols are being adhered to or not.  Leaders are beginning to think in terms of collaborative, multi-disciplinary pathways versus siloed consults. This shift in thinking is helping everyone to connect the dots and improve patient outcomes.


The solution is the adoption of workflow automation technology that presents the patient's story within one rounding view. Having easy, mobile access to the right information at the right time – and for the right caregiver - creates a reduction in readmissions hospital systems are seeking, along with improved efficiencies in the delivery of care.

Challenge #3 - Evidence-Based Discharge Determinations

The power of access to real-time, evidence-based data transforms the way physicians work.  Organizations support physicians by giving them the right access to data they need at the time of care.  Making the discharge determination for CHF patients can be quite a challenge.  On the one hand, if the patient stays in the hospital too long, hospitals are hit with an increased length of stay (LOS).  On the other, if the visit is too short, the patient is at risk for readmission. Both scenarios impact the patient outcome and prove to be a complex balancing act for physicians. The struggle is finding the evidence-based data quickly within their digital labyrinth. The physicians are saying, “show me the evidence-based, actionable data,” so I can do my work.


Physicians are looking for risk-value accessibility to guide them through the evidence-based clinical parameters in a methodical manner.  They want to know if key CHF parameters are moving in the right direction from day-to-day, in one view. CLARIFIRE provides guidance within the patient round.  For example, if three out of five evidence-based risk factors are indicated, physicians are alerted within the daily round. Likewise, the daily round also guides them on over-extended length of stays. The visible alerts provide fluid access to changing parameters that enhance the capabilities of physicians.


Reducing readmissions is possible, but the solution must be efficient, systematic, and based on evidence. Tackling the complexity means meeting the digital and physician challenges with patient touchpoints head-on. This challenge is solved with CLARIFIRE® and the visibility of DRG codes, automation of data scouring, system calculated risk values, and controls in place that mitigate risks.  Using our solution, physicians have access to the right data at the right time, all in one easy view.  Care empowered by workflow automation is the solution for visibility into processes and DRG variations. The proven result is evidence-based care with improved outcomes and reduced readmission rates.

Care Empowered Through Workflow Automation

Why CLARIFIRE for Clinical Pathways Automation

CLARIFIRE workflow for Clinical Pathways standardizes, modernizes, and automates adherence to chosen hospital protocols and related processes.  The mobile access and visibility of real-time patient information, along with essential key risk indicators that show the patient status with a glance, is the powerful strategy that hospital systems should pay attention to.  We have proven that CLARIFIRE enables impactful results in improved outcomes and reduced readmissions.

Want to know more about how we do this?  CLICK HERE for a demo of our groundbreaking solution.


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Lauren Walling

Lauren Walling is a graduate of Emory University with a degree in Industrial Psychology, as well as an MBA from the John Sykes School of Business from The University of Tampa. She is a member of the Healthcare Business Women's Association, National Association of Professional Women, and the Morton Plant Corporate Membership and Planters Society. Lauren works with large Healthcare Systems implementing Patient Experience and Outcome Solutions that streamline processes, increase patient experience and improve quality and safety.  


[1] (2017 readmission rates)
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