When managing patient care transitions, timely follow up after discharge is critical.

It allows you to catch potential complications early, fill gaps in their follow-up care, and capture experience feedback while it’s still top-of-mind with the patient. But when, exactly, should you be making your calls?

If you’ve read anything about post discharge follow up, your answer is likely sometime between 24-72 hours.

This, generally speaking, is a good benchmark to set for your program. However, just like every other aspect of your post discharge follow up program, the real answer depends on each individual patient.

As we discussed in the previous article, The Future of Patient Experience Management, following up with patients after they leave the hospital is critical to finding issues that impact patient health and their experience of care—and the telephone remains the most effective way to connect with patients after discharge.

The rates at which you’re able to conduct follow-up calls, connect with patients, and glean relevant data continue to be stubborn obstacles for organizations of every size.

However, what many organizations fail to realize is that their biggest challenge revolves around change management—the act of shifting calling schedules, script messaging, feedback notifications, and reporting.

More than 60 million Americans rely on Medicaid programs for their insurance coverage—and that number is projected to grow to 80 million by the year 2020 if all states embrace the enrollment expansion offered by the Affordable Care Act (ACA).

As the newly insured look at their options for healthcare, many will find that health centers provide convenient and reliable services.

To prepare for this influx of Medicaid patients, health centers have the opportunity to operate with a reimbursement designation of Federally Qualified Health Center (FQHC), qualifying them for grants under Section 330 of the Public Health Service Act. Nationally, these FQHCs receive 37.7% of their funding from Medicaid and 23.2% from federal grants, allowing over 1,100 FQHCs in the United States to provide care for more than 70 million patient appointments each year.

Health centers have been proven to successfully increase access to care, improving health outcome and containing healthcare costs. But as health centers look at the increasing number of patients who will seek care in the future, it's critical they look outside the walls of the clinic to ensure adequate patient access.

By now, most healthcare professionals understand the relationship between patient satisfaction and meaningful care.

Monitoring and measuring patient perceptions of care (referred to the "Patient Experience") provides us with valuable insight into whether patients feel they received appropriate care at your facility, and whether they feel they've been sufficiently prepared to manage their recovery after leaving the hospital. 

In the span of just a few years, the Patient Experience has emerged as one of the strongest rallying cries for healthcare quality improvement. But with limited amount of time, resources, and budget at your disposal, how do you prioritize which patient improvement efforts should be tackled first?

Evaluating your employees’ performance can be a challenge. Evaluating your own performance is fraught with difficulties. When hospital units implement their own patient care within a post discharge framework, barriers to success immediately emerge:

CMS is imposing penalties on hospitals with above average 30-day readmission rates.

There's no getting around it. It's time to act.

You've done your research on how to improve health outcomes for CHF, AMI, and Pneumonia patients and know that following up with them after they leave the hospital is critical.

You've become a true believer; implementing your own post discharge follow up program.

But, for some reason, your program isn't preventing readmissions like it should

So, what gives?

Traditionally, few healthcare organizations opt to lead – most are shoved along by litigation, regulation, and political whim. This is understandable on many levels; however, the thinking is a relic of the past. It only persists because new concepts are hard to internalize and managing continuous improvement in complex organizations is very difficult – it is easier to do nothing and wait for that kick from behind - with the hope it will never come.

However, thanks to new CMS regulations, many healthcare organizations have begun developing mechanisms for continuous improvement – these may not be fully appreciated now - but that is about to change.

By now you understand that timely follow up, evaluation, and coaching are critical to managing patient health after discharge.

So the question becomes, which follow up strategy is best for you and your patients?

One option that's gaining popularity recently (namely because of its price) is to use automated outreach calls – a.k.a robot calls.

In short, this option is very likely a bad idea. 

This isn't to say you shouldn't use them at all. Automated outreach calls are an important part of your communication toolkit – one that you should absolutely use within your population health strategy.

You just shouldn't use them for post discharge follow up.

And here's why.

It's settled. The Supreme Court has ruled to uphold the Patient Protection and Affordable Care Act.

As the nation absorbs and reacts to this landmark case, healthcare insurers and practitioners like you will be rolling up their sleeves and getting back to work.

You'll continue to improve the delivery of care to your patients – focusing on service quality over quantity – ensuring your patients receive safer, more appropriate healthcare.

If there was ever any doubt about the importance of managing care transitions – it's gone now.

A big reason why you make post-visit follow up calls is to remove gaps in care created by non-compliance of discharge instructions. 

That's because coaching patients within 24 hours of discharge catches issues quickly.

However, there are things you can (and should) do that will increase the likelihood your patients will understand and retain the instructions they receive at the point of discharge. 

One important area to focus on is the take home instructions themselves.

Here are a few ways to make your post-visit discharge instructions easier to understand and recall: