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5 Questions to Determine Readmission Rate Effectiveness

Joan Moss, RN, MSN, Senior Vice President, Sg2, for HealthLeaders Media, June 30, 2011

Hospitals have always known that reducing readmissions should be a priority quality goal but, until now, the payment incentives have not been in place. Like it or not, health care reform has provided a new impetus to do the right thing.

Financial penalties on providers with "excess" readmissions will begin in fiscal year 2013, but claims data collection on those penalties starts this October. The Centers for Medicare & Medicaid Services (CMS) measures readmissions within a 30-day time frame after patients are discharged for their initial admission. A readmission to any acute care hospital, for any reason, regardless of whether it is to the hospital from which the patient was originally discharged, or whether the readmission has any relation to the original hospital stay, will be counted. This is the definition of an "all-cause" readmission and does not exclude elective or planned admissions.

CMS will risk adjust readmissions penalties based on comorbidities and other patient variables, and initial penalties will focus on excess readmissions for congestive heart failure (CHF), pneumonia and acute myocardial infarction (AMI). Additional readmission penalties for chronic obstructive pulmonary disease (COPD), coronary artery bypass graft, percutaneous coronary intervention and other vascular procedures will begin in fiscal year 2015. What these penalties really indicate, however, is a larger CMS goal to move to a value proposition in terms of what it will pay for. To make sure your organization is on the right side of that value proposition relative to readmissions, have your leadership team ask themselves the following 5 questions.

Question 1: What is our business exposure based on CMS penalties and future accountable care organization (ACO) quality reporting requirements?
Put another way, what is your strategy for managing readmissions based on your current readmission rates? How much of your revenue could be at stake?

1 | 2 | 3 | 4

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3 comments on "5 Questions to Determine Readmission Rate Effectiveness"


Solomon J. Zak, M.D. (7/7/2011 at 9:39 AM)
Most authorities fail to understand the effectiveness of discharge planning. One needs to [INVALID] computer screens that are specific for comprehensive discharge planning for each at risk diagnosis (and co-morbidity). At the time of discharge, All attending physicians, including the Primary Care Physician and discharge staff must complete these screens which must be precisely diagnostically correct retrospectively and prospectively. For example, if a 67 year old member has not had (vaccine) pneumococcal immunization, that should be given before discharge. Importantly the Primary Care Physician must be identified as the RESPONSIBLE physician, whether the patient is being treated by a Cardiologist, Oncologist, Surgeon, etc. Issue: There must be a SINGLE accountable physician identified and at risk.

Siva Subramanian (6/30/2011 at 7:04 PM)
Excellent article! Most hospitals understand that they are at some financial risk but not every one has a clear picture of how bad it will be once the penalties go into effect. Once they have this picture, they will need to work on improving readmission rates through quality improvement interventions (e.g. Project BOOST, Project RED). The challenge will be to do it in a way that is not only effective but also repeatable, measurable and sustainable over time. This is where IT tools can help. We, at CareinSync (www.careinsync.com), have developed a collaborative care transitions management tool that helps a multidisciplinary team manage patient care transitions in a way that not only improves quality of care and reduces readmissions but also improves efficiency. By incorporating the hospitals chosen QI interventions and monitoring them using collaborative checklists, messaging and alerts, the tool ensures that team is always in sync with the patient discharge plan. A real-time dashboard gives up-to-date and accurate status of the patient discharge plan. Another dashboard provides management and executives with real-time quality and efficiency metrics. For more information please contact me at info@careinsync.com

Su (6/30/2011 at 5:52 PM)
At most hospitals, diabetes and and poor glycemia control contribute to high rates of readmission. Earlier this year, MX.com and Adventist Health System partnered to create the Readmission Reduction through Glycemia Management toolkit for inpatients, specifically designed to help hospital leaders improve readmission rates arising from diabetes-related complications. Diabetes and related complications continue to take their toll. The Lancet just reported an astonishing statistic: Diabetes has tripled in the U.S. and doubled worldwide. (Apologies if this gets posted multiple times. It doesn't seem to take.)