Only 799 out of the 3,400 hospitals subject to the Centers for Medicare and Medicaid Services (CMS) Hospital Readmissions Reduction Program will not be penalized for excessive readmissions in fiscal 2016, according to Modern Healthcare.1 That means that 2,800 hospitals are scrambling to reduce their readmission rates to avoid further penalties. The hospitals that did not get penalized this year are focusing on continuously improving their rates to ensure they aren’t subject to payment reductions in the future. What are hospitals doing now to prevent readmissions?
Most hospitals are identifying which patients are at high risk of returning to the hospital within 30 days. Some hospitals use predictive analytics to evaluate demographic characteristics and other data to flag high risk patients on or shortly after admission. One study suggests that hospitals stratify patients based on discharge levels of hemoglobin and sodium, whether discharged from oncology, number of procedures during first admission, elective or non-elective admission, number of previous admissions in the year, and the length of stay.2
Other hospitals factor in patient’s age, discharge destination, whether the patient identified a primary care physician, and diagnosis, especially congestive heart failure, pneumonia, stroke, sepsis and renal failure.3
Updated readmission measures from CMS expand the population cohort analyzed for the program to include patients those discharged with sepsis or respiratory failure primary diagnoses along with a secondary diagnosis of pneumonia present on admission and those who had coronary artery bypass procedures. 4,5 The CMS criteria already include patients diagnosed with acute myocardial infarction, heart failure, and pneumonia as well as those with chronic obstructive pulmonary disease and those who had total hip and total knee replacements.
At one hospital, each patient’s risk level appears in the medical record. The information alerts caregivers to which patients may need more care, greater education in disease management or more follow up after discharge. This risk analysis combined with structured follow up for patients who transition to a long-term care facility enabled the hospital to achieve a 25% decrease in patient readmissions and keep readmissions well below the national average while improving patient care.6
Rice S. Most hospitals face 30-day readmissions penalty in fiscal 2016. Modern Healthcare. http://www.modernhealthcare.com/article/20150803/NEWS/150809981
Evans M. Study identifies patients at high risk for hospital readmissions. Modern Healthcare. March 25, 2013.http://www.modernhealthcare.com/article/20130325/NEWS/303259949
Hall S. Analytics help hospital cut readmissions by 25%. June 28, 2013. FiercehealthIT.com. http://www.fiercehealthit.com/story/analytics-telepresence-help-hospital-cut-readmissions-25/2013-06-28
Hospital readmission reduction program. AHA Fact Sheet. September 8, 2015. http://www.aha.org/content/14/fs-readmissions.pdf
Daly R. More hospitals hit by readmissions penalty. August, 4, 2015. HFMA.org. https://www.hfma.org/Content.aspx?id=35230
Innovative information technology solutions facilitates 25% reduction in readmission rates at El Camino Hospital. June 27, 2013. CHIME. https://www.nationalreadmissionprevention.com/documents/el-camino-hospital.pdf