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Avoiding Penalties for Hospital Readmissions with Population Health Technology

Avoiding Penalties for Hospital Readmissions with Population Health Technology

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The Centers for Medicare & Medicaid Services’ (CMS) Hospital Readmission Reduction Program (HRRP) was created to promote value-based care principles when it comes to newly discharged patients. The program also penalizes hospitals for excess readmissions compared to similar hospitals’ expected readmission rates. The program is in its ninth year, and the 2021 penalties for an excess of 30-day readmission rates are in. Currently, 2,545 out of 3,080 hospitals will be penalized, a total of 83% based on data from July 2016 to June 2019 (pre-COVID-19). It is not new information that hospital readmissions are associated with high financial costs and unfavorable patient outcomes. While it remains to be seen if the program will be suspended next year due to the pandemic, it begs the questions of what hospitals can do to prevent 30-day readmissions and if it is time to invest in the right solutions to help do so.

Defining Inpatient Readmissions and Background on the Hospital Readmissions Reduction Program

Firstly, it is important to understand how CMS defines an inpatient readmission. An inpatient readmission references a person who has been readmitted to the same or another acute care facility within 30 days of the initial hospital stay. Before 2012, hospitals had little to no incentives to reduce readmissions, which is quite shocking due to their enormous cost. In 2012, CMS implemented the Hospital Readmissions Reduction Program to improve care coordination and better engage patients and their caregivers in their treatment following discharge. The program’s overarching goal is to reduce avoidable readmissions (thus reducing costs) and improve patients’ quality of care.

The Necessary Solutions to Implement

When attempting to prevent avoidable readmissions, organizations must implement tools that help identify issues before they happen and prioritize preventative visits. Care teams need a solution that can provide timely data, notify them when patients are discharged, and an analytics solution to manage their progress throughout the patient’s care.

Admission Discharge Transfer (ADT) Feeds and Health Information Exchange (HIE)

Staying ahead of readmissions requires accurate and timely data. In the scope of hospital readmissions, the use of Admission Discharge Transfer (ADT) feeds to monitor a patient’s journey in and out of the hospital offers real-time notifications. ADTs are sent into a Health Information Exchange, or HIE with the patient’s health record. The use of ADT feeds simplifies patient engagement for care management teams; they can outreach to patients via phone, email, or another contact method to monitor post-discharge behaviors and schedule follow-ups with the patient’s attributed provider.

Care Management and Patient Engagement

The best care management and patient engagement tactics promote communication before escalation. Physicians and nurses can use real-time data to create cohorts based on HIE and ADT feeds, and group patients admitted or discharged from the hospital. They can then prioritize outreach based on their risk scores and administer predefined programs for post-discharge care. The primary role of care teams in preventing readmissions is to ensure that patients receive the recommended follow-up care and monitor those with a non-compliant track record. Care managers can develop care plans and craft initiatives to maintain contact and prioritize those at highest risk using John’s Hopkins ACG risk scoring. As mentioned in ADT, successful patient engagement consists of personalized outreach methods that will be the most resonant to the patient to send reminders for follow-up appointments, medication information, and other treatment suggestions.

Analytics Solutions

Having the analytics to house a patient’s healthcare history promotes organization, care gap resolution, and closer patient management. It is also integral in overseeing associated spend and utilization. Maintaining cost and utilization should be simple to make for easy reporting, ideally in one centralized location to view trend analyses, quality gaps, and admission and readmission rates.

These penalties after a challenging financial year will set organizations further back as they try to recover. Preventing hospital readmissions requires a closer eye on patients, which is only made easier with the right technology. For more information on Lightbeam’s innovative solutions to improve patient outcomes and bottom lines, contact us.

Melissa Tyler is an Director of Advisory Services at Lightbeam.

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