Reducing Hospital Readmissions
Hospital readmissions are a major challenge for health care systems, as they indicate poor quality of care, increase costs and expose patients to potential harm. According to the Centers for Medicare and Medicaid Services (CMS), about 15% of Medicare beneficiaries are readmitted within 30 days of discharge, costing the program more than $17 billion annually . To address this issue, CMS implemented the Hospital Readmissions Reduction Program (HRRP) in 2012, which penalizes hospitals with higher than expected rates of readmissions for six conditions or procedures: acute myocardial infarction (AMI), chronic obstructive pulmonary disease (COPD), heart failure (HF), pneumonia, coronary artery bypass graft (CABG) surgery and elective primary total hip arthroplasty and/or total knee arthroplasty (THA/TKA) .
However, reducing hospital readmissions is not a simple task, as it requires a coordinated effort from multiple stakeholders, including clinicians, patients, caregivers and community partners. Evidence suggests that there are several processes that can help prevent readmissions, such as:
– Providing patient education on their condition, medications, self-care and warning signs before discharge .
– Reconciling medications prior to discharge and ensuring patients have access to their prescriptions .
– Scheduling timely follow-up appointments with primary care providers or specialists and facilitating the transfer of information .
– Conducting post-discharge phone calls or home visits to monitor patients’ condition, adherence and needs .
– Engaging patients and caregivers in the discharge planning process and addressing their preferences, goals and barriers .
– Utilizing bridging personnel, such as care coordinators or transitional care nurses, who can follow patients across settings and provide continuity of care .
– Leveraging community resources and support services, such as social workers, pharmacists, home health agencies or telehealth .
– Implementing standardized tools and protocols to identify high-risk patients and tailor interventions accordingly .
A recent observational study of 10 VA hospitals found that sites that used more of these recommended care transition processes had lower risk-standardized readmission rates (RSRR) than sites that used fewer processes . The study also identified several barriers to implementing these processes consistently, such as lack of staff time, resources, training and communication. Therefore, to further reduce readmissions, health care systems may need to adopt new strategies to facilitate the implementation of these evidence-based processes, such as integrating them into the workflow, providing incentives and feedback, and fostering a culture of quality improvement .
Reducing hospital readmissions is a complex and multifaceted challenge that requires a comprehensive and collaborative approach. By implementing evidence-based processes that enhance communication and care coordination across settings, health care systems can improve the quality of care for patients, reduce costs for payers and avoid penalties from CMS.
Bibliography
: Pugh J., Penney L.S., Noël P.H., Neller S., Mader M., Finley E.P., Lanham H.J., Leykum L. (2021). Evidence based processes dissertation writers to prevent readmissions: more is better, a ten-site observational study. BMC Health Services Research 21:189. https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-021-06193-x
: CMS. (n.d.). Hosp. Readmission Reduction | CMS. https://www.cms.gov/medicare/quality/value-based-programs/hospital-readmissions
: Esposito L. (2018). 8 Ways to Reduce Hospital Readmissions. U.S. News & World Report. https://health.usnews.com/health-care/patient-advice/slideshows/8-ways-to-reduce-hospital-readmissions
