Study links HCAHPS, readmission rates

High performers have fewer readmissions

If your hospital receives high scores on the Hospital Consumer Assessment of Health Care Providers and Systems (HCAHPS), 30-day readmission rates are likely to be low, according to a study by Press Ganey, a South Bend, IN, health care performance improvement organization.

Press Ganey analyzed hospitals’ readmission penalty data and compared it to their performance on the Centers for Medicare & Medicaid Services (CMS) value-based purchasing measures. The study found a strong correlation between 30-day readmissions and performance on the HCAHPS portion of the Value-Based Purchasing Program. Performance on the clinical measures included in value-based purchasing was not linked to readmissions rates.

Good communication with patients and family members is a major factor in performance on patient perception of care measures as well as on the hospital’s success in preventing 30-day readmissions, points out Nell Buhlman, vice president for product strategy for Press Ganey.

The HCAHPS survey asks patients to rate communication with nurses and physicians, responsiveness of the hospital staff, and discharge information, along with questions about cleanliness and quietness of the hospital environment, and pain management. Many of the questions focus on communication and the hospital’s effectiveness in engaging patients — factors that also affect patients’ ability to care for themselves after discharge and avoid being readmitted, she adds.

“Developing a good foundation for patient-centric care and focusing on patient and caregiver communication are an excellent step toward improving a hospital’s performance on the HCAHPS and success in preventing readmissions,” she adds.

The message for case managers is that they should start discharge planning on admission and communicate frequently with patients and family members during the stay, Buhlman says.

Many hospital readmissions occur because patients don’t follow their discharge instructions, fail to take their medication correctly, and don’t have the community resources they need to manage after discharge, all of which indicate gaps in communication, Buhlman says.

“If patients understand their discharge plan and have lots of opportunities to ask questions, they are more likely to be compliant with their medication regimen and discharge instructions,” she points out. At the same time, if case managers take the time to find out about patients’ support systems, home environment, psychosocial needs, and any barriers to receiving care in the community, the discharge plan is more likely to be effective, she adds.

Inform patients about their expected length of stay from the beginning and repeat the conversation every day of the stay, she advises. “When patients are in the hospital and on medication, they experience anxiety and stress and may not remember something they hear only once. Case managers should renew the conversation about their discharge date and discharge plan every day and give patients a chance to ask questions,” she says.

She also advises establishing partnerships with post-acute providers to facilitate transitions in care. “Healthcare performance measures are moving beyond the traditional spheres of responsibility. Providers throughout the continuum should work together to make sure transitions are smooth and that they are providing information to care for patients at the next level of care,” she says.