Biting the All-Cause Readmissions Bullet
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This article appears in the May issue of HealthLeaders magazine.
When asked why their efforts to prevent 30-day readmissions focus only on patients with heart failure, pneumonia, or heart attack, many hospital leaders shrug: because those readmissions are the only ones for which hospitals suffer a stiff reimbursement penalty.
While many hospitals intend to target all-cause readmissions eventually, for now, it represents a steep front-end expense their budgets are not yet ready to absorb in a fee-for-service world, especially for readmissions that are not yet at risk for penalties.
Amy Boutwell, MD, MPP, is a readmission prevention expert and practicing physician at Newton-Wellesley Hospital in Newton, Mass. She recalls a seminar she held in December for representatives of 62 New Jersey hospitals.
"I asked everyone in the group, 'Is anyone taking this all-cause approach?' And none of them were," she says. "They just don't have it on their radar. Their 'first phase' of efforts is still very much focused just on one disease. Their challenge in 2013 is to move from one disease-focused pilot to a broad portfolio of efforts."
But a few hospitals are forging ahead on the all-cause front. They're working on pilots and special programs that are reducing readmissions regardless of diagnosis, first on a unit or floor, and then across their entire hospital or system. Integrated systems are working with their physician networks to make sure there's a provider ready to "catch" these patients after they're discharged to give them what they need so they don't come back.
They're hiring specialty care coordinators and transition coaches. And they're tailoring follow-up care for patients with multiple comorbidities, from mental health and literacy issues to poorly controlled diabetes, asthma, substance abuse, and chronic pain.
They're working with skilled nursing facilities and home health agencies in their communities to make sure their discharged patients don't reappear in their emergency departments within 30 days. In some cases, programs track patients for as long as 60 and 90 days, not just because it's good for the patient: Some hospitals say it's good for their bottom lines, especially when the readmitted patient is uninsured or underinsured.
"The reason we've gone beyond those three diagnoses is partially because we assume the government is moving to all-cause readmissions, so we are acting on that," says Lee Ann Liska, chief operating officer for the six-hospital, 1,617-bed Mercy Health in southwest Ohio.
"If you have a vulnerable population struggling with chronic disease, multiple illnesses, and challenges like socioeconomic issues, poor living conditions, poverty, illiteracy, as a mission-based organization we believe if we invest in the front end we'll save on the back end by avoiding unnecessary readmissions," Liska says.
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