Transcending the Hospital’s Four Walls to Achieve Collaborative Care Coordination
This is a preview of restricted content.
- If you are an Advisory Board member, please log in.
- If you are logged in and still see this message, the content is outside your memberships portfolio, and we invite you to learn more by contacting us.
- If you are not an Advisory Board member and wish to learn more, please contact us.
Topics: Readmissions, Quality, Performance Improvement
Hospitals will soon be held accountable for care provided beyond their four walls, most notably related to readmissions. While readmission rates are already publicly available on Hospital Compare, payment penalties for excess readmissions will soon take effect, and the recent health reform bill calls for the implementation of a bundled payment system in future years. To prepare for these radical market changes, hospitals need to significantly improve care quality and coordination across the continuum of care. This study provides 17 best practices for promoting seamless transitions both within and beyond the four walls of the hospital, corresponding to the following key areas of focus:
- Isolating improvement opportunities
- Promoting seamless transitions across the continuum
- Migrating toward shared responsibility
Executive Summary
The Advent of Scrutiny on Readmission Rates
Although hospital readmissions have been a perennial problem facing the health care industry, the level of scrutiny over readmission rates has intensified only recently. Several groundbreaking studies—including the 2007 MedPac report to Congress and Journal of the American Medical Association (JAMA) study by Stephen Jencks and his colleagues—have illuminated the enormous cost and alarming prevalence of readmissions. Most importantly, however, these studies quantified the preventable nature of the vast majority of readmissions, showing that there is indeed plenty of room for improvement.
Dragging Our Feet for Good Reason
One of the reasons that hospitals have traditionally accepted readmissions as par for the course is the perverse financial incentives at play. Hospital readmissions make up a significant proportion of total reimbursement—as much as 35 percent on average nationally for all-conditions. Moreover, hospitals typically shoulder the financial burden of the additional efforts associated with reducing readmissions, including enhanced discharge processes, follow-up phone calls, and home visits.
Multitude of Motivators for Focusing on Readmissions
Fortunately, hospitals now have the financial incentive to reduce readmissions; Section 3590 of the Patient Protection and Affordable Care Act outlines a plan for a readmissions reduction program whereby hospitals would be fi nancially penalized for excessive readmissions. In addition to the national payment incentives, there are other motivators for decreasing avoidable readmissions. First, readmissions are clearly a quality of care issue at the core, and reducing unnecessary hospitalization is a mission-critical issue for hospitals. Secondly, 30-day all-cause readmission rates for AMI, HF, and pneumonia are publicly available on the Hospital Compare website. Finally, readmissions are an integral part of the larger vision for a more coordinated, effective health care system.
Implementing a Principled Strategy
Given the rising sense of urgency on the topic, the Clinical Advisory has identified 17 best practices for reducing readmissions— both within and beyond the four walls of the hospital—in the key areas listed below.
In addition, the Clinical Advisory Board has published a number of collateral materials, available in the Appendix of this publication, to aid in implementation of the strategies presented.
Essay - Readmissions in the National Spotlight
