10 Proven Methods: How to Reduce Hospital Readmissions
Experiencing hospital readmission within 30 days is often considered a failure in the eyes of providers and their patients, and certainly to the Centers for Medicare and Medicaid Services (CMS), who penalizes these occurrences. The costs are high—physically, mentally, and financially. These are the key reasons why you need to know how to reduce hospital readmissions.
But there’s another reason why it’s important to reduce hospital readmissions, and it’s a big one.
High readmissions indicate a hospital’s or team’s quality of care, which is utilized for assessments by authorities. For these reasons, lowering readmissions has been at the forefront of healthcare research. This research shows there are some strategies and tools that hospitals should employ if they will reduce hospital readmissions successfully.
1. Understand Federal Policy
Under the Hospital Readmission Reduction Program (HRRP), established in 2012 by the Affordable Care Act (ACA), the Centers for Medicare & Medicaid Services (CMS) incentivize hospitals with payment adjustments “to improve communication and care coordination efforts to better engage patients and caregivers in post-discharge planning.”
The purpose of the incentives is to “add quality measurement, transparency, and improvement to value-based payment in the inpatient care setting.” It gives an “opportunity to improve the quality of care and save taxpayer dollars by incentivizing providers to reduce excess readmissions.”
The maximum penalty for excessive rehospitalization in fiscal 2021 is a 3% cut in payment for each Medicare patient, with the average penalty across hospitals totaling 0.69%.
Questions to Ask:
- How does your hospital rank nationally for readmission averages?
- Are you reliant on “entrenched silos of care, where acute care hospitals [are] largely incentivized to get patients only well enough to leave the hospital” instead of providing supportive, transitional care?
2. Identify the Patients Who Are Most at Risk for Readmission
Healthcare providers must rely on two types of data to assess each patient’s risk for hospital readmission within 30 days.
Empirical data from EHRs (electronic health records): This includes demographics, medical histories, medications, comorbidities, previous exacerbations and hospitalizations, increased length of initial hospital stay, etc.
ML (Machine Learning) ADT (Admission, Discharge, and Transfer) data: This includes real-time data generated by EHRs to instantly update and notify physicians and nurses on patient status, thereby capturing and summarizing important contextual information.
Questions to Ask:
- Is the data we gather sufficient for assessing actual risk for each patient?
- Are we using the data to its fullest ability?
3. Prevent Healthcare-Acquired Infections
A study published in NCBI notes that “patients with a positive clinical culture obtained more than 48 hours after hospital admission had an increased hazard of readmission.” Also, “the incidence of 30-day readmission among patients with a positive clinical culture result was 25%, compared with 15% for patients with a negative result or no clinical culture.” Lastly, “healthcare-associated infections are also associated with considerable morbidity and mortality among infected patients.”
Questions to Ask:
- Is patient risk properly assessed and accounted for before, during, and after admission?
- Are there better infection control policies and procedures that can be put into place at your hospital?
4. Use a Transition of Care Model
- How can your hospital focus on improving care, enhancing patient outcomes, and reducing costs among the “vulnerable, chronically ill, older adults identified in health systems and community-based settings”?
- Is care prepared, coordinated, and delivered in collaboration with patients, their caregivers, and other health team members?
5. Confirm a Dependable Caregiver
- Should home healthcare be prescribed?
- Does the patient have reliable assistance with transportation and hygiene needs?
- Does the caregiver have all the needed information?
- Do you need to contact social workers to provide resources for these needs?
6. Support Medication Adherence
7. Discuss Warning Signs
- Does the patient know the early warning signs of a problem and how to address them?
- Do SIM patients have a say in their preferred relapse prevention and treatment plan?
8. Establish Necessary Follow-Up Care
- Is transportation or time an issue for a patient to make it to a follow-up appointment?
- Are other options made available to them (i.e., an in-home or telehealth visit)?
9. Prioritize Patient Understanding of Discharge Instructions
- Are the patient's condition, treatment, care plan, anticipated problems, etc., up to date?
- Can provider and patient have an uninterrupted two-way conversation?
- Is there enough time afforded for asking and answering questions?
- Do you use the Teach-Back method (which can potentially reduce readmission rates by 45%)?
10. Use Specialized Tools to Reduce Hospital Readmissions
What is PatientBond and What Does it Do?
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