The Hospital Readmissions Reduction Program, mandated by the Affordable Care Act, requires the Centers for Medicare & Medicaid (CMS) to reduce payments to Inpatient Prospective Payment System (IPPS) hospitals with excess readmissions.
Readmission is defined as an admission to an IPPS acute care hospital within 30 days of a discharge from the same or another IPPS acute care hospital.
For Fiscal Year (FY) 2016, the Centers for Medicare and Medicaid Services (CMS) has estimated that total readmissions penalties will be approximately $420M, down slightly from $428M in FY 2015.
Penalties are being levied on 2,620 facilities for FY 2016, with the highest penalty for a single facility being more than $3.6 million. Forty-nine hospitals were penalized at least $1 million in FY 2015.
To calculate the penalty, CMS reviews the claims for five readmission measures for excess readmissions. The claims are grouped by measure based on diagnosis and procedure codes. The FY 2016 measures are unchanged from FY 2015:
- Acute Myocardial Infarction (AMI)
- Heart Failure
- Chronic Obstructive Pulmonary Disease (COPD)
- Total Hip and/or Knee Arthroplasty
The FY 2017 measures will include one addition: coronary artery bypass graft (CABG) surgery.
With national readmission rates as high one in five, and higher for certain diseases, many providers are seeking ways to reduce their readmission rate. Among some successful strategies are the following:
Dictate discharge summaries within 24 hours of discharge. Standard practice and policy at most hospitals is that discharge summaries are completed within 30 days of the discharge. But consider “anticipatory guidance" for those patients who get discharged, go home, and find they can't fill their meds, insurance doesn't cover the med or they have questions. They call their primary care provider, who didn't even know they were admitted. Information needs to be available at the time of discharge.
Intensify the Transition Process
At every juncture in patient care process, especially discharge, have teams talk to each other about the patient. Taking this person-centered approach shifts the concept from discharge — which is a moment in time signifying a sign-off — to a transition — a shared accountability that assures the receiving providers understand who this patient is.
Provide Medication on Discharge
Send the patient home with a 30-day medication supply, wrapped in packaging that clearly explains timing, dosage, frequency, etc.
Make a Follow-up Plan before Discharge
Have your staff make follow-up appointments with the patient's physician and don't discharge the patient until this schedule is set up. Make sure the patient has transportation to the physician's office and understands the importance of meeting that time frame; follow up with a phone call to the physician to assure that the visit was completed.
Health coaches, intensive care clinicians, and wireless technology can all be utilized to record vital signs on a daily basis for discharged Medicare patients. Phone calls of between five and 15 minutes, frequently enough to gain patients’ trust, can help them stay out of the hospital.
Identify those most at risk
Customize your hospital's admission and re-admission rates for demographic and disease characteristics to identify those at highest risk, and expend extra resources on their care needs.
Just like Meals-on-Wheels can be scheduled in advance, so can case management, housekeeping services, transportation to the pharmacy and physician's office.
Say Goodbye with a critical eye
Discharge plans are often written in ignorance of the patient's pre-admission history and experience. Don’t hesitate to be critical of the plans patients get.
Are they really hearing you?
Patients say they understand what they're supposed to do after they leave the hospital. But they are often heavily medicated, stressed, groggy and confused, and they may be unable to understand what they are being told, much less remember it two days later. "Teach back," in which they and their caregivers repeat back those instructions, needs to be constantly reinforced.
Focus on Highest-risk Patients
Examine the readmission patterns at your hospital and see which patients, with which conditions, diseases or procedures, have the most readmissions. Push limited resources toward this group of patients in a more intense way.
Listen to the Patient
Providing patients and their family members with informed choices and counseling in the emergency room setting may avert painful, unnecessary admissions. Because, even worse than a readmission is the readmission of a patient who does not want to be readmitted!