Four Ways Hospitals Can Avoid Readmissions

Janice Simmons, January 27, 2010

Tucked into the House and Senate healthcare reform bills are provisions that would give the Secretary of Health and Human Services the power to identify "excess hospital readmissions"—and then penalize hospitals that surpass that rate.

Payments for discharges paid by Medicare could be reduced by up to 3% in the Senate bill or 5% in the House bill.

Not all readmissions are avoidable, but for those hospitals where many of those readmissions are "unplanned and potentially the result of missteps in care either during the hospitalization or in the period immediately following the hospitalization," the Commonwealth Fund has put together a guide to help hospitals reduce their occurrence. The guide, released on Tuesday, suggests strategies that hospitals could try at different stages of the care continuum to reduce avoidable readmissions.

Addressing potentially avoidable readmissions requires a community approach with input from entities across the continuum of care, the guide noted. Better healthcare outcomes are not only dependent on receiving better care in the hospital, but increasingly, on receiving better care at home, it said.

Hospital leaders could benefit from "positioning" their organizations to succeed in the face of financial penalties and other payment reforms suggested in the legislative proposals to avoid readmissions. This means taking step by step actions, the guide said, to provide a springboard for hospital leaders to "proactively address avoidable readmissions."

Here are the steps the guide suggests for hospital leaders to avoid readmissions:

Examine your hospital's current rate of readmissions. Currently, payers, legislators, and other healthcare stakeholders have been focusing on Medicare readmissions data as evidenced by the reporting of 30 day readmission rates for heart attacks, heart failure, and pneumonia on Hospital Compare at

Hospitals could examine readmissions data for trends by looking at: Readmission rates for different conditions; examination of the rates by physician to determine if the patterns of readmissions are appropriate; or reviewing readmission rates at different times.

Assess and prioritize improvement opportunities. The prioritization process should capitalize on "immediate opportunities" for the hospital's improvement. Hospital leaders can consider: Focusing on specific patient populations that may have high readmissions or focusing on an organization's strengths, such as a multilingual staff that can communicate with patients or an electronic medical record that can promote better care coordination inside and outside the hospital.

Develop an action plan of strategies to implement. Hospitals may need to involve key stakeholders in the care delivery process within the organization, such as patients, physicians, pharmacists, social services, nutritionists, physical therapists, and the community. Outside the organization, partnerships should be considered with other healthcare providers and public and private support groups in their communities to aid patients' transitions back into the community.

Monitor a hospital's progress. Monitoring a hospital's progress will inform hospital leaders of "the efficacy of these strategies and perhaps guide them in implementing additional strategies," according to the guide. Monitoring a hospital's progress should focus on readmission rates for different conditions, by practitioners, by readmission rates by readmission source, and readmission rates over different time frames.

Janice Simmons Janice Simmons is a senior editor and Washington, DC, correspondent for HealthLeaders Media Online. She can be reached at
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