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Hospital Readmissions Take A Dip - But Reduction Incentive Isn't Problem-Free

Naoki Takano

Of 186,000 Medicare patients admitted to Indiana Hospitals in 2015, about one in six needed to return to the hospital within a month for different treatment. That’s a small decline from 2010, a drop in-line with national trends.

The data comes from the Centers for Medicare and Medicaid Services, or CMS, which attributes the decrease to the Affordable Care Act’s Hospital Readmission Reduction Program. The program docks Medicare payouts to hospitals that see a higher readmittance rate than expected for older patients receiving care for certain common conditions, such as hip or knee replacement surgery.

The Reduction Program was created to address bloat in the healthcare system. Readmissions can be scary and frustrating for patients — but they’re also expensive. Experts say many are unnecessary and preventable and they waste $17 billion from the government annually.

Christopher Doehring, Franciscan Health Indianapolis Vice President of Medical Affairs, says his hospital was addressing these issues before the program started four years ago, but the Reduction Program definitely acted as an incentive.

“Systems like ours — and I daresay nearly every hospital in the country — have been motivated to do everything they possibly can to minimize the risk of readmissions,” Doehring says.

Even though the program only penalizes for certain re-hospitalizations, it docks Medicare pay across the board. Doehring says that can significantly affect a hospitals’ income.

“This program’s not going to make a hospital go under,” he says. “But it has a little more of an amplified effect than ‘Oh if you have too many readmissions in your heart attack patients, then next year you’re going to get paid less for your heart attack patients.’”

Doehring says the initial step in preventing readmissions is making sure a patient is indeed ready to be discharged in the first place.

Then, communication about proper care after discharge is crucial, especially when it comes to talking about a person’s medication requirements.

He says the majority of re-admissions are medication-related.

Pat Rutherford of the nonprofit Institute for Healthcare Improvement agrees that preventing readmissions is often a matter of communication — between doctors, patients and other healthcare providers such as nursing home staff or home caregivers.

“There’s not new things that clinicians and staff and hospitals need to do, in my opinion,” says Rutherford. “They just need to do the things they already do better.”

For example, hospitals debrief a patient before discharge, but Rutherford says the focus shouldn’t be on whether a debrief happened, but whether the patient understood the hospital worker clearly:

“[The] question is: Do we do a better job of understanding what they understand as opposed to documenting what clinicians teach?” she says.

Rutherford credits the CMS program with incentivizing hospitals so they’ll think about the issue, but says she’d like to see penalties for nursing homes and other care providers too.

“There are so many complexities to measuring this and who gets the penalties, when really it’s the problem that expands the continuum, of care,” she says. “It’s not just a hospital problem.”

Rutherford also worries hospitals could be reclassifying people as outpatients under observation status, in order to keep initial admission rates low.

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