Recent data reveals that in just one year Medicare alone spends $17 billion for unplanned readmissions in the fee-for-service segment of its program. Moreover, the Medicare Payment Advisory Commission estimates that Medicare spends $12 billion per year for hospital readmissions deemed “potentially preventable.” In an effort to reduce costs and curb unnecessary spending and as part of the Patient Protection Affordable Care Act (PPACA), Medicare is poised to implement its Hospital Readmission Reduction Program on October 1, 2012. Hospitals and long term care facilities with high readmission rates can lose up to 3% of their regular Medicare reimbursements.
This—along with any additional penalties or cuts Medicare may impose— underscores the importance for long term and skilled nursing facilities to take a proactive stance on readmissions. It’s imperative that long term care facilities with high readmission rates do everything possible to lower these rates. Indeed, according to a report published in Health Affairs, about 40% of Medicare patients who are discharged from hospitals are admitted to a skilled nursing or rehab facility to complete their recovery—and within 30 days, nearly one in five of these patients will wind up back in the hospital.
Innovative facilities are already experimenting with techniques to mitigate this problem—and the remainder of this article will reveal some of the most efficient and effective strategies you can implement.
Key Strategies to Reduce Readmissions
Leverage tools and questionnaires to identify high risk patients. Tools like questionnaires can help prepare staff to make informed decisions at every step of the care continuum. For example, listing key warning signs and symptoms on a questionnaire can help staff identify residents and patients with the highest risk for developing acute change of condition. Leveraging health information technology, such as electronic health records, patient registries, and risk stratification software can also help staff to quickly and effectively identify patients at the highest risk for hospital readmission.
Of course, the key here is to make sure your staff knows when and how to use these tools. Proper training is paramount. For example, a brief mention of a new questionnaire during a staff meeting won’t cut it. Buy-in and enforcement from the top is critical to adherence and thus success.
Empower staff to address and manage acute changes in condition. In reality, there are several medical scenarios that long-term and skilled nursing facilities can address competently and successfully. If your facility is prepared with the right tools (as mentioned above) equipment, and training, you have every reason to address and manage changes in condition. Giving your staff the right tools and training will undoubtedly empower them to make informed decisions and thus reduce unnecessary readmissions.
Consider practice sessions and scenarios for your staff and offer coaching opportunities. Provide your staff with a safe environment to voice their questions, concerns, and opinions. If you address their concerns in this manner, they will feel much more confident and capable to assess and take action when they identify a patient’s change of condition.
Assess after readmission. When patients are readmitted, make sure you make a learning opportunity out of it. Ask and answer questions like: Could this transfer have been avoided? Were there “early warnings” of a decline in the patient’s condition? Could precautions have been taken? Could you have actually provided the acute care the patient needed?
These types of questions can help your staff take a more proactive approach in the future. By simply assessing a readmission/transfer after-the-fact, you can better manage and address similar scenarios when they arise. Your primary goal in this type of assessment is to address the primary reason why a patient was transferred to a hospital. If you can definitively answer that it was necessary, you know you did your job. If the transfer is questionable, you know there is room for improvement.
Leverage the continuum of care. Many organizations and healthcare systems are participating in Accountable Care Organizations (ACOs). ACOs are groups of doctors, hospitals, and other healthcare providers who come together voluntarily to give coordinated, high quality care to their patients. Under ACOs, it won’t matter how long a patient stays at a facility as long as that’s where the person needs to be. With ACOs, the focus remains on placing the patient where they can get the most appropriate care. That means the rest of the network has to be more flexible and able to take patients appropriately to the level of their acuity, to get them in and out quickly and appropriately, and to be able to do the transitions of care safely. Having all the pieces of the acute and post-acute care continuum working together will be essential for coping with healthcare reform, especially readmissions. Want more information on ACOs? Be sure to check out What you Need to Know about ACOs which is archived on our website!
Financial incentives that reward or hold healthcare providers accountable for patient outcomes across inpatient and outpatient settings are emerging as healthcare reform continues to unfold. Although this certainly requires a focused and proactive approach, the results can prove to be quite positive, in terms of patient satisfaction, staff and organization efficiencies, and cost containment. The strategies just discussed should help get you started in your efforts to reduce unnecessary readmissions. Moreover, you can take a small sigh of relief, as the Centers for Medicare & Medicaid Services is giving facilities a bit of a break during the first year of this specific reform: Penalty limits will be capped at 1%.