Becker's Hospital Review

Executive Briefing: Reducing Hospital Readmissions 29 Sponsored by: 5 Steps for Reducing Inappropriate Hospital Readmissions By Anuja Vaidya I t is an indisputable fact that inappropriate hospital readmissions are a drain on hospital resources, time and money. These readmissions result in billions of dollars being wasted. Each year, nearly 20 percent of Medicare beneficiaries are readmitted to hospitals within 30 days of discharge and account for $17.5 billion in additional costs for CMS. To combat the additional costs, CMS established the Readmission Reduction Program. The program took effect in October 2012, and it aims to reduce readmissions by slashing reimbursements for hospitals that have a high number of preventable readmissions for specific conditions, such as heart failure, heart attack and pneumonia. Additional diseases and diagnoses will be added to the program in the years to come. Up until Oct. 1, 2013, the penalty for hospitals with readmission rates in excess of the rate established by CMS was a maximum of 1 percent. After Oct. 1, it rose to 2 percent, and it will increase to 3 percent on Oct. 1, 2014. Challenges to reducing readmission rates There are eight characteristics of high-risk patients, according to the Society of Hospital Medicine: prior hospitalizations, problem medications, depression, certain principal diagnoses, use of multiple medications, poor health literacy, poor patient support and palliative care. Once the providers and staff know who the high-risk patients are, they can take steps to ensure any extra care the patient may need is given, which will help prevent readmission. "Each year, nearly 20 percent of Medicare beneficiaries are readmitted to hospitals within 30 days of discharge" One of the biggest challenges to reducing inappropriate readmissions is flow of information and communication, says Jasen W. Gundersen, MD, president of Knoxville, Tenn.-based TeamHealth Hospital Medicine. "Keeping a concise and accurate flow of information is critical," he explains. Unclear discharge instructions, problematic discharge processes and medication reconciliation are also common causes of inappropriate readmissions. "Another challenge is re-engineering the discharge process so that it is really patient centered," says Paul Hildebrand, MD, associate director of the TeamHealth Patient Safety Organization. Strategies for reducing readmission rates Luckily, the challenges are not impossible to overcome. Inappropriate readmissions are preventable through process improvement and more effective coordination during and after a patient stay. Here are five steps hospitals can take to reduce inappropriate readmissions: 1. Recognizing high-risk patients. To effectively reduce readmissions, hospitals need to recognize high-risk patients as soon as they are admitted. "You need to recognize them up front, and then you need to work extensively with them and their families," says Dr. Gundersen. 2. Communicating effectively among providers and care teams. The hallmark of an excellent readmission reduction program is excellent communication, says Dr. Hildebrand. The healthcare team must communicate appropriately, clearly and in a timely manner with one another, he says. One strategy that hospitals can implement to improve communication is multidisciplinary bedside rounding. This type of rounding requires all caregivers — physicians, nurses, specialists, case managers — to visit the patient at the same time and discuss the patient's care plan together, along with the patient. The care team must also use appropriate and thorough documentation to relay information to each other and to outpatient providers who will take over the case once the patient leaves the hospital. Outpatient providers need to be given a detailed discharge summary so they are aware of any issues that could potentially result in a patient being readmitted. "There needs to be direct and concrete communication between providers to ensure no confusion," says Dr. Gundersen.

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