Hospital readmission rates are being highly scrutinized by the Department of Health and Human Services Office of the Inspector General. These regulatory agencies are pressing the Health Care Financing Administration to use Peer Review Organizations to analyze and correct the problem. Relatively recent legislation penalizes hospitals for readmissions within a 30 day period after discharge from the hospital.
Hospitals are now being held accountable and subjected to financial penalties for readmission. The magnitude of the problem can be shown by the annual cost of hospital readmissions. The estimated annual cost of hospital readmissions for Medicare is $26 billion annually. Of that amount, $17 billion is attributable to avoidable readmissions. These readmissions could have been prevented with either patient education or by ensuring the patient was medically stable upon discharge; just two examples of the many ways readmissions can be prevented.
The Readmissions Reduction Act requires Centers for Medicare and Medicaid to reduce payments to hospitals with excess readmissions effective October 1, 2012. The Prospective Payment System (PPS) though Medicare reimburses hospitals per procedure and not on a fee-for-service basis. One lump sum of money is doled out to the facility based upon diagnostic coding, not on how many tests and procedures are performed. The intent of this reimbursement structure is to motivate hospitals and doctors to render care effectively, efficiently and without waste. The old way of doing business promoted excessive stays, testing and procedures. Some ask the question: is the new way of reimbursement putting patients in harm’s way?
Some argue a correlation exists between decreasing Average Length of Stay (ALOS) and the increasing readmission rates. The reviews are mixed according to one study conducted by Dr. Kaboli and colleague using data from the Veterans Affairs (VA) medical system.
Here are some ways that hospitals can prevent readmissions:
How to Prevent Readmissions
- Identify at risk patients and create a plan of care to mitigate that risk
- Identify patients with language barriers and secure a translator
- Join an incentive program that rewards positive outcomes
- Join a collaborative for new ideas and implementation methods
- Follow-up with patients post-discharge
- Offer patient/caregiver education and training
- Provide tele-monitoring in the home
- Ensure the patient is being discharged to the most appropriate level of care
Readmissions cannot be attributed to any one reason. Discharging a patient is a process and breakdown can occur anywhere along the way. Poor planning, lack of patient/caregiver training, and inappropriate placement can all affect patient readmission rates. With so much at stake it is imperative the process is refined to ensure patient health and wellbeing is the top priority.
Long Term Acute Care Hospitals were created to serve a once underserved segment of the patient population. This option allows patients whom meet the criteria an extended period of time to recover to their highest functional level. LTACH’s provide comparable levels of care to traditional hospitals and at Specialty Hospital of Central Jersey care is delivered with a team approach achieving the patient\’s goals over a longer course of time. Please contact us at Specialty Hospital of Central Jersey by calling 732.942.3592. We are conveniently located at 600 River Avenue in Lakewood, New Jersey.