What a TV Show Can Teach Us About Readmissions
"Providers and patients need to reorient a perspective that providing enhanced services to patients in the home or office—'more care'—is still much more cost effective than sending non-acutely ill patients to the ED for rehospitalization," Boutwell adds.
Four Strategies to Prevent Readmission
Boutwell and IHI offer four strategies hospitals can start employing immediately to prevent readmissions: ( See complete list at www.ihi.org/staar.)
- Measure your hospital's "all cause 30-day readmission" rate.
- Form a continuum team of receivers: nursing homes, home health agencies, skilled nursing facilities, hospice, office practice, and include a patient/family representative.
- Review the stories of five recently readmitted patients.
- Improve core processes, in collaboration with partners on the cross continuum team. Use the entire hospital stay to educate the patient and family on post discharge care and communicate with post-discharge providers to ensure some follow-up with the patient, such as a home visit or a phone call.
Hospitals are starting to see the potential and are moving to take action, says Boutwell. "We now have dozens of hospitals working with us at IHI. They come to us with these concrete barriers of why the patient's post-discharge care doesn't go well. They say, 'The patient doesn't qualify for home bound status' or 'the patient can't get an appointment to see her doctor in a few days.' "
The work now "is on finding ways to shift services to provide more support at time of transition."
Some of the questions providers should ask when reviewing their readmission rates might be: Are patients in one city or county more likely to be readmitted? Are they likely to be in one socio-economic group or another, or have difficulty getting to a pharmacy to fill a new prescription? Are higher readmission rates associated with certain age groups? Or are they perhaps more likely to occur depending on where they were initially discharged to?
Are readmissions more common when patients are discharged from small hospitals or larger hospitals? Are they more likely to occur at day seven, day 10, or day 29, and at what time are they most preventable?
In the January issue of the journal Health Affairs, researchers at Brown University and Harvard Medical School found that when a hospitalized patient is discharged to a skilled nursing facility instead of to home, they have an even greater chance—one in four versus one in five—of being readmitted or "bouncing back" to the hospital.
These are findings that hospitals would do well to take seriously. They need to do more, even if it means spending considerable sums of money and forging partnerships with doctors and after-care systems and facilities to manage their patients' post-discharge recoveries better.
Quality Care and Money At Stake
Not only is the patient's health at stake, there's money at stake, too.
The Centers for Medicare and Medicaid now penalizes hospitals by denying them reimbursement for care required because of provider mistakes. And, the agency also requires hospitals to "voluntarily" report on a number of quality measures such as readmissions, but reduces reimbursement by 2 percentage points if the hospital fails to report them.
So far, Boutwell and other hospital quality experts acknowledge, those reductions have not presented much of a threat. They haven't been that frequent or that high.
But that is soon to change. "The hospitals realize that very soon they will not be paid for many of these (avoidable) readmissions," Boutwell says. "They know they have to do something."
On Oct. 1, 2012, the new health reform law's Hospital Readmissions Reduction Program takes effect, authorizing a complex formula that will reduce the amount of money paid to hospitals with higher than average readmission rates.
When that happens, and hospitals get serious about keeping patients healthier outside their facilities, Mrs. Hufnagel—wherever she is today—might finally be happy with her care.
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Cheryl Clark is senior quality editor and California correspondent for HealthLeaders Media. She is a member of the Association of Health Care Journalists.
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