This is an excerpt of an article that first appeared in the June 2017 issue of Patient Safety Monitor Journal.
To say readmissions are a big deal in medicine is a massive understatement. The Hospital Readmissions Reduction Program (HRRP) was enacted in 2010 specifically to take on this problem and has imposed nearly $1 billion in penalties. An estimated $17 billion in Medicare spending is spent annually on avoidable hospital readmissions. Readmission rates are currently used in CMS’s hospital star ratings system, and the agency financially penalizes hospitals that have high readmission rates. In August 2016, CMS announced a few changes to the HRRP that are expected to save CMS $538 million by increasing the number of hospitals penalized and the amount they’re fined. By the end of 2017, it’s expected that more than half of hospitals will be fined for high 30-day readmission rates, according to CMS projections. That’s 2,588 hospitals expected to lose up to 3% of their Medicare payment.
There’s been much discussion over how much control physicians actually have on readmission rates. Some studies have even found that readmissions sometimes improve outcomes.
However, the fact remains that facilities are paying millions in readmission fines and penalties, which hospitals and clinics could be using for promoting patient safety and quality improvement projects. Here are some methods to make sure patients who leave the hospital don’t wind up right back in the lobby.
Create a readmissions reduction team
One of the reasons hospitals struggle is that the causes of readmissions are all over the map, says Michelle Schneidermann, MD, a professor of clinical medicine at Zuckerberg San Francisco General Hospital (SFGH) and medical director of San Francisco’s Medical Respite. There are system-level problems that are within a hospital’s control, such as poor discharge planning and care coordination. Then there are patient-level factors that hospitals can’t do much about, such as substance abuse or mental illness.
“Furthermore, I don’t think there’s clear consensus on what proportion of readmissions are even preventable,” she says. “Last I checked, the literature cites rates somewhere between 5% and 80%, and there’s more emerging evidence that it’s going to shake out somewhere in the 20% range. But it’s really hard to know how to benchmark this measure, and I think it’s unfair for hospitals.”