Benefits of reducing hospitals readmission

The Benefits of reducing hospitals readmission can never be overestimated. Furthermore, the costs of hospital readmissions are a significant area of concern in the healthcare sector since they have an effect on both the financial health and level of care provided by hospitals.

To safeguard your hospital’s bottom line as value-based reimbursement models start to replace fee-for-service, you must come up with a plan to cut back on readmissions.

The payment reduction for each hospital is determined by how well the hospital performed throughout a rolling performance period.

All Medicare fee-for-service base operational diagnosis-related group payments for the remainder of the fiscal year are then subject to payment reductions. The payment reduction is restricted to a maximum of 3%.

The Advantages of Cutting Down on Hospital Readmissions

Reducing hospital readmissions has been a top focus in healthcare for the past ten years. This pre-ACA analysis of claims data from October 2003 to December 2004 for Medicare fee-for-service will help to clarify why.

1. Positivity in Quality Reputation

Patients may be reluctant to go to a hospital with a high readmission rate for justifiable reasons. Due to the link between financial performance and care quality, reputation for quality is seen as a key profit driver.

Higher-quality treatment can increase profitability by generating more money or by reducing the cost of hospital readmissions by avoiding fines.

2. Patient Communication Is Improved

For patients with a larger than 20% baseline risk of readmission, receiving follow-up care from their primary care doctors (PCP) within 7 days is associated with considerable reductions in readmission risk.

Although it is advised in the patient’s discharge plan, sometimes people are unable to understand the information given to them.

Fortunately, there is a very straightforward fix: extensive, patient-focused communication.

3. Ensuring patients follow care.

Instructions can be accomplished by utilizing simple language, reviewing discharge instructions vocally, and providing digital and/or printed copies.

In order to encourage patients to disclose information like medications, they don’t regularly take and to get clarification on anything that may have been unclear or misunderstood, conversations between patients and providers should be open forums where patients can freely ask questions and share any information or concerns.

4. Optimised Care Transition

Because they are not notified when a patient is hospitalized, physicians and care managers have historically struggled to reduce readmissions.

Patients may forget to contact a member of their care team after being hospitalized, so they learn about it from claims data.

Since claims and authorization data are sometimes several months behind schedule, providers might not be made aware of hospital admission and consequently, be unable to offer suitable follow-up care. It has been demonstrated that setting up real-time ADT notifications lowers readmissions.

Brevard Health Alliance has witnessed a decrease in admissions overall since ENS implementation, with hospital readmission rates for Medicaid patients falling from 17.29 percent in 2017 to 8.59 percent in 2018 and those for Medicare patients falling from 19.15 percent to 13.25 percent in 2018.

Fortunately, there are resources available. It has been demonstrated that the Encounter Notification System (ENS) powered by Audacious Inquiry efficiently tracks patients, assisting in bettering care transitions and filling in care gaps for the uninsured and underinsured.

Preventing 30 day hospital readmission

The Hospital Readmission Reduction Program (HRRP), a value-based buying program, was established by the 2010 Affordable Care Act (ACA).

Because it is value-based, it enables the Centers for Medicare & Medicaid Services (CMS) to lower payments to hospitals with 30-day readmission rates for the following ailments and/or operations that are greater than anticipated based on risk standardization

10 proven ways to reduce hospital readmission

Below, you will find the 10 proven ways to reduce hospitals readmission;

  • 1. Recognize current regulations

To determine compensation amounts and fines, CMS uses a “readmission ratio.” For each medical condition, the ratio assesses how well a hospital performs in comparison to the national average.

The program initially covered pneumonia, heart failure, and acute myocardial infarction (AMI) (PN). Total knee arthroplasty (TKA), elective total hip arthroplasty (THA), and chronic obstructive pulmonary disease (COPD) were included in 2015. 2017 will see the addition of coronary artery bypass graft (CABG) surgery.

  • 2. Locate Patients Who Are High Risk for Readmission

Individual patients are more likely to need to be readmitted soon after leaving the hospital if they have a variety of traits and conditions.

Specific medical or surgical diagnoses, co-morbidities, emotional factors, personal issues, mental health factors, advanced age, multiple medications and associated side effects, level of caregiver and home support, history of readmissions, monetary concerns, and inadequate living conditions are some of the factors that contribute to re-hospitalization.

  • 3. Apply the Medication Reconciliation Method

The practice of comparing a patient’s prescription orders to every medication they have ever taken is known as “medication reconciliation” (The Joint Commission).

After hospital release, medication-related adverse events are a major reason for readmissions. According to research by Dr. Alan Foster, adverse medication events affected 11% of patients who were discharged, and 27% of those occurrences were thought to be preventable.

According to research by Kilcup et al., patients who had their medications reviewed and reconciled by a pharmacist over the phone after release had readmission rates that were significantly lower after 7 days (0.8 percent vs. 0.4 percent) and 14 days (5 percent vs. 9 percent) following discharge.

  • 4. Prevent Infections Acquired in Healthcare

One in twenty hospitalized patients receives treatment for an infection linked to healthcare (HAI). About 83 percent of HAIs fall into one of the following categories:

  1. Catheter-related urinary tract infections
  2. Bloodstream infections linked to central lines (CLABSI)
  3. infections at the surgical site (SSI)
  4. pneumonia brought induced by a ventilator (VAP)

Among the microbes that cause several HAIs are:

  1. Staphylococcus aureus methicillin-resistant (MRSA)
  2. enterococci resistant to vancomycin (VRE)
  3. difficile Clostridium (CD)

Hospital patients who had positive clinical cultures (VRE, MRSA, and CD) more than 48 hours after admission had a higher probability of being readmitted, according to researchers from the University of Maryland.

  • 5. Maximize the use of technology

Every day, tens of thousands of hospital patients navigate the healthcare system. Numerous intricate exchanges take place while patients are transferred from admission to inpatient medical, surgical, and specialized units and subsequently released.

The hospital’s command center must keep track of a patient’s location as well as the supplies and equipment needed to treat their condition, in addition to requiring up-to-date patient information and data for care professionals.

As patients progress through the healthcare care continuum, technological solutions, such as computerized provider order entry, decision support, bar code medication administration, decision support, and robotic pharmacies, can play critical roles in patient safety.

  • 6. Increased Communication During Handoff

Adverse events, treatment delays or omissions, ineffective treatment, longer hospital stays and higher expenditures, patient injury, and needless readmissions are all possible outcomes of insufficient handoffs.

The Joint Commission Center for Transforming Healthcare states that “when patients are transferred or handed-off, it is believed that 80 percent of significant medical errors include miscommunication between caregivers.” The Joint Commission advises the following for handoff communication:

  1. Have two-way discussions.
  2. Reduce or eliminate disruptions.
  3. Give the receiving provider enough time to ask inquiries.
  4. Describe the condition, the recommended course of action, the necessary services, any recent changes, and any potential issues.
  5. Give the recipient enough time to review the patient’s history.
  6. Use the teach-back method to make sure the receiver has understood.
  • 7. Use a model for transitions of care.

The six tactics listed above are each distinct parts of a comprehensive strategy to enhance patient care and reduce readmissions to hospitals. The goal of transition of care models is to arrange and standardize these discrete elements into a hospital program that will help and inform patients as they move from admission to post-discharge via the care continuum.

To ensure that the best inpatient treatment is given, the transition of care models incorporate interdisciplinary collaboration, education, and communication.

Additionally, the primary care doctors are involved in the discharge process to ensure that patients receive any necessary follow-up phone calls or home visits. There is various Transition of Care model examples, including:

  1. Better Adult Outcomes through Safe Transitions (BOOST)
  2. Geriatric Resources for Assessment (GRACE)
  • 8. Take part in payor incentive programs

All around the country, hospitals, and health systems have joined or formed partnerships with incentive programs with payors to encourage physicians to successfully reduce avoidable hospital admissions.

For instance, in July, Independence Blue Cross, located in Philadelphia, reached an agreement to collaborate with Abington (Pa.) Health and other Pennsylvania healthcare organizations on a hospital-physician incentive scheme.

The pay-for-performance model is intended to motivate hospitals and physicians to work together in an effort to decrease hospital-acquired infections and readmissions and adhere to evidence-based recommendations for surgical treatment and care for heart attacks, heart failure, and pneumonia. It is aligned with federal accountable care guidelines.

Similar to this, the Maryland Health Services Cost Review Commission introduced a voluntary scheme that caps payments for inpatient care over a three-year period in March. Maryland hospitals might lose money if readmissions increased while making significant savings if readmissions decreased.

Participating hospitals would collaborate with local doctors and other healthcare providers to make sure that patients receive the required care, preferably in lower-cost settings, in order to achieve the aim.

  • 9. Join a collaborative that focuses on readmission prevention.

Collaboratives can give health systems and hospitals an opportunity to work together and share best practices and strategies for minimizing hospital readmissions, even while they do not entail financial incentives.

For instance, to lower hospital readmissions for heart failure, the New Jersey Hospital Association started a year-long partnership in June with 50 hospitals, nursing homes, and home health companies.

Understanding the causes of readmissions, identifying best practices to lower the rate, establishing resources to enhance treatment for patients with heart failure, and generating resources for people to better manage their disease were among the objectives of the collaborative.

  • 10. A seven-day follow-up should be scheduled for patients.

According to medical studies, individuals who visited their doctor within seven days of being discharged had a lower risk of being readmitted to the hospital.

Hospital participants in a CMS pilot program that ran from 2008 to 2010 sought to reduce hospital readmissions within 30 days after discharge by 2%.

By working with doctors to make sure patients were booked for follow-up visits within seven days, Valley Baptist Medical Centers in Brownsville, Texas, and Harlingen, Texas, met that objective, generating 2.8 percent and 4.2 percent reductions in readmissions, respectively.

Nurses preventing hospital readmission

Readmissions can be significantly decreased by nurses and nurse case managers (NCMs) through effective collaboration, communication, planning, and education.

We can reduce the risk of readmission starting at the time of admission and continuing throughout the predischarge and postdischarge periods by:

  1. Choosing the right post-discharge care setting.
  2. determining the patient’s readiness for discharge.
  3. assembling a thorough and accurate discharge summary, and coordinating care among various settings and providers.
  4. including the patient and family caregivers in the care plan.
  5. making post-discharge follow-up phone calls.

Conclusion on the Benefits of reducing hospitals readmission

Too many patients have a revolving door at the hospital. 20% of Medicare patients who are discharged from the hospital are then readmitted within 30 days.

Preventable readmissions are a result of inadequate standardization of discharge procedures, preparation of patients and family caregivers for discharge, medication education of patients, and communication with post-discharge providers.

Benefits of reducing hospitals readmission Frequently Asked Questions(FAQ)

Here, you will find the answers to the most asked questions about the Benefits of reducing hospitals readmission;

  1. What is the impact of hospital readmissions?

Because of the fines levied by CMS and other payers for readmissions, there is a negative effect on revenue.

Readmission rates are typically lower at hospitals that rank in the top quartile for quality. In a previous post, HealthStream mentioned that hospitals that take care of the most vulnerable patients are more likely to face readmission fines.

  1. What is the most significant cause for preventable hospital readmissions?

The leading causes of avoidable readmissions are disengagement and noncompliance. Patients who disregard their discharge instructions may not appreciate the significance of their therapies or take them seriously.

  1. Why is hospital avoidance important?

Hospital Avoidance launched as a test program on March 16, 2016. Hospital Avoidance will follow up and provide support to prevent readmission if it is determined to be in the patient’s and caregiver’s best interests.

Dementia symptoms include becoming more confused and less independent (Alzheimer’s Society).


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