Fixing the Hospital Readmissions Reduction Program
Reducing hospital readmissions is an important way to help reduce healthcare spending and improve quality of care, and since the implementation of the Hospital Readmissions Reduction Program (HRRP), hospitals have been making progress.
The Hospital Readmission Reduction Program penalizes hospitals with higher-than-expected hospital readmissions for certain health conditions like heart failure, pneumonia, and heart attack. To avoid hospital readmission penalties, hospitals can work to improve clinical care practices to reduce readmissions.
However, it’s important to realize that reducing readmissions is a very complex issue. Not all readmissions can or should be prevented. What HRRP did not weigh as strongly as it should have were the many factors that are beyond the control of hospitals — for example, sociodemographic factors such as poverty — which has resulted in some serious questions about the long-term sustainability and fairness of this program.
Reducing readmissions should still be every hospital’s goal, but HRRP needs some adjustment to be more effective, to account for factors beyond hospital control, and to provide solutions to hospitals instead of just handing out penalties.
Specific Concerns Raised About HRRP
Some specific concerns about HRRP have been raised by hospitals:
- Including readmissions that are unrelated to the original admission when determining hospital readmission penalties.
- No risk adjustment for sociodemographic factors, often outside of the facility’s control, that can influence the risk of readmission.
CMS continues to increase the reimbursement at risk while also adding additional conditions to this program, and as more hospitals begin to face these penalties, the shortcomings of this program become more apparent.
With studies showing that hospitals are often just adjusting the way they classify patients and other studies showing that mortality rates for certain conditions are on the rise as readmissions decrease, it’s obvious that HRRP needs some refinement to avoid penalizing hospitals unfairly while reducing readmissions in a safe way.
Policy Changes to Fix HRRP
One of the most important policy changes that could be made to help fix HRRP is to start reweighting hospital readmission penalties to ensure mortality rates receive stronger consideration relative to hospital readmissions.
Researchers have recently found that the readmissions program has a negative impact on heart failure mortality, and since the implementation of HRRP, the mortality rate of Medicare patients admitted with congestive heart failure has gone up. Obviously, this is an unintended consequence, but it’s essential to make sure that measures taken to reduce readmissions doesn’t result in negative patient outcomes.
Policymakers are also recommending that CMS start to use risk adjustment when calculating readmission penalties. Hospitals serving economically disadvantaged patients and safety-net and teaching hospitals have higher rates of readmissions, and studies have shown that patients living in high-poverty areas have a 25 percent higher chance of a readmission than peers living in higher-income areas.
Hospitals caring for the neediest patients are currently more likely to end up paying penalties, and changes should be made to HRRP to stop penalizing these hospitals when the factors for readmission are out of their control.
Offering Solutions to Hospitals to Help Lower Readmissions
While it’s obvious that policy changes are needed to address the problems with the Hospital Readmissions Reduction Program, it’s also important for CMS to start offering solutions to hospitals to help lower readmissions.
Simply penalizing hospitals without offering solutions has proven to be ineffective. Taking the focus off the patient and putting it on numbers is problematic. Encouraging solutions such as improved patient engagement, using methods that have been proven to drive desired health behaviors, not only will help reduce readmissions; it will also improve patient satisfaction and patient outcomes.
Patient engagement, particularly after discharge, is an area where many hospitals can improve. Better patient engagement can lead to better patient outcomes and can help reduce readmissions for multiple health conditions.
Healthcare facilities may not think they have sufficient healthcare staff on hand to take care of follow-up with patients after discharge, but this is where a digital patient engagement platform, such as PatientBond, can be invaluable. Digital patient engagement platforms make it easy to set up two-way communication with patients, whether patients prefer text messages, interactive voice response, or emails.
The platform makes use of psychographic segmentation to develop communications that will resonate with patients based upon their unique motivations and beliefs. Relevant messages are sent to patients, effectively communicating with patients to improve compliance with post-discharge instructions and improve health outcomes. For example, one hospital system reduced 30-day readmissions for congestive heart failure more than 90 percent while achieving high (94 percent) patient satisfaction scores.
It’s become obvious that HRRP needs to be enhanced, and that policies need to be changed to focus on patient outcomes instead simply focusing on readmission rates. Offering incentives, solutions, and rewards may provide a more effective way to improve problems with readmissions than doling out penalties.
However, even if changes are made to HRRP, hospitals also need to implement innovative solutions that can help them reduce hospital readmissions in a cost-effective manner. Digital patient engagement platforms could go a long way toward improving patient engagement, satisfaction, and overall outcomes.