Tag Archives: Hospital Readmissions

image_pdfimage_print

Everyone’s Focus – Preventing Hospital Readmissions

Posted on by

So picking up from my last post, it seems like decreasing hospital readmissions is an opportunity perfect for the ACO.  Quality can be improved and unnecessary costs lowered.  Everyone would benefit.  You might think that the only possible exception would be the hospitals since decreasing readmissions would decrease their revenue.  Until recently that was the case.  But one of the provisions of the Accountable Care Act has established a financial penalty for hospitals whose readmission rates for Medicare patients with heart failure, heart attack or pneumonia exceeded the national average in the past.  The penalties began in October of 2012 and can decrease a hospital’s reimbursement from Medicare by up to 1% of its charges during 2013.  It is estimated that the penalties will amount to $250 million dollars in 2013.  The maximum percentage penalty will increase to 2% and then 3% in the next two years for hospitals that don’t lower their rate.  So hospitals now also have a strong reason to support programs designed to prevent readmissions.

 Preventing Readmissions

No matter who manages it, a program to prevent readmissions must have some basic components:

  • Patient identification – It is critical that the team responsible for the program gets notification of the patient’s discharge as promptly as possible.
  • Patient prioritization (if possible) – This can help the team focus on the patients more likely to be readmitted.
  • Patient outreach to
    • Schedule an office visit with the patient’s physician to check on their progress.  The patient is also told what symptoms should cause them to contact the physician immediately and not wait until the scheduled appointment since deterioration can sometimes occur very rapidly.
    • Assess needs and make sure components of the discharge plan are being implemented as intended.
    • Medication reconciliation to make sure the patient is taking the right medications.  This includes addressing any problems the patient may have in obtaining the medications.

Who Should Run A Readmission Avoidance Program?

While a hospital can run such a program, they will have to make sure they have adequate staff to manage the care coordination pieces.  Integration with the patient’s physician can also be a problem.  However, a common part of most ACOs is a team of clinical staff, usually nurses, who work with the patients’ physicians to coordinate their care.  This team is focused on the needs of the physicians’ patients so it is natural for them to play the role of reaching out to the discharged patient to assess and address their needs.  So, an ACO seems to have an advantage in conducting a readmission avoidance program.  Their only critical need is getting real-time notification of the patient’s discharge.  Thanks to the recent Medicare penalties for readmissions, hospitals have an incentive to get the ACO prompt discharge information so the ACO can reach out to the patient.

In the next post I’ll provide more details about how these program components can be put into operation in different communities.

For Your Health – Dr. Bob

Hospital Discharges – An Opportunity for ACOs

Posted on by

After reading my last post on ACOs you may be wondering how an ACO consisting of primary care physicians can hope to save money on the costs of the Medicare patients attributed to them when so much of the care is beyond their control.  After all, the beneficiary can see any specialist they choose, and many hospitalizations can take place without the PCP’s knowledge.  That’s true, so there may always be components of a person’s care that cannot be well-coordinated, but there are still a lot of opportunities that an ACO can address if they are willing to invest in the system changes that are necessary.

I’d like to spend the rest of this post explaining why focusing on the transitions of care that a patient goes through is a prime target of most ACOs.  When I use the term “transition” it applies to any change of care setting for a patient.  It includes going from their home into a hospital, from a hospital to a rehabilitation hospital or from the hospital back to their home.  At each of these transitions there needs to be a communication of all elements of the care the patient has been receiving and what needs to continue or be changed going forward.  This is especially critical for a patient with multiple chronic medical problems such as high blood pressure or diabetes.  Probably the time when most miscommunications take place is when a patient is discharged from the hospital to their home.

Transitions of Care – Hospital Discharge

When a patient is discharged from an acute care hospital after being treated for something like severe pneumonia or a heart attack, someone from the clinical staff gives them a written copy of discharge instructions and discusses those instructions with them to make sure the patient understands them.  Unfortunately, what was often clear in the hospital isn’t so clear at home.  Lack of clarity around discharge instructions can lead to complications, reversal of the improvement that began in the hospital and hospital readmission.  There are studies that find that about 50% of these readmissions can be prevented.

Size of the Opportunity

Medicare estimates that 20% of patients discharged from a hospital are readmitted within 30 days.  One example of the financial consequences can be found in data for Knoxville, TN published by Qsource, a Quality Improvement Organization (QIO).  They found that in 2009 14% of the approximately 188,000 Medicare beneficiaries in Knoxville were hospitalized.  Consistent with Medicare’s national findings, 20% of those individuals had one or more readmission which cost $57 million and the 241 beneficiaries who had 4 or more readmissions had costs totaling $10 million.  Not every readmission is preventable, but when you look at the issues that lead to many of them, there are clear opportunities to improve the quality of care and prevent unnecessary and costly readmissions.  The challenge is to identify those whose readmission can be prevented and deliver the needed information and services to keep them healthy.

In the next post I’ll discuss some new regulations from Medicare that focus on the readmission issue and other strategies that can be used by ACOs.

For Your Health – Dr. Bob