Readmissions aren't a losing battle

Karen Cheung-Larivee

Oct. 1 is D-day for many hospitals. Along with clinical outcomes under value-based purchasing and patient satisfaction penalties kicking in, providers have to worry about curbing readmissions, which, by the way, aren't improving much nationally.

Starting Monday, the Centers for Medicare & Medicaid Services will cut Medicare reimbursements by up to 1 percent and slash them even more of up to 3 percent in coming years for patient discharges that result in readmissions within 30 days.

But it's not a losing battle. My advice to hospitals: Don't give up.

Greg Maynard, clinical professor of medicine at the University of California, San Diego, and director of UCSD's Center for Innovation and Improvement Science, told FierceHealthcare that hospitals can't expect to fix readmissions overnight. Instead, Maynard encouraged hospitals to continue to "chip away at the process."

As transitional care models across the country have shown, the key to curbing readmission is employing a number of best practices at discharge and during follow-up care. That means not only follow-up phone calls to discharged patients but also figuring out which patients need those calls, which caregiver is responsible for making them and what to include in the phone call script, Maynard explained.

Questions shouldn't just revolve around patient satisfaction (Was your hospital experience a good one?) but include questions directly related to patient care (Did you get your medications? Do you know where your medical appointment is?).

CMS isn't just paying lip service to transitional care models, as evidenced by its efforts to develop best practices at the demonstration sites established under the Affordable Care Act. Numerous studies and organizations have found that interventions during discharge and after patients leave the hospital can help them stay on medications, make their medical appointments and engage in their own care.

CMS is targeting the three conditions: acute myocardial infarction, heart failure and pneumonia--at least initially. By 2015, CMS will introduce readmission penalties for additional conditions, expected to include chronic obstructive pulmonary disease, vascular problems, angioplasty and heart bypass surgical complications.

That might sound disheartening to hospital leaders, who will likely face reduced Medicare payments in the immediate future. But it's important to note readmissions penalties reflect the goal of continuous improvement.

"The quick patch, if you will, is to proactively go after those populations in which the penalties are based--CHF patients, acute MI--so you focus on those patients," Maynard said. But he warned that's a short-sighted view of readmissions control.

A limited focus won't solve the problem of patients bouncing back to the hospital.

"Realize it's not just about reducing readmissions rates. It's about reducing adverse drug events. It's about increasing patient satisfaction and increasing staff satisfaction [and] clearing up confusion" on the part of the patient, Maynard said.

The next generation of readmission penalties will likely change the way hospitals look at frequent fliers-- especially those with heart and vascular problems. But the same quality improvement principles apply, Maynard noted.

Regardless of what measures CMS will scrutinize in the coming years, transitional care will be the key to reining in readmissions.

"There's always going to be a transition-of-care piece built in … like follow-up phone calls and appointments," Maynard said about future programs under Project BOOST, a national model for transitional care. Maynard hinted that the program would further bridge inpatient and outpatient process improvements.

"Transitional care [figures] into everything we do, no matter what the condition," he said.

Hospitals can tailor their processes for a specific condition, but it's just as easy to practice the same principles for all patients--not just the ones on CMS' list. --Karen (@FierceHealth)