Turning the Tide of Hospital Readmissions
Hospital readmissions are a significant driver of negative clinical and financial outcomes in healthcare delivery. Historically, efforts to reduce readmissions have been less than optimal, so finding ways to prevent them has been a serious unmet need.
Readmissions impact the Triple Aim of healthcare reform: improving patient experience and population health while reducing net costs. Fortunately, as we’ll see, the Triple Aim also informs solutions.
A stubborn problem with a significant burden
A hospital readmission is defined as a subsequent hospital admission
within a given time period following an original admission. Readmissions occur all too frequently and the consequences have been noteworthy:
- 3.3 million adults are readmitted to hospitals within 30 days in the US.
- 56% of Medicare beneficiaries were readmitted (2011) vs 19%
of patients covered by Commercial insurance
- 58% of readmission costs were associated with Medicare, at a cost
of $44 billion
- >50% of patients readmitted within 30 days have no evidence
of follow-up before readmission
Some hospitals point out that these statistics are adjusted neither for sociodemographic risk factors nor readmissions unrelated to the original admission. However, all stakeholders agree that they reveal a serious issue. High rates of patient readmissions may indicate inadequate quality of care in hospitals — and/or a lack of proper post-discharge planning and coordination.
HRRP: fixing with a stick
Solutions for poor readmission records have been implemented, some with more success than others. As elsewhere with healthcare reform, Medicare is here leading the way — by paying hospitals based on the quality of care rather than quantity of the services provided. The Centers of Medicare and Medicaid established the Hospital Readmissions Reduction Program (HRRP) in 2010 to encourage continuity of care — and penalize hospitals with higher-than-average Medicare readmissions rates.
HRRP penalties started as 1% and have increased to 3%, based in part on 30-day unplanned readmission for COPD, heart attacks, heart failure, pneumonia, and stroke. Patients admitted to certain hospitals are more likely to have readmissions compared to other hospitals. In 2014, 92% of New Jersey hospitals were penalized for readmissions. The percentage of penalized hospitals will increase as more conditions are included in the program.
Accountable care: fixing with a carrot
Accountable care, based in part on better care coordination, is itself a solution to help reduce readmissions. Accountable care organizations and patient-centered medical homes are showing better than average rates of readmission, especially with high-risk patients.
Among factors most strongly associated with potential preventable readmissions are failure to relay important information to outpatient health care professionals, lack of discussions about care goals among patients with serious illnesses, and patient or family had difficulty managing symptoms at home. [JAMA]
Communication is key — frequent communication across the whole care team. Other actions in successful discharge programs include early case management involvement and discharge planning as well as targeting high-risk patients.
Post-discharge follow-up programs can reduce readmissions
by up to 30%
Ongoing follow-up care is essential for reducing readmissions. Triple Aim goals highlight the continuum of care to help reduce net costs while improving patient experience and population health: [CMS4]
- Focus on better communications between providers, and patients and their caregivers
- Improve discharge planning, education, and follow-up for discharged patients
- Use electronic medical records to share information and provide continuity of care
Late-breaking good news
The efforts to improve quality care and reduce readmissions are working. In September, 2016, CMS reported that readmission rates fell by 8 percent nationally between 2010 and 2015. Today, CMS is releasing new data showing how these improvements are helping Medicare patients across all 50 states and the District of Columbia.
The data show that since 2010, all states but one have seen Medicare 30-day readmission rates fall. In 43 states, readmission rates fell by more than 5% — and in 11 states, readmission rates fell by more than 10%.
Calling all Pharmaceutical companies!
Pharmaceutical companies can play an important role in reducing preventable readmissions by supplying health literate and customizable discharge kits, including content and space for:
- Unbranded educational material about medication compliance
- Post-discharge healthcare provider appointments and contact information
- Test results, if applicable
- Patient questions, concerns, and symptoms to be discussed at follow-up appointments
In addition, pharma can help drive the addition of post-discharge medications to health-system electronic medical records and encourage communication between the hospital and community physicians. The way forward is clear. Stakeholders across healthcare delivery can collaborate and align with the overall goal of healthcare reform to improve patient experience and population health while reducing net costs.