Reducing Hospital Readmissions With Simple Post-Discharge Calls
Each year, approximately 16% of patients in United States hospitals are readmitted within 30 days of discharge. Readmissions and the additional treatments they entail are costly to both patients and insurers. Increasingly, they are costly to hospitals as well.
A portion of readmissions are considered unavoidable, such as a planned readmission for chemotherapy, or an unexpected adverse event unrelated to the original diagnosis. However, many other readmissions are considered preventable through high quality clinical care and effective patient education and discharge procedures.
The Financial Impact Of Hospital Readmissions
In an effort to reduce hospital readmission rates nationwide, the Centers for Medicare and Medicaid Services (CMS) began financially penalizing hospitals with higher than expected readmission rates via their Hospital Readmissions Reduction Program (HRRP) that began in 2012. The cost of those penalties across United States hospitals increased significantly from a total of $290 million in fiscal year (FY) 2013 to an estimated $563 million FY 2019.
Failure to reduce readmissions has become more expensive over the program’s lifetime. In the first year of the HRRP, the maximum penalty was 1% of Medicare reimbursements withheld. By design, that maximum penalty has since increased to 3%.
National hospital readmission rates have dropped since the program launched, but not enough to decrease penalties. Of the 3,129 general hospitals evaluated in the HRRP in 2019, 83% received a penalty.
The increases are due in part to additional health conditions included in the program. In the program’s first year, CMS evaluated the readmission rates of patients with heart attacks, heart failure, and pneumonia to determine whether a hospital faced penalties. Today, CMS also measures readmission rates of patients with chronic lung disease, hip and knee replacement, or coronary artery bypass graft surgery. Readmissions that were scheduled to occur are not counted.
Additionally, the program is set up such that CMS evaluates each hospital’s readmission rates relative to the national average for each condition. Even as readmission rates drop overall, there will always be hospitals that have more readmissions than the national average.
A 2016 study on hospital profitability published in the journal Health Affairs found that most hospitals in the United States are not profitable, and the median acute care hospital is losing $82 per discharge. Given those numbers, it’s imperative for hospitals to reduce readmission rates and reduce the amount of Medicare reimbursements left on the table.
Readmission Rates And Causes In The United States
Some number of patients will always be readmitted after discharge. However, the wide range of readmission rates across hospitals suggests that there are addressable factors behind readmissions. In some cases, a readmission may be related to what happened during the original hospitalization, and in other instances, patient readmission is tied to what happens after the patient is discharged from the hospital.
A study on preventability and causes of readmissions published in JAMA Internal Medicine in 2016 reviewed the cases of 1,000 general medicine patients readmitted within 30 days of discharge across twelve United States hospitals from April 1, 2012 to March 31, 2013. Of those 1,000 readmissions, 26.9% were considered to be potentially preventable.
According to the study, common factors in potentially preventable readmissions were largely related to what happened at the time of discharge and after the patient went home. The authors cited emergency department decision making at the time of readmission, patient failure to keep important follow-up appointments, premature discharge, and lack of patient awareness about who to contact after discharge as the most common factors.
The study’s authors concluded that: “High-priority areas for improvement efforts include improved communication among health care teams and between healthcare professionals and patients, greater attention to patients’ readiness for discharge, enhanced disease monitoring, and better support for patient self-management.”
CMS’s steep penalties are motivated by a desire to provide better patient care and, in doing so, to reduce healthcare costs. One of the best ways hospitals can prevent unnecessary readmissions is by calling patients after their discharge to check in on symptoms, review medications and treatment plans, and offer patients an opportunity to ask questions about their recovery.