PeraHealth Insights

Seven Things You Need to Know About Readmissions

Readmissions1. As a clinician and healthcare leader, how do you define the Healthcare Readmissions Reduction Program (HRRP), in your own words?

The goal of the Centers for Medicare and Medicaid Services (CMS) HRRP is to mitigate the instance of “excess” readmissions at healthcare organizations. Excess readmissions can signal quality defects in care.

With HRRP, CMS applies payment reductions to all Medicare fee-for-service (FFS) base operating DRG payments for the fiscal year, and penalties can go up to three percent of payments. There is no reward for low readmission rates in the program; it is merely a penalty-associated effort.

People often assume any readmissions reduction program is part of the CMS effort, but many commercial payors also have their own readmission reduction programs.

2. How are hospitals currently being measured and rewarded or penalized on readmissions?

CMS can withhold up to three percent of reimbursements for hospitals if they have a higher-than-expected number of readmissions within 30 days of discharge for six conditions: Chronic obstructive pulmonary disease (COPD); Coronary artery bypass graft surgery; Heart attacks; Heart failure; Hip and knee replacements; and Pneumonia.

For the 2018 fiscal year, 2,573 hospitals are getting some type of readmission penalty…so that includes the majority, or roughly 80 percent, of hospitals in the country. The average penalty is .73 percent.

Readmissions data also feeds into Medicare Spending per Beneficiary (MSPB) measure calculations for efficiency and affects payments to solo practitioners and groups of practitioners. As such, readmissions also impact the Value Based Purchasing efforts through this additional program.

3. What do we know about future additions to these incentives and what hospitals should do now to prepare?

We’ve known, since the outset, that CMS regularly adds conditions to the program. I always encourage hospitals to read proposed rules on as soon as CMS releases them…and to supply comments on those rules. Proposed rules often signal what policies and programs CMS is considering for the future.

4. How do readmissions affect patients and families?

Excess readmissions can be a signal of care management improvement opportunities and point to defects in quality of care. For example, discharge instructions are sometimes incomplete or wrong and cause confusion for the patient and family.

Almost one in five Medicare patients experiences a readmission. The readmission rate is also high for Medicaid patients. These groups are some of the most vulnerable patient populations, and the government has attempted to focus improvement efforts on these groups to mitigate the incidence of readmissions.

For patient and families, the impact of readmissions can include increased morbidity, pain and suffering, and decreased satisfaction.

5. How can hospital units work together to identify readmission risk, and ideally prevent readmissions?

Starting at the time of patient admission, organizations should begin preparing for that patient’s discharge. PeraHealth’s Rothman Index (RI) helps clinicians ensure that the patient is improving to the point he/she is ready to transition to the next setting of care. During the patient’s acute care stay, clinical teams are able to visualize a graphical trend of the patient’s condition. In the event it is needed, clinical teams are alerted to deterioration and can intervene appropriately.

The RI trend also provides clinicians with information to help guide discharge decision making, including readiness for discharge and potential for post-acute support. Throughout the hospital stay, multidisciplinary teams (to include care management staff), should be reviewing and discussing RI trends to ensure that patients are ready for discharge, thereby mitigating risk for readmissions. For example: Is this patient ready for discharge or would he/she benefit from additional time in the hospital? Would another care setting be better than the hospital? Does the patient need more resources in the home?

6. How are hospitals integrating the Rothman Index into the workflow, for example, in transfer and/or discharge decision criteria?

Many organizations track the RI trajectory to make sure it’s safe to transfer the patient in or out of the intensive care unit or discharge the patient to home or another setting of care, such as a skilled nursing facility. Clinicians are also exchanging RI information during bedside shift reports, safety huddles, and multi-disciplinary rounds as a regular part of the care process.

7. How can healthcare teams improve communication on the team and with patients and families…to make them a part of team?

As the saying goes, “A picture is worth a thousand words.” We have several organizations that use the RI to communicate with patients and families. You can see and show a very clear pattern for the patient plotted over a hospital stay and even over multiple hospital stays. Providers can share the RI graph to depict information related to appropriate discharge, or for example, a patient’s need for palliative care.

Rising to the readmissions challenge, the Rothman Society for Innovation and Research, PeraHealth’s new research and development arm, is in the midst of a study to determine how the RI can best be used to help predict readmission risk and enable reduced readmission rates over time. Register for the upcoming Society webinar on June 7, 2018, from 1-2 p.m. ET, for an update on these important findings and next steps.