Reducing Hospital Readmissions

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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

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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

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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

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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. 

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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.

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30-Day All-Cause Risk-Standardized Readmission
Results for AMI, HF, PN
Measure CTMC Rate Readmission National Rate
AMI 19.6 19.2
Heart Failure 24.6 24.7
Pneumonia 17.0 18.5
Based on discharges from July 2008-June 2011 Data
from Hospital Compare website.
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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).

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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

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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

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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

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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.

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Questions???
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Thank You for your Time and Attention.
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References

• http//www.hret.org/care/projects/resources/Readmi
  ssion_Guide.pdf
• www.rarereadmissions.org/documents/RARE_Discharge_
  Observation.doc 
• 21st Annual MidasUser 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

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References

• http//www.qualitynet.org/dcs/ContentServer?cid12
  19069855273pagenameQnetPublic2FPage2FQnetTier2
  cPage
• http//www.hospitalcompare.hhs.gov/hospital-compar
  e.aspxvwgrph1cmprTab3cmprID4502722C670056s
  tsltd20TXlocSan20Marcos2C20TXlat29.883274
  9lng-97.94139410000002versionalternate..AspxA
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