Focus on Preventable Readmissions Could Save Hospitals Financial Penalties

Reporting of hospital readmission rates should be based exclusively on preventable or potentially preventable readmissions, so that hospitals are not unfairly penalized, according to researchers from the Perelman School of Medicine at the University of Pennsylvania and Vanderbilt University.

Preventable hospital readmissions are estimated to constitute just 25 percent of all readmissions, but the Centers for Medicare and Medicaid Services (CMS) does not take into account whether a readmission is preventable when assessing hospitals’ performance on this quality metric.

Under the Affordable Care Act (ACA), hospitals must report readmission rates for heart attack, heart failure, and pneumonia to CMS. CMS then imposes financial penalties on institutions having an excessive number of readmissions that take place within 30 days following patient discharge. Additional medical conditions will be added in 2015. Many patients with these conditions suffer from additional illnesses that are complex and come with many comorbid conditions.

Other payors, such as private insurers, are likely to follow the federal lead and withhold funding for high readmission rates. As a result, hospitals and health systems nationwide are devoting significant time, effort, and money to reducing readmissions. Steps include increasing patient education before discharge, introducing or expanding home health visits, and working more closely with nursing homes and rehabilitation centers.

Until a validated measure of preventability is developed, the authors recommend the following steps:

  1. First, the readmission time period should be reduced from the current 30 days to seven or 15 days, because studies show that early readmissions — those within seven to 15 days of discharge — are more likely preventable than those occurring later.
  2. Second, policymakers should take the socioeconomic status of patients into account by only comparing hospitals serving similar patient communities when determining penalties for excess readmission rates.
  3. Finally, adjusting for other community factors such as practice patterns and access to care is necessary to more accurately reflect factors under a hospital’s control.

Such a shift would require agreement among healthcare researchers and policymakers on how to identify and measure preventable or potentially preventable readmissions. While there are existing methods for doing so, there is no consensus on which is best. Furthermore, some of these methods are proprietary and thus unavailable for evaluation by others. These methods use such techniques as identifying readmission for conditions closely related to the original diagnosis or complications arising from the original admission, researchers say.

Source: Penn Medicine, June 25, 2014

Community Care Connections for Dual Eligibles: Closing Social Gaps to Improve Health Outcomes

Community Care Connections for Dual Eligibles: Closing Social Gaps to Improve Health Outcomes details the WellCare approach to duals’ care coordination — a healthy mix of public health and social support in which a team of advocates works the front lines of the community, cataloging and pooling resources with a common goal — the reopening of a local food bank, for example.

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  • One Response to Focus on Preventable Readmissions Could Save Hospitals Financial Penalties

    1. Shertl Riley says:

      Hospitals need a strong comprehensive community based care management program to keep their readmission down. By collaborating and partnering with a company that has experience with in RN, SW and NP community/home visit care management; they will go a long way in decreasing readmissions for all chronic care, frail elderly and oncology patients.
      Sheryl Riley, RN, OCN, CMCN
      Director of Clinical Services, SAI systems

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