Readmission in Acute Care Hospitals
Readmission is the return of a patient to an acute care hospital within 30 days after discharge from a medically necessary stay. A readmission is a significant concern to health care professionals because it wastes time and resources, negatively affects patient satisfaction, and leads to poorer outcomes.
Priority on Reducing Readmissions
Reducing readmissions is a priority for payers, providers, and policymakers who want to improve patient outcomes while also controlling costs. In 2012, the Centers for Medicare & Medicaid Services began reducing Medicare payments to certain hospitals with excess 30-day readmission rates.
Hospital Readmissions Reduction Program (HRRP)
In addition to these penalties, CMS collects and publishes hospital readmission rates for selected diagnoses based on the HRRP. The HRRP began with readmissions after initial admissions for heart attack, heart failure, pneumonia, COPD, elective hip or knee replacement, and coronary artery bypass graft surgery. In 2015, these conditions were expanded to include readmissions following the diagnosis of COPD and pneumonia.
Strategies to Reduce Readmissions
There are many ways to reduce readmissions, including implementing quality improvement initiatives and strategies to better transition patients back home or to community-based care. However, some of the more effective strategies are not easy to implement and require a coordinated strategy to achieve their objectives.
Post-Hospital Follow-Up Care
Ensure that patients have a plan of care after they leave the hospital, including schedules for post-hospital follow-up visits and contact with physicians. Studies show that timely post-hospital follow-up increases patient engagement, reduces the risk of readmissions, and is associated with lower cost.
Patient-Centered Care Models
Use patient-centered care models to address the root causes of readmissions. Focus on the underlying factors that lead to readmissions and work to mitigate them with interventions such as patient education, scheduling follow-up appointments, and providing access to resources that encourage positive behaviors after hospitalization.
Community Partnerships
Develop partnerships with community partners to provide social, emotional, financial, and nutritional support for low-income and socially isolated patients. These relationships can reduce barriers to health care and help patients heal more quickly.
Social Determinants of Health
Hospital readmission rates vary widely from place to place and are often affected by socioeconomic factors such as low income, family structure, lack of transportation, poor food security, and health literacy. Patients with these characteristics are more likely to have complications, experience readmissions, and become more dependent on hospital staff and services than patients without these problems.
Importance of Lowering Readmissions
Reducing these rates can have a large impact on the health of patients and their families, as well as on the economy. The goal of reducing readmissions is a national priority and can save health care institutions billions of dollars over time.
Tools and Research for Reducing Readmissions
A variety of tools, data, and research can help hospital leaders reduce readmissions by identifying the root causes of high rates and developing strategies to address them. These efforts are helping to improve patient outcomes and health care system efficiency across the United States.
Implications for Medicare
The goal of lowering readmissions is important because it can help slow the growth in Medicare spending and signal that improved care is occurring for patients who have been hospitalized one or more times during the year. Reductions in readmissions could be a promising outcome from Medicare’s payment and delivery system reforms.
