Keeping Readmission Rates Low with Treatment Guidelines

This article appears in the January 2012 issue of HealthLeaders magazine.

An elderly woman was admitted to UPMC Hamot for diverticulitis last year. Upon her arrival back home, her home health nurse detected that the woman had gained about 8 pounds in water weight.

"Rather than be readmitted to the hospital, they got her connected with telehealth, monitored her, and adjusted her diuretics," says Jim Donnelly, RN, MBA, chief quality officer and chief nursing officer for the 412-licensed-bed Erie, PA, hospital. "Remote monitoring precluded the need for a visit to her physician's office, the hospital, or the ER. That's the implementation of what we're able to deliver."

Donnelly witnessed the at-home management of this particular patient first-hand—she's his live-in mother-in-law.

This situation exemplifies the successful use of UPMC Hamot's treatment guidelines, which have helped to keep the organization's readmission rates among the lowest in the country for some service lines.

Low readmission rates are reaching a new level of importance. Beginning in 2013, hospitals with "excess" readmissions will face financial penalties. Those ranking in the highest quartile in the country could lose 1% of their Medicare DRG in the first year, 2% in the second, and 3% in the third. That amounts to about $850 million in the first year.

UPMC Hamot, Lancaster (PA) General Hospital, and Muncie, IN–based Indiana University Health Ball Memorial Hospital have readmission rates that beat Medicare's HospitalCompare dataset national average in three key areas: 30-day readmission rates for heart attacks, 30-day readmission rates for heart failure, and 30-day readmission rates for pneumonia.

There is a common thread tied to each organization's success: detailed treatment guidelines. 

Working with after-care facilities
The 379-licensed- and staffed-bed IU Health Ball Memorial Hospital began drafting treatment guidelines about 12 years ago, says Claire Lee, RN, the administrative director for quality and safety.

"We researched best practices, and we standardized those practices," she says. "Then we put together teams of physicians and caregivers that care for the population of patients we were focusing on and developed standardized treatment guidelines that were then put into use."