Reducing Hospital Readmissions

1. Reducing Hospital Readmissions Payment Reduction Initiatives from Medicare Ranae N. Beeker, RN,MSN,CCM,ACMAdmissions Coordinator/RN Case Manager Sue Noyes, RN,BSN,CCM Manager Case Management/Social Services

2. Readmissions • Definition: A readmission is a return hospitalization after an earlier hospital admission. • Medicare is reviewing “all cause” readmissions for 30 days post hospitalization • Exception: Same-day readmissions for the same condition to the same hospital

3. Reducing Avoidable Hospital Readmissions • Current focus of Center for Medicare and Medicaid Services (CMS) with goal to achieve three-part aim outcomes: • 1) Better Care • 2) Better Health • 3) Lower Costs • Readmissions national cost $17 billion annually. 76% considered avoidable

4. Why are they important? • Affordable Care Act directed by Medicare (CMS) will financially penalize hospitals • July 2012 Readmission data publicly reported • Readmissions are expensive, adverse events for patients • Indicator for level of quality of care received • Effective October 1, 2012 (FFY 2013). Medicare payment reductions under this program will be capped at 1.0% in FFY 2013.  The capped reduction amount will increase over time. 

5. Medicare Payment Advisory Commission (MedPAC) • Identified Acute Myocardial Infarction ( AMI) Heart Failure (HF) and Pneumonia (PN) readmissions as common, costly and often preventable. • These conditions impose a substantial burden on patients and the healthcare system and there is marked variation in outcomes by institution.

6. 30-Day All-Cause Risk-Standardized Readmission Results for AMI, HF, PN Based on discharges from July 2008-June 2011 Data from Hospital Compare website.

7. What is CTMC doing to reduce readmissions? • Working to promote transitions of care are smooth, seamless (Transitions of Care Committee) • Identifying patients with readmission potential on admission • Working with area nursing homes/skilled nursing facilities • Working with our Home Health (as well as other Home Health agencies that service our area).

8. Sample of Readmission Diagnoses • Sepsis • Altered Mental Status related to infection or encephalopathy • Acute Kidney Failure • Anemia, Gastrointestinal Bleed • Dehydration related to diarrhea or N/V • Pneumonia • Cardiac Dysrhythmias • Chronic Obstructive Pulmonary Disease • Acute on Chronic Congestive Heart Failure • Acute Myocardial Infarction

9. Reporting Readmission Rates Creates Incentives for Hospitals to: • Evaluate the spectrum of care for patients • Identify systemic or condition-specific changes to make care safer and more effective • Invest in interventions that reduce complications of care • Improve process for assessing the readiness of patients for discharge • Improve discharge instructions • Reconcile medications • More carefully transition patients to next level of care i.e outpatient care or other institutional care

10. Opportunities for Improvement • End of Life Care Planning opportunity • Partner with Home Health Agencies • Partner with Nursing Homes • Promote smooth transition of care (regardless of disposition) • Establish high-risk criteria for discharge staff (i.e. Social Workers, Case Managers and nursing staff) • Create readmission evaluation tool • New concept idea: Huddle (5min) with identified readmission (team approach) • Promote f/u appt for all discharge patients within 5-7 days of discharge

11. Next Steps…. • CTMC will be providing information as Medicare continues to move forward on budget reduction initiatives. • Work collaboratively with physicians & health care community . • Mode of contact: via your office staff, email, & Medical Staff office. • Do not hesitate to call Case Management or Administration with questions… • This is definitely a work in progress for all hospital systems.

12. Questions???

13. Thank You for your Time and Attention.

14. References: • http://www.hret.org/care/projects/resources/Readmission_Guide.pdf • www.rarereadmissions.org/documents/RARE_Discharge_Observation.doc · • 21st Annual Midas+User Symposium: Potentially Preventable Readmissions • Wagonhurst, Patrice “Tools to Successfully Apply for the CMS Community-Based Care Transitions Program • 2012.Nikiforakis,K. Cheshire Medical Center. Keene, NH

15. References: • http://www.qualitynet.org/dcs/ContentServer?cid=1219069855273&pagename=QnetPublic%2FPage%2FQnetTier2&c=Page • http://www.hospitalcompare.hhs.gov/hospital-compare.aspx#vwgrph=1&cmprTab=3&cmprID=450272%2C670056&stsltd=%20TX&loc=San%20Marcos%2C%20TX&lat=29.8832749&lng=-97.94139410000002&version=alternate..&AspxAutoDetectCookieSupport=1