Healthcare reform is based on transparency, shared data and continuous learning. Behavior changes slowly surface to shift the system’s cost quality continuum in a more favorable direction. Currently, there’s too much emphasis in our care system that drives uncoordinated and inefficient delivery of services that do not directly result in improved outcomes and lower costs. Readmissions have been targeted as an example of excessive care costs that could have been avoided if timely and appropriate decisions were made to predict and augment the course of medical conditions with appropriate care and coordination. “Readmission” is when patients who’ve had a recent stay in the hospital go back into the hospital again.
Under some circumstances, Medicare beneficiaries who are discharged from a hospital into a post-acute or LTC facility are sent back to hospitals by these providers. Such providers may send beneficiaries to the hospital because they are not equipped, or lack sufficient information to deliver the required level of care to a particular beneficiary. In some instances, lengths of stay in hospitals may be too short, resulting in greater utilization of chronic care and rehabilitation facilities after discharge. Such short lengths of stay can also lead to readmissions.
Readmissions are considered a marker for poor quality care, wasted revenue and inefficient use of resources. The Medicare Payment Advisory Commission has concluded that two-thirds of all readmissions are avoidable. Medicare is spending an additional $15 billion a year on readmissions (about $7,200 per readmission).
Research shows that 15-25% of people who are discharged from the hospital will be readmitted to the hospital within 30 days or less, adding billions of dollars to healthcare spending. Many of these readmissions are preventable through simple, low-cost interventions, both inside the hospital and after discharge. But hospitals and doctors lose revenue if they reduce readmissions, and in many cases, Medicare and other health insurers won’t pay for the services that would keep patients out of the hospital, even though they will pay every time they go into the hospital.
Until now, most hospitals and doctors had no idea how many of their patients were readmitted, so the first step in reducing readmissions was to implement a system to report readmission rates. Next Medicare and other payment systems changed practice to support programs that will reduce readmissions and stop rewarding hospitals and physicians that have high readmission rates.
The CMS Hospital Compare website now features data on 30-day mortality and readmission rates for inpatients admitted with heart attack, heart failure and pneumonia. The data encompasses three full years of claims data, from 2007 to 2010. Mandatory reporting and awareness has had a positive effect. This year, national 30-day readmissions rates for heart attack, heart failure and pneumonia showed small changes. Public awareness and comparisons has provided the incentive for hospitals to adjust operational and clinical behaviors. And if that “carrot” fails to get the wagon rolling the proverbial stick is also available with current legislation that carries significant penalties for excessive readmission rates. Hospitals stand to lose as much as 3% of their revenues if readmission penalties are enforced.
Ensuring that timely and comprehensive discharge information is provided by the hospital to the post-acute and LTC provider is one of several options to improve follow-up care into post-acute and LTC settings. Policy makers have also suggested bundling Medicare payments to hospitals and post-acute care providers to encourage better collaboration among providers and to enhance accountability for patient outcomes and treatment costs. Electronic health records that contain comprehensive information on a patient’s diagnoses, health history, and treatment information are essential to success. The patient’s post-discharge management and follow up care is becoming a required core competency and these data captured from patients are invaluable to process improvement and reducing readmission rates.