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    • Hospital Readmissions in the Era of the Patient Protection and Affordable Care Act
      January 16, 2013

      Hospital readmissions rates have been rising over the years, with heart attack, heart failure and pneumonia patients the most likely to be readmitted after an initial hospitalization.

      Hospitalizations account for approximately 33 percent of total Medicare expenditures and represent the largest single program outlay. Nearly 2.5 million or 20 percent of Medicare beneficiaries who were hospitalized were readmitted to hospitals within 30 days of discharge, and more than 30 percent were readmitted within 90 days, according to 2010 Centers for Medicare and Medicaid Services (CMS) data.

      Readmissions are costly and detrimental to the health of patients. Moving in and out of hospitals repeatedly is emotionally taxing, encourages medical errors and can indicate poor quality care, especially when the readmissions are preventable. Readmissions may also contribute to cognitive decline in elderly patients.1

      The government is getting serious about reducing the number of avoidable rehospitalizations. Under the Hospital Readmission Reduction Program of The Patient Protection and Affordable Care Act of 2012, the Centers for Medicare and Medicaid Services will calculate acute care hospitals’ readmissions rates and then compare them to expected readmissions rates, using models developed based upon factors such as patient age and comorbidities, and conditions and procedures at a hospital. The act mandates that acute care hospitals with higher-than-expected readmissions will receive lower Medicare payments. In the first two fiscal years, the reduced payments will apply to readmissions related to heart failure, heart attack and pneumonia. In the next few years, CMS may expand the list of conditions to include chronic obstructive pulmonary disease and additional cardiac procedures and vascular conditions, according to the Web site of the American Association of Medical Colleges.

      If hospitals exceed an estimated 30-day readmission rate for patients with these conditions, they will be subject to a reduction in payment rates up to one percent. The reduction will increase by one percent each year being capped at three percent in 2014. According to the government, avoidable hospital readmissions cost Medicare about $17 billion per year, and this act and its implementation are aimed at slashing that burden.

      Many hospitals are already feeling the effects. Kaiser Health News and The New York Times recently reported that since October 1, 2012, Medicare has already imposed penalties against 2,217 hospitals for too many readmissions, and 307 of those hospitals will receive the maximum one-percent reduction in Medicare payments per patient over the coming year. For Barnes-Jewish Hospital in St. Louis, one of those penalized, this means a loss of $2 million.

      Studies have shown that 30 days is a reasonable measure because readmissions that occur within a 30-day period are often attributed to care at the time of discharge or transition; hospitals and post-acute providers can take steps to assure that patients are prepared for discharge, by improving transition communication, better managing disease, educating patients further and paying closer attention to medication management, among other strategies.2 One published study found that the robustness of patient education at discharge was a good predictor of discharge readiness, which in turn could affect rates of readmissions. These findings, said the study authors, could have implications for development of patient education programs and changes in post-discharge transition planning.3

      As a post-acute partner for acute care hospitals, Kindred transitional care hospitals are dedicated to addressing the challenge of reducing readmissions by taking steps to improve the discharge and transition process from the acute care hospital to one of our facilities. Once a patient is at a transitional care hospital, our goal is to provide excellent care and rehabilitation services aimed at smooth patient transition either to another Kindred facility or service, or home. Kindred transitional care hospitals reduced rehospitalization rates by 8.3 percent from 2008 to 2012, down to 11.2 percent, and we are proud of our success and committed to continuing to work hard to reduce those rates even further.

       

      1 Wilson RS, Hebert LE, Scherr PA, Dong X, Leurgens SE, Evans DA. Cognitive decline after hospitalization in a community population of older persons. Neurology. 2012 Mar 27;78(13):950-6. Epub 2012 Mar 21.

      2 Horwitz L, Partovian C, Lin Z, Herrin J, Grady J, Conover M, Montague J, Dillaway C, Bartczak K, Ross J, Bernheim S, Drye E, Krumholz H. (2011). Hospital-Wide (All Condition) 30-Day Risk-Standardized Readmission Measure (DRAFT Measure Methodology Report). New Haven, CT: Yale New Haven Health Services Corporation/ Center for Outcomes Research & Evaluation. Retrieved November 7, 2012, from http://www.cms.gov/site-search/search-results.html?q=hospital%20wide%20all%20condition%2030%20Day%20risk%20standardized%20readmission%20measure

      3 Weiss ME, Placentine LB, Lokken L, Ancona J, Archer J, Gresser S, Holmes SB, Toman S, Toy A, Vega-Stromberg T. Perceived readiness for hospital discharge in adult medical-surgical patients. Clin Nurse Spec. 2007 Jan-Feb; 21(1): 31-42.

       

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