Summary: Areas for reducing readmissions are a major contributor to the rising costs of healthcare. As such, the ACA has designated CMS to set forth and oversee the readmissions  process, including assessing penalties for hospitals with excessive readmission rates.

Areas for Reducing Readmissions

Hospital readmissions are rising to incomprehensible levels, contributing to the increased healthcare expenditures. As one of the provisions of the Affordable Care Act, PPS hospitals with higher than expected readmission rates will be assessed penalties in the form of reduced Medicare payments across all discharges. These reduced rates are currently set as:

• Maximum of 1% for 2013
• Maximum of 2% for 2014
• Maximum of 3% starting in 2015

For the purposes of determining readmission levels, data will be analyzed on a 30-day readmission basis for heart attack, heart failure, and pneumonia. Excluded in the readmission data are planned readmissions and readmissions that are not related to the initial admission. Beginning in 2015, there are several other illnesses which may be added to the readmission list. These include: chronic obstructive pulmonary disorder and several cardiac and vascular surgical procedures.

As a result of the ACA, many demonstration projects have been in the works. One such project is called RARE. RARE stands for Reducing Avoidable Readmissions Effectively. RARE is a campaign led by the Institute for Clinical Systems Improvement, the Minnesota Hospital Association, and Stratus Health.

Areas for reducing readmissions are extremely important in today’s healthcare system.

Goals of RARE – Triple Aim:

Improve population health

• Prevent 4,000 avoidable readmission from 7/1/11 to 12/31/12
• Reduce overall readmissions by 20%

Improve the patient experience

• Help patients and families to spend 16,000 less nights of sleep in the hospital
• Improve by 5% the Hospital Consumer Assessment of Healthcare Providers and Systems survey questions related specifically to hospital discharges

Affordability of Care

• Decrease health care costs by avoiding 4,000 preventable readmissions, with preliminary estimates at more than $30 million annually

5 Key Areas RARE Focuses Upon to Reduce Readmissions

• Comprehensive discharge planning – best practices focus upon the discharge planning process, discharge plan content, care coordination, and health literacy/communication.
• Medication management – best practices focus upon assessment of the patient’s knowledge of medications, reconciling medications upon admission, medications ordered are compared to the medication list, medication discrepancies are resolved, the most current medication list is given to the next healthcare provider, medication clarification during transition, education to the patient, written list and instructions are provided to both the patient and his/her family, complex cases may require intervention from Pharmacy and/or Medication Therapy Management
• Patient and family engagement – best practices include specific issues regarding self-care, care planning, and health literacy/patient-provider communication
• Transition care support – best practices include assessment of the patient’s understanding of the discharge plan, provide assignment instructions to the patient in regard to the next provider and their contact information, give the patient his/her health record and issues to look for, provide telephone follow-up within 2-3 days to ensure the discharge plan is being followed, provide a follow up coach, make the follow up appointment for the patient, establish community networks, use telehealth if possible, coordinate care using multidisciplinary teams, provide additional patient education, organize post discharge outpatient services and medical equipment
• Transition communications – best practices will target accountability, responsibility, coordination of care, and family involvement

Success of the RARE Demonstration

During the established timeframe, 5,441 readmissions were avoided, which exceeded the goal of 4,000. The results enabled patients to spend 21,764 nights in their own beds which exceeded the goal of 16,000 and reduced healthcare expenditures by more than $40 million, which exceeded the goal of $30 million. To further emphasize the success of this demonstration, goals have been set for 2013 which include: an additional 2,000 readmissions prevented, continue to reduce readmissions by 20%, help patients spend an additional 8,000 nights in their own beds, and save an additional $20 million in health care expenses. If past experience is indicative of future performance, we expect RARE to exceed all set forth goals for 2013.

For further details on this demonstration, please go to the RARE website: http://www.rarereadmissions.org/index.html

Do You Need Assistance Assessing, Reducing and Monitoring Your Readmissions?

If you need any assistance in assessing and reducing your hospital readmissions, BHM Healthcare Solutions is a healthcare management consulting firm, with one of our many specialties reducing hospital readmissions. Please contact us today for your free consultation to see how we can help you reduce your readmissions, add to your bottom line, and provide better quality care for your patients. 1-888-831-1171 or results@bhmpc.com. If you’re interested in learning more about key areas for reducing readmissions, don’t forget to follow our blog and social media channels.