Focus on readmissions just keeps increasing
Hospitals penalized when patients come back
Readmissions are a big factor in Medicare spending per beneficiary since an additional hospital stay adds significantly to the total cost of care, points out Susan Wallace, MEd, RHIA, CCS, CDIP, CCDS, director of inpatient compliance for Administrative Consultant Services, a Shawnee, OK-based healthcare consulting firm.
In effect, value-based purchasing penalizes hospitals twice for readmissions—once in the readmission reduction program and again in value-based purchasing, since the cost of a readmission typically is more expensive than the original admission.
Hospitals need to be assessing every patient who is readmitted to find out why he or she came back and taking steps to avoid making the same mistake twice, she adds.
Look at readmissions and break down where patients were admitted from and their discharge destination. Then drill down and determine why patients were readmitted, what their discharge plan was, and where they were before they were readmitted.
Jackie Birmingham, RN, BSN, MS, CMAC, vice president emerita of clinical leadership for Curaspan Health Group, advises hospitals to also examine the readmission rates of each post-acute provider and determine if patients will be referred to providers with high rates of readmission.
In some cases, it may be that the provider wasn’t the best choice for the patient, she adds.
Hospital case managers need to be familiar with what kind of care each post-acute provider gives so they can determine the right one, Birmingham says. For instance, skilled nursing facilities and acute rehabilitation facilities both may provide physical and occupational therapy, but patients are appropriate for one setting but not the other. Long-term acute care hospitals and inpatient rehabilitation both provide a hospital level of care, she adds.
The case manager should determine the appropriate level of care, then find organizations that can provide that level of care and give the patient a choice, she says. However, hospital case managers often don’t know enough about post-acute levels of care to provide patients with a list of the appropriate type of provider from which to choose, she says.
Invite the intake coordinators from post-acute providers to meet with the case management staff to describe the services they provide and which patient are appropriate and which are not, Birmingham suggests.
She advises case managers to visit the post-acute facilities to which they discharge patients and to spend time with a home health nurse. "If case managers never have made a home health visit, they can’t imagine what homebound people go through for simple things, like getting prescriptions filled or grocery shopping. Case managers who have never worked in a particular environment, like a skilled nursing facility, need to visit the ones where they’re sending patients and find out what they are like," Birmingham says.
Make sure whoever does your patient education lets patients know what to expect at the next level of care, Birmingham says. "Some patients who are discharged with home health may think they are going to have a nurse 24 hours a day or a health aide seven days a week. If they don’t have the support they need, their discharge plan may fail. If patients are discharged to a skilled nursing facility and they don’t like it, they may give the hospital a low score on the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS), which also affects a hospital’s value-based purchasing scores," she says.
