It’s estimated that about 25% of patients discharged from the hospital to a post-acute care facility, nursing home, rehabilitation facility or skilled nursing facility wind up back in the hospital within 30 days. Far from a new issue in healthcare, high hospital readmission rates now cost hospitals in the form of financial penalties from the Centers for Medicare and Medicaid Services (CMS).
Beginning in October 2012, CMS was required by the Affordable Care Act to reduce its payments to facilities with excessive readmission rates. When patients are returned to the hospital from another facility within 30 days after being discharged, it not only creates pain and suffering for them and their families, but it also adds an increased cost to Medicare.
So far, hospitals have borne the burden of reducing the readmission rate, but many experts suggest that the post-acute care facilities themselves should contribute to the solution. First, adopting an evidence-based care model to standardize the quality and efficiency of post-acute care would ensure that institutions and facilities provide a higher level of attention to this often neglected patient population. For example, not every nursing home has an on-site physician to see patients when it’s medically necessary, so the staff sends those patients back to the hospital emergency department. This practice often leads to hospital readmission.
Poor communication at discharge and inadequate follow-up care from post-acute and long-term care providers is also a common culprit of hospital readmissions. Experts point to physician/provider organizations that have integrated both acute and post-acute hospitalists as an example of optimal communication and improved results. Handoffs from one setting to the next are more coordinated, patient care is seamless and miscommunications are eliminated. When physicians and nursing teams from both settings are not working closely together to manage that patient’s care, problems arise that can lead to readmissions.
Federal policy has shifted toward reining in waste when it comes to managing costs for Medicare patients in the post-acute environment. Innovative payment models designed and implemented by the Center for Medicare and Medicaid Innovation (CMMI) at CMS have created opportunities for providers to become engaged in the care redesign process. Redesigning care in a way that not only prevents waste, but also makes it more coordinated across the acute and post-acute care continuum will go a long way toward reducing readmissions.
But there’s a much better reason to redesign care than reducing waste and coordinating care. These kinds of changes will ultimately improve the quality of life for patients -- most of them elderly -- at a time when they sometimes cannot advocate for themselves. When we treat our own elderly population with more care, dignity and respect, we all benefit.
Are you involved in transitioning patients from the acute care setting to a post-acute care facility? Do you care for patients in a post-acute care setting? What do you think can be done to reduce hospital readmissions and redesign care to be more coordinated and less wasteful across the continuum?