Reduce Hospital Readmissions & Associated Penalties with Medlinks Cost Containment

The Problem

As the payer reimbursement model moved away from paper service to value-based care, chronic care professionals and CFOs saw the revision of their priorities. The Center for Medicare and Medicaid Services had announced that by 2017, nearly 90% of all Medicare payments will be value-based, which presented an enormous challenge for hospital readmissions, defined as the return of the same patient to the hospital for the same condition within 30 days.

America’s healthcare system now faces a dangerous and costly crisis. Too many patients are getting readmitted to the hospital shortly after discharge due to poor care transitions. People get sick, they come to the hospital, and when they’re well enough to go home but because there’s not good transitions and coordination of care, they end up getting readmitted for the same condition that brought them in the hospital in the first place. This is a really important issue to address not only because hospital readmissions cost big to the hospitals, but because they are also a marker of bad quality care, especially for the most vulnerable in the society: racial and ethnic minorities, the poor, and the elderly.

Legal Implications of Hospital Readmissions

The federal government regards hospital readmissions within 30 days of the discharge as an indicator of premature discharge and poor quality. Hospitals are penalized by a reduction in reimbursement based on a comparison of observed versus expected readmission profiles for similar hospitals in the area. The graduated penalty is 1-3% of reimbursement depending on the ratio. This somewhat conflicts with the traditional focus on reducing the length of stay as a necessity of the prospective payment scheme that reimburses a fixed amount for diagnosis irrespective of the number of days in the hospital. Not only must the discharge be rapid but now also safe. Analysis of Medicare data — the public insurance plan for seniors — indicates that nearly11% of all readmissions occur within the first two days of discharge, rising to approximately twenty percent within the first week.

Reasons Behind Hospital Readmissions and the Cost

Hospitals are scrambling to determine why a quarter of patients are readmitted quickly. The causes are complex and multifactorial. We have a healthcare system that remains fragmented. Hospitals don’t necessarily talk to physician offices or post-acute care providers like nursing homes. Poor communication between hospitalS, clinicians and primary care providers often results in a lack of care coordination after discharge and thus, increases the chance of patient readmission which is why one of the key goals of chronic care management is coordinating communication from provider to provider and patient to increase compliance and reduce readmission. Not doing that dramatically prolongs the recovery time for patients and costs hospitals and healthcare facilities billions of dollars every year. Nearly 20% of hospitalizations by Medicare beneficiaries are followed by readmissions within 30 days and by one estimate, up to 90 percent of hospital readmissions are unplanned and unnecessary, costing the nation nearly 17 billion dollars every year.

Hospital Readmission Stats

Renal patients have the highest rate of readmission with nearly 1/3rd of kidney transplants. Patients being readmitted due to complications with organ rejection. For various cardiac conditions, 30% of Medicare and Medicaid patients diagnosed with congestive heart failure, were readmitted within 30 days. 1/5th of patients who underwent heart valve procedures were readmitted within 30 days. Based on national averages if you have an acute myocardial infarction, your chances of readmission are 17.8%. Whatever the condition, research indicates many circumstances can lead to hospital readmission, including complications from the initial hospital stay, such as infection from the initial surgical procedure, chronic conditions that create frequent acute events, and poorly managed post-acute care, one of which is medication non-compliance, which contributes to 11% of readmissions.

Strategies Healthcare Facilities are Using to Avoid Hospital Readmissions

Health problems, such as cardiovascular disease, psychiatric illness, obesity, diabetes, frailty, and arthritis are common. The pressure to reduce hospital readmissions leads to the development of new programs. An effective cost and quality management system is paramount. Newer strategies include a seamless transitioning of the patient from inpatient to outpatient, a process that traditionally had not been well developed in the US. The adoption of electronic medical records with associated checklists templates and quality indicators offers the potential for improving and standardizing patient care and communication. Silo specialty care is no longer adequate and in the United States, barriers are breaking down with the growth and strengthening of primary care and medical homes.

Patients are tracked through repeated admissions or ED visits in hospitals and other systems. Once identified, these patients receive focused management— tailored to their needs and once admitted, strategies for these patients include a checklist approach with bedside education, early specialist and primary care office appointments, direct referrals, pulmonary rehabilitation and the delivery of medications before discharge. Well-planned home support is essential for safe discharge and has been shown to reduce readmissions.

A Unified Approach to Reducing Hospital Readmissions in Future

What’s clear to experts is that hospital readmissions are not a problem of just one hospital. Stakeholders inside as well as outside the hospital must work together and with patients to reduce the problem. Healthcare is really in a crisis and it isn’t enough just to do a good job in your own facility and not look at the system as a whole. There’s no one solution to this problem, a unified approach is necessary where a large number of hospitals work together for quality initiatives and come up with plans that can significantly reduce rehospitalization.

Medlinks Cost Containment to Reduce/Prevent Readmission Penalties

Medlinks Cost Containmentwas developed to help chronic care professionals better manage their patients and decrease acute conditions without having to add cost, time or complexity. We provide top-quality solutions to improved outcomes and decreased morbidity, reducing readmissions and penalties associated with them. We aim to help healthcare facilities save a significant amount of money otherwise spent on avoidable readmissions.

To know more about our services, get in touch with us today!

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