Creativity helps limit Medicare readmissions

Since October, Medicare has been calculating the number of Medicare patients readmitted to hospitals within 30 days of their discharge. This data is kept for the new Value Based Purchasing Program, a part of healthcare reform that penalizes hospitals with high rates of readmission by withholding a part of their reimbursement money.

The program has begun to change the payment structure of Medicaid away from government payments to hospitals per procedure, and toward payments for the overall wellness of the patients. These changes are a welcomed change by many patients, and even by some healthcare professionals who believe that this payment structure is the way hospitals will be paid in the future,.

As a result, some hospitals have been employing new techniques to ensure that patients are able to care for themselves at home. According to an article in the “Waco (TX) Tribune-Herald,” referenced by the National Association of Healthcare Access Management (NAHAM), some hospitals in Texas will have a nurse call the patient at home to follow up on their recovery and ask if there is anything the patient needs. Others will automatically schedule a follow-up appointment with the patient’s doctor. Still others may send health care professionals to the patient’s home to ensure a smooth transition.

Many hospitals employ a discharge questionnaire that asks questions such as “will there be a friend or family member to assist you at home,” “Are you able to get to the pharmacy,” and “do you understand any changes in medication?” While these questionnaires have been in place for a while in many hospitals, some have tweaked the questions in an effort to prevent readmissions.

The program, combined with the resulting changes in hospital procedure, mark a significant change in hospital culture. This change will be important over time, as penalties for readmissions only escalate in the coming years. To access the story in the Waco Tribune, go to