A Hidden Cause of Readmissions Comes to Light

Cheryl Clark, for HealthLeaders Media , February 13, 2014

All-Cause Readmission Rates
The Centers for Medicare & Medicaid Services tracks readmissions of patients with heart failure, pneumonia, and heart attack, and punishes hospitals with higher rates by reducing reimbursement by up to 3% of their total base Medicare payment. Starting this October, CMS says, excess readmissions for patients with chronic obstructive pulmonary disease, another medical condition, will be added, as well as total hip and knee procedures, the first surgeries in the algorithm.

Hospitals will soon begin reporting to Medicare their all-cause readmission rates. And officials at CMS have proposed including in the penalty those patients readmitted after coronary artery bypass surgery, bariatric surgery, and vascular surgery, although those procedures are not yet in the readmissions reduction program.

I asked Hawn if quality improvement organizations would push back on her claim that hospitals aren't working hard enough to reduce readmissions among their surgical patients.

Hawn stuck to her guns. "There are probably some out there that are [working hard enough] but I don't think every organization is doing it. It's very resource-intensive. And I don't think they're doing much work around surgery because it's such a diverse group of patients and conditions, with very different complications and reasons for readmissions."

Besides, Hawn says, "they're all mainly focused on the medical conditions now, because that's where the money is at risk now."

That is soon going to change.

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3 comments on "A Hidden Cause of Readmissions Comes to Light"

Kate Toomey (2/20/2014 at 2:02 AM)
An element missing is the key role a SNF can play as a partner in reducing rehospitalizations by ensuring at risk patients receive appropriate care until they are safely ready to go home. Our Central Massachusetts facility ended our last quarter with an 8.3% rehospitalization rate compared to Central Mass average of over 21% and the State over 23%.

Kathleen Dowis (2/19/2014 at 3:43 PM)
CMS is targeting hospitals in areas that they have little or no control, for readmission penalties in an effort to further decrease reimbursement. You can provide all the resources available, but you should not have to be responsible for how a patient chooses to adhere to recommendations/teachings once they leave our care. Unless they are proposing that hospitals start making house calls for the first 30 days after discharge. We are constantly being set up for failure by the regulatory agencies.

G. J. Johnson DHA MSN RN (2/15/2014 at 9:24 AM)
This article highlights what nurses have said for years. Patients cannot be shoved out the door so quickly that a proper assessment, patient and family teaching, arrangements for community services, and modifications to the living environment are lacking. The follow up after discharge falls through the cracks and patients are merely instructed to see their Primary Care Physician or surgeon. No one sees the patient until the patient takes the initiative, and the patient is quite obviously a poor judge of when to seek timely intervention. We need more community-based follow up. Hospitals should invest in nursing services to follow the patient and maintain contact until the person is totally convalesced or placed in a facility. In other words, we need to increase the number of RN case/care managers and home health nurses if readmissions are to be reduced.




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