Here's how CMS wants hospitals to reduce readmissions for low-income, minority patients

Guidance comes amid controversy over CMS's readmissions reduction program

CMS on Tuesday released guidance to help hospitals reduce readmissions among minority and low-income Medicare beneficiaries.

According to CMS, racial and ethnic minorities and other "vulnerable populations" are more likely to be readmitted to the hospital within 30 days of discharge for certain chronic conditions.

Tracking readmissions is good—but not for the reason you might think

Guidance details

CMS developed the guidance with help from the Disparities Solutions Center at Massachusetts General Hospital and National Opinion Research Center at the University of Chicago.

CMS suggests that hospitals first determine which types of patients are frequently readmitted. If, for instance, a hospital discovers that certain racial or ethnic groups are more likely to be readmitted, it could implement cultural-specific training for providers and other staff.

The guidance also says that hospitals should provide interpreter services to patients who speak different languages.

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Further, the guidance recommends that hospitals establish care management teams that include both traditional providers and certain "non-traditional" members, such as community health workers, health coaches, and navigators.

"Investing in these resources, derived from the communities-at-risk, will be essential," the guidance states.

Some want changes to CMS's readmissions program

The new guidance comes amid criticism from stakeholders who say CMS's Hospital Readmissions Reductions Program is unfairly penalizing some hospitals by not adjusting readmissions data based on patients' socioeconomic status.

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Under the program, hospitals could lose up to 3% of Medicare inpatient payments if they have too many beneficiary readmissions within 30 days of discharge following a hospital stay related to heart attack, heart failure, pneumonia, chronic obstructive pulmonary disease, or elective hip and knee surgery.

Right now, CMS adjusts hospitals' readmissions data for certain patient demographic factors, including age, gender, past medical history, and comorbidities when they arrived at the hospital.

But some argue that the program should account for the fact that some providers see more low-income and less-healthy patients who face distinct challenges, such as health literacy issues and difficulty obtaining transportation for medical appointments.

CMS CMO Patrick Conway has said the agency is researching the effect of socioeconomic status on its readmissions program (O'Donnell, USA Today, 1/26; Dickson, Modern Healthcare, 1/26; Morse, Healthcare Finance News, 1/26).

How to avoid readmissions at your facility

Reducing your hospital's readmission rates can seem like an overwhelming task—but it doesn't have to be.

Knowing where to focus is half the battle. We've found that the best strategies target four stages of care with significant potential to influence patient outcomes. The other half is knowing what improvements to make.

That's where our Readmission Reduction Toolkit comes in. We've compiled resources from across the Advisory Board that will help you isolate and correct patient and systemic issues in the four critical stages of care:

Get the toolkit now.

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