Posts Tagged ‘Hospital Readmissions’

Infographic: 7 Cities with Highest Readmission Rates

September 22nd, 2014 by Melanie Matthews

The seven cities with the highest hospital readmission rates include: Chicago, Brooklyn, Philadelphia, Baltimore, Manhattan, Boston and Los Angeles, according to a new analysis by Kaiser Health News, depicted in an infographic by Becker’s Healthcare.

Nineteen hospitals in Chicago exceeded the national average readmission rate. The infographic details how many hospitals in each of the other cities exceeded the average.

7 Cities with Highest Hospital Readmission Rates

2014 Healthcare Benchmarks: Reducing Hospital Readmissions2014 Healthcare Benchmarks: Reducing Hospital Readmissions documents the latest key initiatives and partnerships to reduce readmissions by patients with these costly conditions and others by more than 100 healthcare organizations. This 60-page report, now in its fourth year, for the first time provides details on partnerships with post-acute care to reduce readmissions from these care sites.

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5 Barriers to Optimal Care in the Post-Acute Setting

January 22nd, 2014 by Jessica Fornarotto

Summa Health System’s care coordination network of skilled nursing facilities (SNFs) is working to decrease fragmentation, length of stay and unnecessary readmissions while improving outcomes of care. Mike Demagall, administrator of Bath Manor & Windsong Care Center, a participant in this network, identified five barriers to patient care that originated in the acute care setting.

First, we found a lack of quality information received upon transfer from an acute care to a nursing facility and the lag time in identification of post-acute bed availability. The social worker was calling or faxing information to a facility, and the facility took up to 24 hours to respond as to whether a bed was available. That person may have been ready that day; instead it postponed that discharge another day.

We also had barriers to the patient’s acceptance of the need for post-acute care. Social workers and care coordinators at the bedside tell them when it is time for rehabilitation.

The next barrier was family expectations. Does the family feel that they need to go to the nursing home? The hospital staff and the insurers had to spot the appropriate levels of care. One of the concerns we had was, ‘Is this going to send a lot of our patients — our referrals — to home healthcare and decrease our referrals by participating in this?’ That happened to not be the case at all.

There was still a lack of knowledge and respect toward long-term care (LTC). All the discharge planning individuals, which were the case manager nurses and social workers, were able to tour the facility. Each facility had the opportunity to present their services and what they do. That helped with the overall cohesion of the group, and it moved this project forward.

There was also a lack of quality information received from the nursing facilities on the transfer to an emergency department (ED). That was information that we needed to get back, just as we were asking for information as those residents were coming in.

Excerpted from: 7 Patient-Centered Strategies to Generate Value-Based Reimbursement

SNF Community Partnership Shores Up Accountable Care

October 1st, 2013 by Jessica Fornarotto

To support ACO construction, industry thought leaders advise hospitals to monitor what goes on across its care continuum and to partner with facilities it discharges its patients to most often to reduce 30-day readmissions. A prime example is the skilled nursing facility (SNF) network coordinated by Summa Health System, discussed here by Carolyn Holder, manager of transitional care for Summa Health System, and Michael Demagall, administrator of Bath Manor & Windsong Care Center.

(Carolyn Holder) We have been working on a pilot model for accountable care. Accountable care is the focus on primary care wellness in population health. Patients and families need to be actively engaged in this process. It coincides with having the right level of care provided to the patient where they need it, and that is what we are talking about with accountable care. You need partnering relationships between hospitals and physicians and through all levels of care to be able to support that individual in their wellness or illness effectively.

What is the value of this care coordination that worked in the accountable care model of care? It relates to the Triple Aims and looking at providing safe, patient-centered, timely care. We are collaborating to do that with our partner facilities. We have been working at improving health and patient populations in communities. Patients in this situation need rehab, so they have had some functional impairments and frailty. We are trying to get them back to their optimal level of function. To do this, we partner with our SNFs to support that level of care and lower the per capita cost of healthcare.

We also work with community-based long-term care. That has certainly not taken away from any of our nursing facilities any patients that are appropriate or keeping them in the optimal function that they would want.

(Mike Demagall) Through this development of the ACO on the skilled nursing side in working with the hospitals, one thing we focused on was the key indicator comparisons for our 2010 data.

Along with the hospital, we will provide standardized numbers of information that we can get back, that we are going to be held accountable for from the SNF side. The hospital knows what we do is safe and efficient, patient-centered and equitable for everybody involved. As we move forward with the ACO through care coordination, we will look at numbers and information that we can share as a community with the health system so they know what the facilities are doing. There are many reasons that is done, but one of the greatest accomplishments is everybody working together.

Out of 39 homes in the county, the collaboration has been incredible. Initially there was some hesitation, but the collaboration has moved forward, and we are not afraid to share that information. The information is blocked and as we provide information back, it will be blocked from other members except for the hospital, who knows who those numbers are. However, from my facility, I may see a readmission rate at one facility lower than ours although we have the same type of case mix index. I need to look at our facility and ask, “What can we do to get better? What are they doing that we aren’t?” Therefore, everybody gets better as a group, and that is ultimately the goal of the community and the health population in the community we serve.

Healthcare Business Week in Review: Hospital Readmissions, State-by-State Scorecard, PHOs, HRAs

September 27th, 2013 by Adam Ghosh

It looks like good surgeons are, literally, a cut above the rest, at least according to a new study from Harvard School of Public Health.

Quality surgical care is strongly linked to hospital readmission rates, a somewhat surprising new statistic given that much of policy focus has been on reducing readmissions after hospitalizations for medical conditions, such as heart failure and pneumonia.

Readmissions for medical conditions are primarily driven by how sick the patients are and whether they live in poor or better-off communities; the link between hospital quality and readmissions is less clear. The study sought to find out if there was a relationship between readmission rates after surgery and the quality of surgical care in that hospital; more details inside.

Poor healthcare quality does not discriminate. According to a new study from the Commonwealth Fund scorecard, access to affordable, quality healthcare varies greatly for low and high-income people based on where they live.

The report finds that higher-income people living in states that lag far behind the top scoring states are often worse off than low-income people in states that rank at the very top of the scorecard. The scorecard provides the first state-by-state comparison of the healthcare experiences of the 39 percent of Americans with incomes less than 200 percent of the federal poverty level, and compares their experiences with higher income families.

Lower-income families, particularly those on Medicaid, have grown increasingly more dependent on using the emergency room, despite widely held assumptions that uninsured patients are high ER utilizers, according to a study from the University of California, San Francisco. In order to investigate recent trends between insurance coverage and ED use, researchers analyzed California ED visits by adults aged 19 to 64 years old from 2005 to 2010, and found that the number of visits to California EDs by adults overall increased by 13.2 percent, with Medicaid beneficiaries leading the pack. This study has wide implications with upcoming ACA reforms; many uninsured people are expected to transition to Medicaid, and as a result, overall ED use may increase because Medicaid patients have higher rates of ED use.

Physician-hospital organizations (PHOs) have taken the accountable care organization (ACO) reins from physicians over the last year, according to our 2013 market data. PHO leadership of ACOs almost doubled in the last 12 months; in 2012, one-quarter of ACOs were

physician-led, a trend that replaced the hospital-administered ACOs that dominated in 2011.

As ACOs continue to evolve, the composition of the care delivery model will shift as well, with hospice, long-term care and home health entering the fray.

Lastly, don’t forget to take our Health Risk Assessments in 2013 survey – sophisticated analytics behind today’s health risk assessments or health risk appraisals (HRAs) provide employers, payors and providers an aggregate view of population health and the raw

material to develop prevention and lifestyle change programs. Tell us how your organization uses HRAs to improve population health by October 15, 2013 and get a FREE executive summary of the compiled results.

5 Tips for Seniors to Avoid Hospital Readmissions

June 24th, 2013 by Jessica Fornarotto


Nearly one in five seniors who are hospitalized return to the hospital within 30 days, according to a recent Robert Wood Johnson Foundation report. These readmissions are not only often physically and mentally debilitating to the seniors and their families, but contribute greatly to avoidable and unnecessary expenses on the nation’s healthcare system. To help curb these numbers, SCAN Health Plan recently offered seniors five strategies to lessen the chance of readmission.

  1. Ask questions before discharge. When patients are in the hospital, they’re completely dependent on others for care. But once they’re home, they’re in charge of their own recovery, which makes understanding what to do the key. Patients being discharged from the hospital who ask questions and who have a clear understanding of their after-hospital care instruction are 30 percent less likely to be readmitted or to visit the ED than patients who lack this information, according to a recent study from the AHRQ.
  2. Understand medications. This is particularly important if there have been changes to a medication regimen while in the hospital. Upon discharge, dosages are sometimes changed or a drug is discontinued or added. Patients need to be sure about this and to write it down. They also need to be sure to fill all new prescriptions once they’re home.
  3. Make a plan for follow-up care. Patients need to know when to schedule a follow-up visit to their doctor, and to make sure that they have the transportation to get there. Even if they’re feeling good, they should go anyway. The doctor needs to see a patient in order to track how they’re doing and to gauge whether the treatment plan is working. In addition to doctors, does the patient need to schedule home healthcare with a nurse or therapist, or do they have some new durable medical equipment or home-modification needs?
  4. Communicate with care coordinators. Whether a patient has a professional in-home caregiver, a family member nearby, or resides in an assisted-living community, they need to make sure that their caregiver is up to date on the recent hospitalization and how the patient is feeling. This also goes for the patient communicating with their health plan, as many have programs and professionals in place that can assist with care coordination.
  5. Be aware of “red flags” or complications that should be reported. What is considered “normal” for a patient’s post-hospital condition? What degree of pain or swelling is expected? Patients need to know what to look for, whom to call if they are not feeling well, and to have a clear plan of action in place so they know how to respond to a complication.

Romilla Batra, M.D., vice president and medical director of SCAN, says that readmission rates for seniors can also be reduced by enrolling in a health plan that has a strong emphasis on integrated care and care management. She points to a 2012 study released by Avalere Health that compared 30-day all-cause hospital readmission rates between California dual-eligible (Medicare and Medi-Cal) individuals in traditional Medicare versus those enrolled in SCAN Health Plan. The independent study found that SCAN’s dual-eligible members had a hospital readmission rate that was 25 percent lower than those in fee-for-service.

“Industry-wide efforts are underway to bring down readmission rates including new rules passed as part of the Affordable Care Act that charge additional fees to hospitals with excessive readmissions,” said Dr. Batra. “But ultimately it is still the consumer themselves who can play the biggest role through common sense and following these five easy steps.”

STAAR’s 4 Domains of Process Improvement to Enhance Patient Health

June 18th, 2013 by Jessica Fornarotto

Amy Boutwell, MD, MPP, president of Collaborative Healthcare Strategies, recommends hospitals follow the four domains of process improvement from the State Action on Avoidable Rehospitalizations (STAAR) in order to improve the standards of care for each patient to prevent future health woes.

During HIN’s webinar Readmission Penalties in 2013: A Cross-Continuum Approach To Lessen the Financial Impact, Boutwell listed STAAR’s four domains, which include enhanced assessments, enhanced teaching, real-time communication and timely follow-up care.

STAAR’s four general domains of process improvement do not constitute a cookbook. We recognize that hospitals need to adapt and implement these concepts in various ways to fit their settings, whether rural, urban, academic or community hospitals.

The four major domains are an invitation to reflect. If your hospital is not providing these four elements of care for every single patient leaving your care, regardless of risk, then I invite you to reflect upon why you wouldn’t do this for everyone. Why wouldn’t we make sure that we update our standard of care as people leave our hospital ‘sicker and quicker,’ and take upon themselves a greater burden and more responsibility for after-hospital care? Why wouldn’t we improve our standard of care for everyone in these four areas? The four domains are as follows:

1. Enhanced assessment. This means that we assess patients. That’s what we do in the hospitals; that’s what nurses, doctors and therapists do all the time. But this is the concept of expanding that view, especially of our frequent flyers or our frail patients to the big picture. What is the longitudinal care need beyond the acute episodic presenting need?

2. Enhanced teaching and learning. This is a change from putting packets of information on meal trays to using the three or four days of the hospitalization as a learning opportunity. Identify who is the right learner, because it’s not always the patient. Engage in that health literacy-appropriate teachback technique to convey the key elements — not the entire 85-page booklet on heart failure but the key elements of self-management as the patient transitions from our setting to the next setting.

3. Real-time communication. This is communication both to the receiving providers as well as better updates in communication to the patients and family members. It can’t be okay for us to have rounds at 7:00 or 8:00 in the morning and then tell the patient to call their daughter because they are being discharged at 2:00. This is the experience of many of our patients still. Keeping people updated as to their care plan and their after-hospital care needs is something that we identified as a major theme in many root cause analyses of early readmissions.

But even more to the point around real-time communication is that we’re still not doing a great job in letting the outpatient providers know that their patients are being admitted and discharged and defining the reasons for their hospital stay. What was their course treatment? What were the new results and what medicines were they prescribed? Root cause analyses from every community across the United States now find that real-time communication with their receiving providers is still lacking.

4. Ensuring that there is timely post-acute care follow-up. This will vary based on patient risk, but if your patient is moderate or high-risk, a call to their doctor’s office and an appointment in one to two weeks is not going to do it anymore. We have so much data. If you run your own hospital’s data as to the average time between discharge and readmission, you will find that 25 percent of your readmissions are coming back within three to four days, and 50 percent are coming back within seven to 10 days. We need to get touch points. It doesn’t need to be a follow-up appointment; there are many good models of phone calls, visiting nurses, lay-care providers, etc. We need to follow up with patients to make sure that when they get home, they understand their plan of care, they get their medications and they are not confused.

Infographic: The Path of Care Transitions

April 4th, 2013 by Melanie Matthews

Nearly one in five Medicare patients discharged from the hospital is readmitted within 30 days, according to a new infographic by QSource, the Medicare Quality Improvement Organization (QIO) for Tennessee. Qsource’s infographic on care transitions shows the financial impact of care transitions, along with who can improve the care transition path.

The Path for Care Transitions

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Infographic: Real World Strategies for Reducing Readmissions

December 12th, 2012 by Patricia Donovan

reducing readmissions

We’ve all seen the numbers on potentially avoidable Medicare readmissions, but new penalties from CMS for subpar readmission rates pack a little more punch into these often-published stats from CMS, the AHRQ, MedPac, and other sources. The hard truth is that more than 2,200 hospitals will lose a portion of their inpatient Medicare rates in FY 2013.

Proactive data analysis is one way to keep readmissions penalties at bay. And this new infographic from the Healthcare Intelligence Network consolidates the protocols and strategies many organizations are using to dramatically reduce the number of Medicare beneficiaries that return to the hospital within 30 days, drawing from responses from our annual Reducing Hospital Readmissions survey.

Among their ideas:

  • Follow-up appointments and phone contact shortly after discharge;
  • The use of transition coaches in hospitals, nursing homes and SNFs;
  • Group physical activity sessions that focus on physical, social and emotional well-being;
  • Upping use of telehealth and fall risk assessments.

We invite you to embed this infographic on your own Web site using the code that appears beneath it. Also, share it via your social media channels. A deeper dive into the latest trends to reduce hospital readmissions is reflected in 2012 Healthcare Benchmarks: Reducing Hospital Readmissions.

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Other Infographics from HIN:

Infographic: Hospital Readmission Penalties

October 19th, 2012 by Melanie Matthews

The maximum penalty for hospitals this year for readmissions is 1 percent of their reimbursement, increasing to 3 percent in 2015, according to a new infographic by Billian’s HealthData.

The infographic looks at how many hospitals would have been penalized based on previous data and the states with the highest readmission rates.

Click here to view the infographic.

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Infographic: The Financial Impact of Reducing Avoidable Readmissions

September 22nd, 2012 by Melanie Matthews

Under CMS’ new penalties for avoidable hospital readmissions, the average 300-bed hospital is at risk of losing $9.5 million annually for 11 potentially avoidable conditions, according to a new infographic by ObjectiveHealth, a McKinsey Solution for Healthcare Providers.

Improved coordination of care for these 11 conditions, identified by the Agency for Healthcare Research and Quality, can potentially prevent the need for a re-hospitalization.

The Financial Impact of Reducing Avoidable Readmissions

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