5 Questions to Determine Readmission Rate Effectiveness
Effectively answering this question starts with good analytics, going beyond inpatient numbers to take a broader view of system-wide performance and benchmarking yourself against peer organizations. The more you can "peel the onion" on where readmissions are happening, the better—and 30-day readmission rates are also a good proxy for how well your post-acute care setting referrals are performing. The Sg2 Value Index™ offers an excellent tool for measuring overall clinical performance within these parameters and assessing your penalty risk. Most likely, hospitals in the bottom quartile of performance will bear the brunt of CMS penalties.
Question 2: How can we reduce readmissions without adversely affecting our current financial goals?
This is an important question to analyze with your financial staff, since there is no question that readmissions do make money and if they are reduced in one area, the income needs to be made up in another. Sg2 analysis shows that non-30-day readmission discharges or, in other words, new admissions for conditions not facing penalties, could be one answer. Drilling down to find the best leverage points for readmission prevention allows for focused interventions that are financially feasible, whether by disease, physician or patient geographic origin. A related question might be: How can you craft a multifaceted readmission strategy with a wide range of post-acute care settings? Lower-margin readmissions can also be "backfilled" with higher-margin cases, but health systems must keep in mind that under new payment models, such as ACOs and bundled payment, they will have to pay for readmissions.
Question 3: How can we better manage AMI, CHF and pneumonia patients?
CHF and pneumonia drive 30-day readmission volumes, with CHF accounting for more than 6% of all 30-day readmits, seconded by pneumonia at 4.8%. Nearly 1 in 4 CHF patients (24%) return to the hospital within 30 days with unresolved CHF. Typically, this is because they did not have a follow-up primary care or cardiology exam within 2 to 5 days after discharge, were released to the wrong post-acute care setting, or did not have their medications reconciled with a nurse or pharmacist within the first day or 2 after discharge. Like CHF patients, 66% of AMI readmissions are usually related to recurrence of the same cardiac event or an attack in a new cardiac site.
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