Preventing Unnecessary Readmissions

Transcending the Hospital’s Four Walls to Achieve Collaborative Care Coordination

Topics: Readmissions, Quality, Performance Improvement

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Hospitals will soon be held accountable for care provided beyond their 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, hospitals need to significantly improve care quality and coordination across the continuum of care. This study provides 17 best practices for:

  • Isolating improvement opportunities
  • Promoting seamless transitions across the continuum of care
  • Migrating toward shared responsibility

Executive Summary

The advent of scrutiny on readmission rates

Although hospital readmissions have been a perennial problem for the health care industry, scrutiny of 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 most readmissions—and the ample room for improvement.

Dragging our feet for good reason

One reason that hospitals have been slow in addressing readmissions is the perverse financial incentives at play. Hospital readmissions account for as much as 35% of total reimbursement on average nationally for all conditions.

Moreover, hospitals typically shoulder the financial burden associated with efforts to reduce readmissions, including enhanced discharge processes, follow-up phone calls, and home visits.

Many motivators for focusing on readmissions

Fortunately, hospitals now have a 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 financially penalized for excessive readmissions.

But national payment incentives aren’t the only motivators. Readmissions are also clearly a care quality 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.

Implement a principled strategy

Given this urgency, we have identified 17 best practices for reducing readmissions—both within and beyond the hospital.

In addition, the Appendix of this publication offers a number of collateral materials to help members implement the recommended strategies.