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12 Ways to Reduce Hospital Readmissions (Part 1 of 2)
Starting in late 2012, the Centers for Medicare & Medicaid Services (CMS) will begin penalizing hospitals with higher than expected readmission rates. This is alarming because recent studies have shown that nearly 21% of discharged patients are readmitted within 30 days, and 34% are readmitted within 90 days.
Stephen F. Jencks, M.D., M.P.H., and Amy Boutwell, M.D., internist at Newton-Wellesley Hospital in Newton, MA and Director of Health Policy Strategy for the Institute for Healthcare Improvement are experts on the subject of patient readmissions. They have developed a list of 12 preventative strategies suggested to help hospitals reduce readmission rates. Some of their strategies have yet to be fully tested in some care settings, but high readmission rates are pushing many healthcare facilities to put these proposals to the test.
1. Discharge Summaries
Complete discharge summaries within 24 hours of discharge. Most hospitals abide by the old standard of completing discharge summaries within 30 days of discharge.
However, Boutwell says, “I was trained that the summary is a retrospective report of what happened in hospitalization. But what we need today is anticipatory guidance. Patients get discharged and go home. They can’t fill their meds, insurance doesn’t cover the med or they have questions. They’re nervous and worried. They call their primary care provider, who didn’t even know they were admitted.”
According to Boutwell, the 30-day standard practice “might have sufficed in a time gone by. But that doesn’t work anymore. Information needs to be available at the time of discharge. There’s a growing recognition of this need, but staff bylaws haven’t changed.”
2. Lengthen the Handoff Process
In every step of the patient care process, including discharge, care teams must talk to each other about the patient. Boutwell suggests that discharges should actually be called “transitions.” Jencks says that “senders and receivers, for example hospital discharge planners and skilled nursing facility staff and home health” should meet often enough that they learn about the realities of the transitions, for both sending and receiving.
Boutwell says that “taking this person-centered approach shifts the concept from discharge, which is a moment in time and you’re done with it, to a transition—a shared accountability. We need to make sure the receiving providers understand who this patient is, with a 360-degree view.”
3. Provide Medication on Discharge
Patients should be sent home with a 30-day medication supply, packaged with clearly explained dosage directions. This may be a challenge for hospitals with Medicare patients because of distinctions between Part A and Part B payment; however, for certain high-risk patients, such as patients with congestive heart failure or those with a history of readmittance, it might be preferable for the hospital to just absorb the cost.
4. Make a Follow-up Plan Before Discharging
Hospital staff should make follow-up appointments with a patient’s physician and should only discharge the patient after this appointment is scheduled. It is important to make sure the patient has transportation to and from the physician’s office and the patient understands the value of meeting within the time frame. Staff should also follow up with a phone call to the physician to make sure that the visit was completed.
Home Healthcare Partners in Dallas utilizes health coaches, intensive care clinicians, and wireless technology to record daily vital signs for nearly 2100 discharged Medicare fee-for-service beneficiaries for periods of 60 to 120 days. So far, HHP has followed this method for about 7,000 unduplicated patients over the past two years in hundreds of hospitals.
Wayne Bazzle, HHP’s CEP, says that the method involves calling patients by phone. The 5 to 15 minute calls occur frequently enough that Bazzle says, “we have their trust. We can help them stay out of the hospital if they’re more truthful with us about what’s going on, and if we see some deterioration, we can help them cope. Normally it’s a medication management issue, or they’ve become a little too relaxed with their diet.”
Patients targeted for intense monitoring include those with several co-morbidities, those who have a primary diagnosis of congestive heart failure, chronic obstructive pulmonary disease, diabetes, Alzheimer’s or hypertension.
6. Identify High-Risk Patient Groups
Hospitals need to retool their admission and readmission rates for demographic and disease characteristics to help identify high-risk patients. This can help hospitals to use their limited resources more effectively. Some hospitals have developed special programs for certain patient demographics, such as the group of hospitals in Los Angeles that discharges certain homeless patients to a nearby facility similar to a half-way house. That program saved the hospitals $3 million after just a few months.