Reduce readmissions

March 1, 2013

Plans must offer non-clinical resources to help hospitals make successful transitions

When a patient experiences an “avoidable” readmission, who is accountable? Hospitals are getting penalized for high readmissions, but the situation is not entirely within their control. According to new Robert Wood Johnson Foundation (RWJF) research, a collective effort is needed.
Medicare racks up $17 billion in charges annually for return trips to the hospital that probably didn’t need to happen. In an attempt to prompt hospitals to reduce the rate of readmits, the Centers for Medicare and Medicaid Services (CMS) created a payment program that took effect this year.
Hospitals that lowered their rates were rewarded, but more than 2,000 other hospitals were docked up to 1% for high readmissions. Even though hospitals aren’t the sole source of the problem, it’s become their task to discover and implement solutions.
Fixing the problem is not the government’s role, according to Jonathan Blum, CMS deputy administrator. He said during a recent panel discussion that best practices must come from the industry itself.

Total stakeholder involvement
The main takeaway from the research and panel discussion is that there are many different reasons for readmissions, and therefore, a variety of solutions will need to be devised by the entire assembly of stakeholders.
When I reviewed the RWJF report, I was struck by the combination of factors that can drive a single patient’s readmission, much less the return visits of 10% or 15% or even 17% of a hospital’s Medicare patients.
Variables might include the basic clinical situations we all know about, such as a patient’s illness severity or lack of medication reconciliation. However, other factors that are harder to discern significantly influence readmits, such as a patient’s anxiety over being in the hospital leading to a premature discharge. It’s also not unusual for discharge instructions to be misunderstood or ignored.
To design a readmission reduction plan, panelists recommend a core strategy that includes medication therapy management; outpatient follow up; dynamic personal health records; clinical alerts when conditions worsen; and tools to reduce barriers to patient adherence to treatment. For example, nurses at Cullman Regional Medical Center record their discharge discussions and make the audio available online for patients and caregivers to access from home.
RWJF also suggests that providers plan for discharge earlier in the patient’s stay, rather than waiting until the day of discharge. Education, case management, follow-up care arrangements and multidisciplinary approaches are also recommended, as well as better tracking of readmission data.
Hospitals recognize the causes of readmissions are broad and could be out of reach of what they traditionally can accomplish, according to Eric Coleman, MD, director of care transitions, University of Colorado Anschutz Medical Campus. For example, a patient recovering from pneumonia might not feel well enough to use public transportation to keep his primary care follow-up appointment. Hospitals don’t have the resources to stretch so far beyond the inpatient stay.
But health plans do. Your case managers and social workers are keys to the solution.
If you’re already involved in non-clinical care support, consider aligning your programs with other stakeholders. Get your healthcare community focused on collective solutions that you can offer beyond clinical care.