One of President Obama's biggest accomplishments -- the Affordable Care Act (ACA) -- also established the Hospital Readmissions Reduction Program, which requires CMS to reduce payments to IPPS hospitals with excess readmissions.
In the majority of cases, hospitalization is necessary and appropriate. However, a substantial percentage of all hospitalizations are patients returning to the hospital soon after their previous stay. Evidence shows that 15-25% of people who are discharged from the hospital will be readmitted within 30 days or less, and that many of these readmissions are preventable.
Hospital readmissions can be reduced by improving core discharge planning and transition processes, and enhancing education and support for patient self-management.
In the 2012 IPPS final rule, CMS finalized its policies with regard to the readmission measures under the Hospital Readmissions Reduction Program. It defined readmission as an admission to a subsection hospital within 30 days of a discharge from the same or another subsection hospital and adopted readmission measures for the applicable conditions of acute myocardial infarction, heart failure, and pneumonia.
CMS also established a methodology to calculate the excess readmission ratio for each applicable condition, which is used, in part, to calculate the readmission payment adjustment. A hospital’s excess readmission ratio is a measure of a hospital’s readmission performance compared to the national average for the hospital’s set of patients with that applicable condition.
To calculate the excess readmission ratios there is an adjustment for factors that are clinically relevant including certain patient demographic characteristics, comorbidities, and patient frailty. Three years of discharge data and a minimum of 25 cases are used to calculate a hospital’s excess readmission ratio for each applicable condition.
Subsequently since 2012, several updates have been passed. In the 2014 final rule, CMS adopted the application of an algorithm to account for planned readmissions to the readmissions measures. The 2015 program was expanded to include: patients admitted for an acute exacerbation of chronic obstructive pulmonary disease (COPD); and patients admitted for elective total hip arthroplasty (THA) and total knee arthroplasty (TKA).
In the 2016 final rule, CMS finalized an update to the pneumonia readmission measure by expanding the measure cohort to include additional pneumonia diagnoses: patients with aspiration pneumonia; and sepsis patients coded with pneumonia present on admission (but not including severe sepsis).
Preventing hospital readmissions requires a watchful eye, but it could save millions, of not billions, of dollars in the long run.
1. Take a person-centered approach and refer to changes in location as "transitions," rather than discharges.
2. Dictate discharge summaries within 24 hours of discharge.
3. Send the patient off with a 30-day medication supply, wrapped in packaging that clearly explains timing and dosage.
4. Make a follow-up plan before discharge.
5. Monitor patients post-discharge using telehealth.
6. Identify populations (the homeless, for example) at highest risk for readmission and pay special care.
7. Chronicle what's happening with the patient after discharge.
8. Pre-arrange post-discharge appointments for follow-up care.
9. Consider physician medication reconciliation to avoid negative drug interactions.
10. Ensure that patients understand the discharge instructions by making them repeat and/or demonstrate.
11. Focus on conditions (COPD, for example) that are at highest risk for readmission.
12. Listen to the patient.
In addition to the high costs associated with hospital readmissions, preventable rehospitalization rates are also being used as a quality indicator. So, reducing readmissions is a win-win for all involved: CMS, healthcare facilities, and patients.
Lippincott Advisor, the leading online point-of-care clinical decision support software, can support your efforts to minimize costly readmission penalties and increase federal reimbursement. With over 12,000 evidence-based content entries, the product also includes 3,000 customizable patient teaching handouts to help ensure that patients and LTC residents are in compliance with post-discharge instructions and lower readmission rates. For more information, visit http://lippincottsolutions.com/advisor and fill out the form to request a free demo!