Hospital readmissions are considered by many to be a correctable source of excessive spending and poor quality of care. According to a 2009 study, nearly 20% of Medicare beneficiaries are re-hospitalized within 30 days after discharge, at an annual cost of $17 billion. The causes of avoidable readmissions include hospital-acquired infections and other complications, premature discharge, failure to coordinate and reconcile medications, inadequate communication among hospital personnel, patients, caregivers, and community-based clinicians and poor planning for care transitions.
As part of the PPACA, the Hospital Readmissions Reduction Program requires CMS to reduce payments to IPPS hospitals with excess readmissions, effective for discharges beginning on October 1, 2012. CMS defined readmission as an admission to a hospital within 30 days of a discharge from the same or another hospital. CMS finalized the readmission measures for Acute Myocardial Infarction, Heart Failure and Pneumonia, with plans to include other common diagnoses for which readmissions are preventable. This policy has brought attention to readmission rates as an indicator of quality as well as highlighted the capacity of inpatient warranties and performance incentives in emerging payment reform models.
For hospitals seeking to lower readmission rates, implementing comprehensive care transitions at discharge is essential in helping avoid the deterioration of health that can bring a patient back to the hospital. Outlined below are strategies for reducing hospital readmission and improving the overall quality of care delivered.
Strategies for Reducing Hospital Readmissions
- Prioritizing the delivery of high quality care to will improve performance measures, reduce readmission rates and savings will be realized as a byproduct.
- Use health information technology in the form of electronic health records, patient registries and risk stratification software to integrate care across settings.
- Educate patients and their families on proper management to their conditions. Continued patient education throughout the inpatient stay helps retention of knowledge and prevents confusion at home.
- Perform medication reconciliation to compare the medications the patient is taking upon admission to the hospital with the medications prescribed at discharge. Medication reconciliation provides the patient with a list of medications they should refrain/discontinue using when leaving the hospital, as well as gives them a medication plan of which medicines to take and at what dosage.
- Provide a patient-friendly discharge plan outlining:
- The reason for hospitalization
- Medication Reconciliation
- Pending tests and results
- Post-discharge services needed
- Post-discharge resources for support in health improvement and maintenance
- Symptoms that indicate when the patient should contact their primary care provider
- A post hospitalization appointment with their primary care provider
- Important contact information
- Establish a post-discharge intervention plan for patients in a high-risk category for readmission. Offer these patients intensive post-discharge attention by scheduling home visits within the first 48hrs of discharge, followed by a primary care appointment and making contact to ensure the patient understands their recovery steps.
- Align hospital care with local providers to provide a continuum of care.