Triaging hospital readmission rates

New CMS regulations will penalize hospitals for certain types of readmissions, but there are ways to mitigate these risks.

Traditionally, October is a month of fall activities, such as apple-picking, corn mazes and hay rides; but this year, for healthcare administrators, it was filled with navigating different types of mazes and rides – negotiating the changes in regulations and reimbursement that are now de rigueur.  While it can be argued that each of these initiatives poses administrative challenges, readmission rules and their associated penalties, appear to be some of the toughest to overcome.  In addition to all of the traditional barriers to success, readmissions carry one significant variable: the patient.

When one considers the percentage of the population already predisposed to hospital-acquired conditions (HAC) due to multiple chronic medical conditions, grappling with the imperative to decrease readmissions is no easy task.  Additionally, both readmission rates and penalties are publicly reported, which means hospitals are facing a potential “loyalty shift” from patients who may be misled by the media or competitors that these rates are synonymous with “bad care” or “poor outcomes.”  This means the financial consequences can, in fact, extend beyond readmission penalties and impact value-based payment incentives, which are calculated on both performance quality measures and Hospital Consumer Assessment of Healthcare Providers and Systems (HCHAPS) patient satisfaction scores.

As any healthcare professional can attest, readmissions will occur, however, we are all responsible for investigating root causes, remediating deficiencies, and implementing strategies that engage physicians, clinicians, patients and their families to reduce preventable readmissions.  At first glance, this may seem like a Sisyphean task, but there are strategies that can help:

Perfect your lines of communication.  Atlantic Care in Atlantic City, NJ, recently implemented several changes to reduce readmission rates.  Dr. Tony Reed, senior medical director of Quality and Analytics, recommends rolling out a system-wide initiative emphasizing the importance of verbal and textual electronically-documented communication, which ensures the integrity and continuity of care for each patient throughout his or her stay.  Since adopting this approach, Atlantic has seen a 30 percent reduction in readmissions in the Better Outcomes for Older Adults through Safe Transitions (BOOST) and communication groups.

Assess and acknowledge your risk.  Data analytics can be used to evaluate performance on current and future-targeted diagnosis and procedures, and the inclusion of both historical and trending data will help to provide accurate results.  Be sure to measure your organization’s performance against CMS standards and other available benchmarks.  And keep in mind, to be successful, this analysis must include chart review.  For example, investigate if are you at risk due to:

  • a certain physician or group of physicians,
  • a particular nursing unit,
  • poor documentation,
  • certain patient populations, and
  • in the case of joint replacements, a certain brand of prosthesis.

Drilling down into the data will enable your organization to create effective and tailored strategies, and derive action points.

Embrace concurrency.  Once you have established your at-risk areas, implement practices that monitor care and documentation – while the patient is still in the bed.  Employing point-of-care strategies, such as a clinical documentation improvement (CDI) program and the use of real-time surveillance via clinical language understanding (CLU), will assist in the identification of any patient conditions that are present-on-admission (POA), major complications and comorbidities (MCCs), or pending HACs that may otherwise go unnoticed in an inpatient setting.  The use of technology, like CLU, enables providers to identify at-risk patients more readily at the time of admission, monitor them throughout their stay, and coordinate the best discharge plans.  Additionally, such technology can also help identify patients who are at risk for readmission based upon their social history, past medical encounters, and complexity of disease.

Revisit medication reconciliation.  CMS identified several causes of preventable readmissions including the improper use or failure to take medications as directed.  Medication mismanagement often leads to health complications that can result in the patient’s readmission.  Proper documentation and discussion across the continuum of care ensures patients, and their caregivers, fully understand medication regimens can help reduce those readmissions that result from these complications.

Certain types of readmissions are not preventable, but many are.  It is important that we use all the resources and tools, such as data analytics, available technology, and communicate throughout the continuum of care so that, facilities can spare their patients, as well as themselves, from the unpleasant consequences of hospital readmissions.

Tags: , ,

Cathy Gorman-Klug

About Cathy Gorman-Klug

Cathy has over 30 years of experience in healthcare. She has extensive experience in project design, implementation, and management. In her current role as Product Manager, she is responsible for product strategy and product marketing for Nuance’s quality products. Previously, as a Corporate Director of Privacy and Data Security, she was responsible for compliance with requirements imposed by HIPAA, and other regulatory and accreditation standards for an integrated health system with over 7,000 employees. She holds a Master’s of Science in Nursing Administration from Seton Hall University.