Reduce heart failure readmissions
To help your organization successfully reduce heart failure readmissions, here is the complete guide to heart failure, including:
- Heart failure rates by region (see map)
- Causes of heart failure readmission
- Reimbursement trends
- Real-world strategies for reducing readmissions.
Causes of heart failure readmission
The reasons for readmission are multifactorial and it is difficult to predict individual causes for readmission.
Catherine J. Ryan, PhD, clinical associate professor, college of nursing, University of Illinois at Chicago Department of Biobehavioral Health Science, Chicago, says one way that readmissions have been categorized is simply as preventable or unpreventable. Others have categorized reasons for readmission as clinical, behavioral, and patient-centric, recognizing that the responsibility of readmission may reside with the patient, provider, hospital system, or any combination thereof.
“Heart failure readmissions have been associated with a variety of factors or characteristics,” she says, adding that the most common include advanced age, history of renal disease, history of diabetes, or a heart failure admission within the past year. Other factors include admission to a teaching hospital, discharge against medical advice or discharge to home, receiving Medicaid, and being of African American ancestry.
Related article: The SDOH Factor That Impacts Heart Disease
A study by the Harvard School of Public Health (HSPH) found that elderly black patients were more likely to be readmitted to the hospital after a prior hospital stay for heart failure due to disparities related to both race and the hospitals where patients were treated.
Another study, “The Prevention of Hospital Readmissions in Heart Failure” by the David Geffen School of Medicine at UCLA, Los Angeles, showed that among readmitted Medicare patients with HF, the five most common primary diagnoses—HF, renal disorders, pneumonia, arrhythmias, and sepsis—account for 56% of the readmissions with no other diagnoses accounting for more than 5%.
“Readmission potentially reflects a failure of the discharge process; thus, discharge planning should start at the time of admission,” says Karen M. Vuckovic, PhD, advanced practice registered nurse, division of cardiology, University of Illinois Hospital & Health Sciences System, Chicago. “Health-related quality of life, or an individual’s perceived physical and mental health over time, predicts readmissions in patients with heart failure.”
“For the past several years, there has been a heightened national focus on reducing readmissions and thus identifying patients with the highest risk for readmission,” Ryan says. “Although there have been reductions, readmission rates remain high.”
In the skilled nursing market, Zachary Palace, MD, medical director of RiverSpring Health Hebrew Home at Riverdale in Bronx, New York, says the shift to patient-driven payment model (PDPM) provides facilities with higher reimbursement for more complex Medicare Part A patients, explaining the amount of care needed correlates more directly to the reimbursement received.
The ACA authorized the federal government to penalize hospitals for poor readmission rates for Medicare patients with heart failure, and this has caused many to rethink their strategies.