On Oct. 1, the Centers for Medicare & Medicaid Services began deducting a total of $538 million from nearly 2,600 hospitals over a 12-month period because the agency determined that their Medicare 30-day readmission rates were too high. That's an increase of $108 million in hospital readmission penalties over the previous federal fiscal year, the CMS said.
The growing threat of monetary penalties has hospitals aggressively searching for answers to prevent discharged patients from needlessly coming back to the hospital for additional acute-care services.
Researchers from the Harvard School of Public Health captured that sense of urgency in a survey they did of executives at 951 hospitals. The survey, the results of which were published in the American Journal of Managed Care, found that 65.8 percent of executives said the government's Hospital Readmissions Reduction Program, or HRRP, has significantly or greatly accelerated their efforts to reduce readmissions.
New research offers fresh ideas to hospitals that want to send patients home as healthy as possible and keep them that way lest they see them again in less than 30 days. Here are summaries of five such ideas:
1. Check all vital signs to ensure a patient is medically stable and able to be discharged
A study by researchers from the University of Texas Southwestern Medical Center said 20 percent of patients discharged from hospitals have at least one unstable vital sign. The study, published in the Journal of General Internal Medicine, found that patients discharged with one or more unstable vital sign had higher readmission rates than fully stabilized patients. “At a time when people are developing complicated, black box computerized algorithms to identify patients at high risk of readmission, our study highlights that the stability of vital signs, something doctors review with their own eyes every day, is a simple, clinically objective means of assessing readiness and safety for discharge,” the researchers said.
2. Extend the availability of retail pharmacy hours in rural health care markets
A study published in the Journal of the American Pharmacists Association connected readmission rates and retail pharmacy hours available to patients. Researchers from the Oregon Health and Sciences University College of Pharmacy counted the cumulative number of outpatient pharmacy hours of operation of 507 pharmacies in 48 urban and rural primary-care service areas in the state of Oregon. They then compared those hours with the readmission rates of the 58 hospitals in those same markets. They found that readmission rates dropped as outpatient pharmacy hours rose. “Increasing patients' access to pharmacy services can increase patient care and potentially reduce readmission rates,” the researchers said.
3. Assign pharmacists to do home medication reconciliation consult with newly discharged patients
A study in Health Affairs reported that a medication reconciliation program initiated by a health plan and executed by pharmacists reduced the hospital readmission rates of health plan enrollees. The health plan identified discharged enrollees at high or moderate risk of being readmitted within 30 days based on their medical conditions and number of prescriptions. The pharmacists conducted medication reconciliation consultations at home visits with enrollees at high risk and by phone with enrollees at moderate risk. Among the medication problems identified and corrected during the consultations were medications omitted from discharge instructions, medications that should have been prescribed based on clinical guidelines and potentially harmful drug interactions. Some 12.2 percent of the 131 enrollees in the program in 2013 were readmitted to the hospital for any reason within 30 days of initial discharge compared with 22.1 percent of a comparable group of enrollees not participating in the medication reconciliation program.
4. Expand post-discharge interventions that target socio-economic challenges
A study in JAMA Surgery analyzed the causes of unplanned readmissions of 173 general surgery patients discharged from an academic medical center in Seattle. The researchers found that in only 10 percent of the cases did patients get readmitted because of poor care. Instead, most patients came back to the hospital because they had new soft tissue infections caused by injection drug use, previously undetected soft tissue infections caused by injection drug use, lack of adequate social support for their post-discharge treatment plans or illnesses related to their injury or condition. Most readmissions were caused by “confounding issues of substance abuse or homelessness,” the researchers said. “Identification of the highest risk cohort for readmission can allow more targeted intervention for similar populations with socially challenged patients.”
5. Add or expand occupational therapy services available to newly discharged hospital patients
A study in Medical Care Research and Review reported a link between hospital spending on occupational therapy services and hospital readmission rates. Researchers from Johns Hopkins University and the University of Maryland School of Medicine compared hospital spending on ancillary care services and 30-day readmission rates for Medicare patients discharged following a heart attack, heart failure or pneumonia. They discovered that occupational therapy was the only service that had a statistically significant correlation with lower readmission rates for all three conditions. “One possible explanation is that occupational therapy places a unique and immediate focus on patients' functional and social needs, which can be important drivers of readmission if left unaddressed,” the researchers concluded.
Hospitals are making progress in pushing down their 30-day readmission rates. In June, MedPAC, a congressional advisory board, reported that the 30-day “potentially preventable” readmission rate for Medicare patients admitted for any medical reason slid to 11 percent in 2014 from 12.9 percent in 2010. And in September, the CMS reported that Medicare readmission rates dropped in 49 states and the District of Columbia between 2010 and 2015 with the rate being statistically unchanged in one state.
Hospitals that pursue any or all of the five strategies suggested by the new research may be able to accelerate their progress with the results being better financial health from fewer payment penalties and better health for patients from interventions that keep them healthy after they leave the hospital.
Related: Learn about McKesson's Care Management Solutions