5 Questions to Determine Readmission Rate Effectiveness

Joan Moss, RN, MSN, Senior Vice President, Sg2, for HealthLeaders Media , June 30, 2011

Effectively answering this question starts with good analytics, going beyond inpatient numbers to take a broader view of system-wide performance and benchmarking yourself against peer organizations. The more you can "peel the onion" on where readmissions are happening, the better—and 30-day readmission rates are also a good proxy for how well your post-acute care setting referrals are performing. The Sg2 Value Index™ offers an excellent tool for measuring overall clinical performance within these parameters and assessing your penalty risk. Most likely, hospitals in the bottom quartile of performance will bear the brunt of CMS penalties.

Question 2: How can we reduce readmissions without adversely affecting our current financial goals?
This is an important question to analyze with your financial staff, since there is no question that readmissions do make money and if they are reduced in one area, the income needs to be made up in another. Sg2 analysis shows that non-30-day readmission discharges or, in other words, new admissions for conditions not facing penalties, could be one answer. Drilling down to find the best leverage points for readmission prevention allows for focused interventions that are financially feasible, whether by disease, physician or patient geographic origin. A related question might be: How can you craft a multifaceted readmission strategy with a wide range of post-acute care settings? Lower-margin readmissions can also be "backfilled" with higher-margin cases, but health systems must keep in mind that under new payment models, such as ACOs and bundled payment, they will have to pay for readmissions.

Question 3: How can we better manage AMI, CHF and pneumonia patients?
CHF and pneumonia drive 30-day readmission volumes, with CHF accounting for more than 6% of all 30-day readmits, seconded by pneumonia at 4.8%. Nearly 1 in 4 CHF patients (24%) return to the hospital within 30 days with unresolved CHF. Typically, this is because they did not have a follow-up primary care or cardiology exam within 2 to 5 days after discharge, were released to the wrong post-acute care setting, or did not have their medications reconciled with a nurse or pharmacist within the first day or 2 after discharge. Like CHF patients, 66% of AMI readmissions are usually related to recurrence of the same cardiac event or an attack in a new cardiac site.

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3 comments on "5 Questions to Determine Readmission Rate Effectiveness"

Solomon J. Zak, M.D. (7/7/2011 at 9:39 AM)
Most authorities fail to understand the effectiveness of discharge planning. One needs to [INVALID] computer screens that are specific for comprehensive discharge planning for each at risk diagnosis (and co-morbidity). At the time of discharge, All attending physicians, including the Primary Care Physician and discharge staff must complete these screens which must be precisely diagnostically correct retrospectively and prospectively. For example, if a 67 year old member has not had (vaccine) pneumococcal immunization, that should be given before discharge. Importantly the Primary Care Physician must be identified as the RESPONSIBLE physician, whether the patient is being treated by a Cardiologist, Oncologist, Surgeon, etc. Issue: There must be a SINGLE accountable physician identified and at risk.

Siva Subramanian (6/30/2011 at 7:04 PM)
Excellent article! Most hospitals understand that they are at some financial risk but not every one has a clear picture of how bad it will be once the penalties go into effect. Once they have this picture, they will need to work on improving readmission rates through quality improvement interventions (e.g. Project BOOST, Project RED). The challenge will be to do it in a way that is not only effective but also repeatable, measurable and sustainable over time. This is where IT tools can help. We, at CareinSync (www.careinsync.com), have developed a collaborative care transitions management tool that helps a multidisciplinary team manage patient care transitions in a way that not only improves quality of care and reduces readmissions but also improves efficiency. By incorporating the hospitals chosen QI interventions and monitoring them using collaborative checklists, messaging and alerts, the tool ensures that team is always in sync with the patient discharge plan. A real-time dashboard gives up-to-date and accurate status of the patient discharge plan. Another dashboard provides management and executives with real-time quality and efficiency metrics. For more information please contact me at info@careinsync.com

Su (6/30/2011 at 5:52 PM)
At most hospitals, diabetes and and poor glycemia control contribute to high rates of readmission. Earlier this year, MX.com and Adventist Health System partnered to create the Readmission Reduction through Glycemia Management toolkit for inpatients, specifically designed to help hospital leaders improve readmission rates arising from diabetes-related complications. Diabetes and related complications continue to take their toll. The Lancet just reported an astonishing statistic: Diabetes has tripled in the U.S. and doubled worldwide. (Apologies if this gets posted multiple times. It doesn't seem to take.)




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