What if there was a tool that could take into account various issues—such as lifestyle choices, severity of illness, diet, and family support factors—and spit out the likelihood that a patient would need readmission for his or her illness within 30 days? Such a tool would be a godsend for hospital leaders worried about financial penalties CMS will begin imposing on hospitals for readmissions for the same illness within 30 days of discharge.
The good news is that there is such a tool, at least for congestive heart failure, one of three disease states that will be subject to the penalties. Parkland Health & Hospital System in Dallas is currently testing the tool with other nonprofit partners in the Dallas-Fort Worth metroplex, including Texas Health Resources, and plans to make it available to others at some point in the near future.
It’s an algorithmic program developed by Ruben Amarasingham, MD, the associate chief of medicine services at Parkland and director of the Center for Clinical Innovation. Readmission of such patients is preventable, says the government, and costs Medicare as much as $17 billion a year, according to some estimates, which is the stated reason for the upcoming penalties. Beginning in 2013, the penalties will be as much as 3% of reimbursement for the approximately 20% of patients who are currently readmitted in such a fashion.
That’s not to mention penalties by private insurers. But a lack of success so far doesn’t mean people haven’t been trying.
“There’s been 20 years of systematic research effort to reduce readmissions, but it’s difficult work and can be expensive to apply to everyone,” says Amarasingham. “That’s why it’s been so difficult to sustain high performance. So, our tack has been to focus on patients at higher risk.”