Hospital readmissions are under the microscope. President Obama and his health reform team are calling on hospitals, physicians, home care agencies, and other providers to work together across the care continuum to reduce the number of preventable readmissions.
As patient advocates and care coordinators, nurses are key players in this discussion. You will need to lead or participate in efforts to ensure that patients and their families are adequately prepared for life after acute care.
Exhibit: Hospital Readmission Rates Vary Widely
Potentially preventable readmission rates vary substantially across hospitals—even after adjusting for the types of cases and the severity level of patients. See the exhibit.
Exhibit: Readmission Stats
Various studies and reports highlight why hospital readmissions are currently in the spotlight. See the exhibit.
Sidebar: CMS to Report Hospital Readmission Rates
The Centers for Medicare & Medicaid Services (CMS) is posed to begin publicly reporting 30-day readmission rates for certain medical conditions this summer. Consumers, physicians, and others will be able to visit the Hospital Compare web site (www.hospitalcompare.hhs.gov) to compare your hospital’s readmission rates against the national average and against the rates of other hospitals in your community.
CMS will report 30-day hospital readmission rates for Medicare patients related to three conditions:
- Heart failure
- AMI
- Pneumonia
CMS has also proposed adding one more 30-day readmission measure in 2012 for percutaneous coronary intervention (for all patients age 18 and older).
The collection of readmission data is being handled through the government’s Reporting Hospital Quality Data for Annual Payment Update (RHQDAPU). Most hospitals participate in this program; those that do not are financially penalized through reduced Medicare payment updates.
Learn more: Visit www.qualitynet.org for up-to-date information on CMS’s readmission measures. Look under “Hospitals-Inpatient” for information about “Readmission Measures.”
Sidebar: Strategies for Reducing Readmissions
Provide better, safer care during the inpatient stay. According to one study, hospital readmission rates doubled—from 14 percent to 28 percent—when initial hospitalizations involved adverse patient safety events, such as anesthesia complications and infections. Evidence-based care practices—such as giving blood thinners after joint replacement surgery—can also reduce complications that tend to occur after discharge, resulting in readmission.
Attend to a patient’s medication needs at discharge. Sixty-six percent of the patients who experienced an adverse event within three weeks of hospital discharge suffered an adverse drug event. Physicians and nurses at one hospital improved the appropriate use of medications—and reduced readmissions—for cardiovascular patients by using a checklist of indications and contraindications for five life-saving medications, including beta blockers and warfarin.
Improve communication with patients before and after discharge. Philadelphia hospitals reduced readmissions by 45 percent by having nurses meet frequently with high-risk patients both in the hospital and after discharge to discuss medication management, diet, symptom management, etc. Even ensuring that all patients receive complete instructions about how to take care of themselves after discharge has been shown to reduce readmissions.
Improve communication with other providers. For example, California-based Healthcare Partners has established the goal of getting discharge summaries to primary care physicians within one business day of their patients’ discharges.
Review practice patterns. Some practice patterns may influence the likelihood of readmission. Examples include keeping patients an extra day in the hospital and providing physicians with comparative data on their readmission rates.
Source: 2007 Report to Congress: Reforming the Delivery System, Medicare Payment Advisory Committee, 2008. (Available at www.medpac.gov.)
Sidebar: More Resources
There have been many studies and reports published in the past few years identifying specific approaches and strategies for reducing readmissions. Here are a few to get you started on your search for best practices that will work in your organization.
Bisognano, M. and Boutwell, A., “Improving Transitions to Reduce Readmissions,” Frontiers of Health Services Management, Spring 2009, pg 3-10. This article highlights several approaches to reducing readmissions, including the Ideal Transition Home Model, the Care Transition Model, and the Evercare Care Model (available at www.ihi.org).
The Business of Caring, October 2008. This issue includes three examples of how hospitals are improving the discharge process, and an article on identifying the return on investment in reducing readmissions (available at http://www.hfma.org/publications/business_caring_newsletter/archives/Business+of+Caring-October+2008.htm).
The Care Transitions web site. The Centers for Medicare & Medicaid Services (CMS) chose 14 communities to participate in the agency’s Care Transitions Project, which seeks to eliminate unnecessary hospital readmissions. The web site includes free learning sessions where you can find out about successful approaches to reducing readmissions (visit www.cfmc.org/caretransitions).