Across the U.S., hospitals are struggling to address a national quality of care metric which is not being achieved: readmission rates are too high. In an effort to focus attention on this growing problem, the Hospital Readmissions Reduction Program (HRRP) was introduced and has been unfolding since 2012 with notable financial consequences for low-performing hospitals. In fact, the number of organizations facing penalties has increased every year since—a trend that will only continue in the absence of sustainable, preventative measures.
On October 1, the Centers for Medicare and Medicaid Services (CMS) will apply the latest round of reimbursement penalties for excess 30-day readmission as outlined under the initiative. The penalties will affect 2,665 of the more than 3,400 hospitals subject to the program, resulting in a combined loss of $420 million in Medicare payments.
In addition to its focus on readmissions, CMS continues to emphasize the reduction of healthcare-associated infections (HAIs) as a critical quality measure. According to the Centers for Disease Control and Prevention (CDC), approximately 1 in 25 hospital patients have one HAI at any given time, which can have a significant impact on hospital readmission rates. For example, patients who develop surgical-site infections (SSIs) are five times more likely to be readmitted and twice as likely to die. A 2012 CMS report details the “strong relationship” between HAIs and the increased chance of readmission within 30 days. Patients with a central line-associated bloodstream infection (CLABSI), the odds of being readmitted increase by 33 percent.
On top of the HRRP penalties incurred as a result of these readmissions, hospitals risk further financial penalties if they rank among the worst performers in HAI performance. As such, hospitals that have initiated proactive infection prevention programs minimize the financial risk from the two mandates while reducing 30-day readmissions and improving patient care.
Harnessing Patient Data
Reactive approaches to infection prevention are not sustainable in the era of pay-for-performance measures. Hospitals seeking to develop a proactive program that generates ongoing improvements need only look as far as the patient data within their own clinical systems. The wealth of patient information and medical knowledge contained within modern health IT systems are crucial to significantly reducing HAI rates; however, the data has grown (and continues to grow) across disparate systems (EHRs, labs, pharmacy, etc.), which lack interoperability and a practical means of analysis.
Proactive-infection prevention depends on access to data and a hospital’s ability to deliver it to the point of care in real time. As a result, electronic surveillance systems (ESS) have become essential tools in the fight to reduce HAI rates. Using real-time data aggregation and analysis, ESS systems such as Sentri7®, with embedded evidence-based content, provide clinical decision support (CDS) for clinicians to intervene and initiate early treatment to patients.
The strategy for protecting hospitals against readmission rate penalties is the same as for proactive HAI prevention. The delivery of actionable data to the point of care with evidence-based content through ESS facilitates improved clinical decision making and leads to sustainable improvements in patient safety.