A “RARE” Success Story: 5 Key Areas for Reducing Readmissions

Summary: 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 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 from the readmission data are planned readmissions and readmissions that are not related to the initial admission. Beginning in 2015, several other illnesses 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 — Reducing Avoidable Readmissions Effectively. RARE is a campaign led by the Institute for Clinical Systems Improvement, the Minnesota Hospital Association, and Stratis Health.

Goals of RARE — The Triple Aim

Improve population health

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

Improve the patient experience

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

Affordability of care

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

5 Key Areas RARE Focuses On to Reduce Readmissions

1. Comprehensive discharge planning — best practices focus on the discharge planning process, discharge plan content, care coordination, and health literacy/communication.
2. Medication management — best practices focus on assessing the patient’s knowledge of medications; reconciling medications upon admission; comparing ordered medications to the medication list; resolving medication discrepancies; giving the most current medication list to the next healthcare provider; medication clarification during transition; educating the patient; and providing a written list and instructions to both the patient and their family. Complex cases may require intervention from Pharmacy and/or Medication Therapy Management.
3. Patient and family engagement — best practices include addressing specific issues regarding self-care, care planning, and health literacy/patient-provider communication.
4. Transition care support — best practices include assessing the patient’s understanding of the discharge plan; providing instructions about the next provider and their contact information; giving the patient their health record and issues to look for; providing telephone follow-up within 2–3 days to ensure the discharge plan is being followed; providing a follow-up coach; making the follow-up appointment for the patient; establishing community networks; using telehealth if possible; coordinating care using multidisciplinary teams; providing additional patient education; and organizing post-discharge outpatient services and medical equipment.
5. Transition communications — best practices 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 — exceeding the goal of 16,000 — and reduced healthcare expenditures by more than $40 million, exceeding the goal of $30 million. To further emphasize the success of this demonstration, goals were set for 2013 that included preventing an additional 2,000 readmissions, continuing to reduce readmissions by 20%, helping patients spend an additional 8,000 nights in their own beds, and saving an additional $20 million in healthcare expenses. If past experience is indicative of future performance, we expect RARE to exceed all goals set forth for 2013.

For further details on this demonstration, please visit the RARE website: rarereadmissions.org.

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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 being 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 re*****@***pc.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.