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9 Ways Hospitals are Reducing Readmission Rates

Created Oct 06 2014, 8:00 PM by Lippincott Solutions
  • Center for Medicare Services
  • ACA
  • federal reimbursement
  • Affordable Care Act
  • discharge instructions
  • hospital readmissions
  • CMS

Tuesday, October 7, 2014

Costs to Medicare for Excess Readmissions

While the number of Medicare beneficiaries who were readmitted to the hospital within a month of being discharged dropped to 2 million (18 percent of patients) last year, the annual costs of readmissions still cost Medicare approximately $17 billion. The federal government wants to reduce those costs, and give hospitals an incentive to improve patient outcomes.

How CMS Determines Excess Readmissions

The Centers for Medicare and Medicaid Services (CMS) reduces Medicare payments for Inpatient Prospective Payment System hospitals with excess readmissions based on a ratio measurement. By dividing a hospital’s number of “predicted” 30-day readmissions for heart attack, heart failure, and pneumonia by the number that would be “expected,” based on an average hospital with similar patients, CMS considers the resulting ratio to indicate excess readmissions if it is greater than 1.

Increased Penalties and New Inclusions

The original penalty for excess readmissions was no greater than 1 percent of annual Medicare reimbursements, but CMS increased that penalty this year to 3 percent. Also, for the first time, lung illnesses and elective procedures like hip and knee replacements are counted in the CMS readmissions rate formula.

Take a More Active Role

Hospitals that have been successful in reducing their 30-day readmission rates are now being much more involved in the follow-up care of patients, especially those deemed “at-risk” for landing back in their facility. Some of these measures include:

  1. Working with patients and families at discharge to ensure that they understand the instructions. This includes being able to give instructions in a variety of languages.
  2. Reaching out to patients after they leave the hospital to follow-up on their condition.
  3. Communicating more along the healthcare continuum. For example, hospital nurses are collaborating with nursing home nurses to ensure that discharged patients have been quickly evaluated by doctors.
  4. Spending more time on follow-ups, including visiting patients at home and making sure they are connected with primary care physicians.
  5. Developing post-discharge programs that better identify the risk factors that lead to some patients being readmitted.
  6. Looking for post-acute care partners who are reliable, evidence-driven and have a track record of keeping discharged patients from being readmitted.
  7. Using resources like Boston University Medical Center’s publication on effective discharge strategies, developed through its Project RED (Re-Engineered Discharge) initiative.
  8. Knowing the culture of their organization, the culture of the population served, and adopting transitional care models that fit those cultures.
  9. Investing in data systems to help track and analyze patient discharge and readmission data.

Not all hospital readmissions are preventable; however, many could be avoided with increased care coordination and collaboration. As the penalty data is made public every year, penalized hospitals in competitive markets may also suffer from a tarnished reputation. Health care organizations that take an active approach to reducing readmissions will be most likely to survive and thrive. What has your facility done to reduce readmissions? Has it worked?  What do you think still needs to be done? Tell us in the comments below.