Reducing Readmission Rates Part III

            Starting October 2012 Medicare begins penalties for facilities for readmissions within 30 days of discharge. Late last year Dartmouth Institute for Health Policy and Clinical Practice and Robert Wood Johnson Foundation announced little progress was made during a study from 2003-2009. The report found 1 in 6 Medicare patients were readmitted within 1 month of discharge. A staggering 60% Medicare patients did not follow-up after discharge as a factor.

            Hospitals have until October to make systemic changes to coordinate care across the health care continuum. Systemic changes will include ancillary service coordination. 

Medicare will start a 1% reduction in payments to facilities not reducing the readmission rate for patients with specific diagnoses including pneumonia, heart attack, or heart failure.

The National Committee for Quality Assurance implemented 9 practice standards that align with the Joint Principles of Patient Centered Medical Home including Access and Communication, Patient Tracking and Registry Functions, Care Management, Patient Self-Management Support, Electronic Prescribing, Test Tracking, Referral Tracking,

Performance Reporting and Improvement, and Advanced Electronic Communications.

             Group Health Cooperative published a study after one year of using the model emergency room visits saw a 29% reduction rate. Hospitalizations decreased 11%. The medical home visits decreased 6%. The caveat is the model administrative cost increased $ 53 per patient. The emergency room savings saw a decrease of $ 54 per patient.

           CMS Partnership for Patients initiatives is to improve the quality, safety, and affordability of health care not exclusive for the Medicare population, rather for all. The partnership has nine core areas to improve hospital readmission rates by 20% by 2013. The elements include adverse drug events, catheter-associated Urinary Tract Infection, Central Line-associated bloodstream infection, Injuries from Falls, and Immobility, Obstetrical adverse events, pressure ulcers, surgical site infections, Venous thromboembolism, Ventilator-associated Pneumonia, preventable readmissions.

            Higher Volume of Post-acute Care Patients Associated With a Lower Rehospitalizations Rate in Skilled Nursing Facilities by Li Y (at el,) says yes. The study found a 15% reduction in readmission rates within 30 days of discharge. Patients that transfer to step down care requiring skilled nursing care supports the need for improved care coordination.