Reducing Healthcare Facility Readmission Rates
It seems like a nightmare scenario; a patient is treated and released from your healthcare facility only to return weeks or even days later. What happened? Was there some sort of medical error that caused a HAI? Was the correct surgery performed…on the correct body part? Recently, the Affordable Care Act instituted the Hospital Readmissions Reduction Program, which requires the Centers for Medicare and Medicaid Services to reduce payments to hospitals with excess readmissions. Readmission is defined as “an admission to a… hospital within 30 days of discharge from the same or another… hospital.” These penalties make it more important than ever for hospitals to take a proactive approach to prevent readmissions. In this blog post, I will take a look at some strategies that healthcare facilities can use to decrease their readmission rates.
Here are 10 strategies for reducing readmission rates.
1. Understand which patient populations are at greatest risk of readmissions. Recent research suggests that Medicaid and uninsured patients are at greatest risk for preventable hospital readmissions.
2. Manage chronic diseases effectively in the outpatient setting. High admissions equal high readmissions. According to a recent article in the New England Journal of Medicine, there is a substantial association between regional rates of rehospitalization and overall admission rates.
3. Participate in incentive programs with payers. Hospital and health systems across the country have been enrolling or partnering in incentive programs with payers designed to incentivize providers to effectively drive down unnecessary hospital admissions. Pay-for-performance models, aligned with federal accountable care guidelines, are designed to incentivize hospitals and physicians to collaborate in efforts to reduce hospital-acquired infections and readmissions and follow evidence-based guidelines for surgical care and the treatment of heart attacks, heart failure and pneumonia.
4. Stratify patients to align the appropriate clinical care. Patients with chronic diseases should be stratified into high, medium, and low risk categories based on their age, socioeconomic level, education, co-morbidities, dependence on medication management, the frequency of their use of the emergency room, and recent hospital admissions. The goal is apply the most appropriate intervention based on the patient’s needs and condition to optimize clinical outcomes and quality of life.
5. Ensure patients schedule a seven-day follow-up. Medical studies have suggested that patients who followed up with their physician within seven days of discharge were less likely to be readmitted to the hospital.
6. Implement a robust home healthcare program. Post-discharge care can also be a powerful mechanism for preventing readmissions. Research has shown that home healthcare, such as medical social services or home health aides, can be effective.
7. Leverage technology innovation to improve team communication. A simple recent innovation impacting patient care coordination is the ability of multidisciplinary members to text each other. Other innovations include Carebook, an online networking platform which connects care providers to form multidisciplinary care teams, collaborate on safe transition plans for their patients, coordinate care, and engage patients and caregivers with a patient-centered after-care map.
8. Ensure smooth transitions with a strong transition plan. A key component in transitions of care for a patient returning home is the transition plan. Develop the transition plan on admission with the family. The plan should consider issues such as the home environment, whether the patient is physically and cognitively able to care for themselves, availability of support systems, and whether palliative or hospice support is appropriate. It should ensure that there is a timely follow up visit with the primary care provider or case manager. Also, the patient and family need to be educated at a level that considers language, educational level, and cultural preferences.
9. Engage patient through telehealth tools. An increasing number of organizations are taking advantage of patient portals and personal health records, and even more are using other approaches to engage patients in their care, including e-mailing, texting, and social media channels. A system that allows patients to communicate with caregivers, perform self-care activities, and participate in health screenings, for example, can improve quality of care and outcomes, especially for patients with chronic diseases.
10. Monitor progress with metrics. Development of a scorecard that allows the healthcare team to evaluate the success of their interventions, track trends, and identify opportunities for program improvement is a fundamental component of any readmission reduction program.
There are signs that hospitals made headway in this ongoing battle. Not only have Medicare readmissions fallen for the second consecutive year, individual hospitals and systems nationwide found innovative ways to improve population health and reduce readmissions. Read this article that contains six readmission success stories.