Posted on November 18, 2015
Across the country, hospitals have faced reductions in their Medicare payments related to high readmission rates for the last four years. While rates are generally improving, so are penalties for many facilities. A Kaiser Health News analysis of Medicare records indicates that 2,592 hospitals nationwide will lose a total of $420 million in payments.1
The penalties apply for patients with heart attack, heart failure, pneumonia, chronic lung problems or elective hip or knee replacements who received care from July 2011 to June 2014 and were readmitted within 30 days. Medicare enacted the penalties to reduce early hospital readmissions, particularly among high-risk and elderly patients, about 20% of whom are readmitted within 30 days. The cost of readmittance isn’t trivial: Studies show readmissions cost around $26 billion each year.2
What can hospitals do to reduce readmission rates? Five strategies can significantly reduce avoidable readmissions:3
Admissions can flag many high-risk patients, including those with previous recent admissions, on or needing palliative care, taking 10 or more medications or on medications such as anticoagulants, insulin or narcotics, or with physical limitations that restrict their ability to care for themselves. High-risk patients also include those admitted for issues related to cancer, stroke, diabetes, chronic obstructive pulmonary disease or heart failure or who have a history or positive screen for depression or substance abuse.4
Some patients will become at high-risk for readmission during their stay in the hospital. Patients who develop health-care associated infections (HAIs) have a 40% increased risk of readmission.5 Clinicians can flag patients who develop HAIs for more intensive follow up and can use electronic surveillance software to alert staff of patients at risk of developing these infections in order to take proactive measures.
Both multidisciplinary bedside rounding and thorough documentation can improve communication among providers and others involved in patient care. Clinical decision support systems can ensure that all team members have easy access to national and facility-specific treatment guidelines and are consistent regarding expectations for care.
Pharmacists and clinical decision support software can help prescribers select the most effective antibiotic for treatment and recommend the right dose and duration for the patient’s specific concerns (such as drug interactions or organ dysfunction) using prospective audit, order sets and other tools. Pharmacists can also work with high-risk patients to reconcile their medications, eliminating duplications, interactions and contraindications that could lead to a readmission.
In this “teach back” method, patients tell caregivers in their own words what medications they need to take and how often, when they need a follow up appointment, and what symptoms should send them back to the hospital. This method helps staff verify that patients truly understand what is expected during their recovery.
Many hospitals have implemented telephone follow up programs that contact high-risk patients within 48 to 72 hours after discharge. Other hospitals discharge patients with monitoring devices so that providers can monitor key metrics and advise the patient to seek care before their condition deteriorates and requires another hospitalization.
Russell J. Illinois hospitals penalized for too many patient readmissions. Chicago Tribune. August 14, 2015.
Jencks SF, Williams MV, Coleman EA. Rehospitalizations among patients in the Medicare fee-for-service program. N Engl J Med. 2009;360(14):1418-1428.
Kahn F. Reducing Hospital Readmissions Rates: How to Avoid Upcoming Penalties and Maintain Patient Wellness. Becker’s Infection Control & Clinical Quality. December 17, 2013.