Early identification for fewer readmissions

Hospital patient readmissions are a major expense for the U.S. healthcare system. That’s why CMS introduced significant penalties related to high rates of readmissions within the Hospital Readmission Reduction Program (HRRP). Since CMS began imposing them in 2012, the percentage of hospitals penalized for readmissions has increased nearly every year—reaching a high of 79% for FY 2017—costing hospitals a total of $1.9 billion. Given this trend and that CMS has proposed adding a new readmissions diagnosis to the six existing measure areas, the percentage of hospitals penalized could continue to grow.

Despite the high cost of hospital patient readmissions, this widely prevalent problem seems to be getting worse instead of better. This paper examines:

  • The potential impact of recent changes to HRRP by CMS
  • Challenges hospitals face in preventing readmissions
  • Why some readmission reduction efforts are ineffective
  • Guidance on best practices for an effective readmission reduction program

The Challenge

Readmission reduction program shortcomings are often traced back to a hospital’s inability to accurately identify high-risk patients. This can result in a labor-intensive scattershot approach requiring the addition of full-time equivalent employees in nursing and pharmacy. Conversely, a program that provides real-time data about patient care enables clinicians to monitor and intervene to prevent little problems from causing bigger ones before a patient is discharged.

The Solution

The Q‑Centrix Readmission Reduction solution delivers real-time risk scores while a patient is still admitted to the hospital. Early understanding of at-risk patients before discharge, and long before they are detected by other platforms, allows our partners to take action sooner to prevent readmissions and improve patient outcomes.

Unlike other solutions, our Readmission Reduction solution offers real-time patient data via an easy-to-read dashboard. In addition, our risk model combines factors of your hospital's unique patient population with LACE and Charleston Comorbidity Index algorithms versus risk-prediction models alone.

How It Works:

01

Each admission is reviewed by Quality Information Specialists while the patient is still in the hospital.

02

Patients are evaluated for risk factors and assigned a score based on age, health history, and comorbid conditions.

03

A hospital’s performance is evaluated based on best practices in care coordination and risk reduction, or on a hospital’s custom care protocols.

04

The risk score provided enables the hospitals to investigate the underlying causes of readmissions and develop programs to improve patient outcomes and reduce readmission rates.

Our solution allows your hospital to:

  • Concurrently review patients to identify those at high risk for early readmission
  • Guide clinical teams through best practices to reduce readmissions
  • Understand the drivers of readmissions for different patient populations and diagnosis groups (HF, AMI, PN, COPD, CABG, hip or knee replacement, sepsis, etc.)
  • Coordinate care across any site of care without the need for EHR access or interoperability

Learn about the technology included in the Readmission Reduction solution

Improving Overall Quality

Hospital readmissions not only have serious financial implications but can be an important indicator of the quality of care, particularly for surgical patient readmissions, since their major driver is complications. Focusing on readmissions rates is a good way to promote accountability and improve coordination of care after patients are discharged from the hospital.

Additional Information on CMS Penalty Areas

CMS HRRP payment penalties are based on readmissions that occur within 30 days of discharge for patients initially hospitalized with certain conditions. Since its launch, the program has grown from three to the following six diagnosis measure areas with one more proposed by CMS to start later:

  • Heart attack
  • Heart failure
  • Pneumonia
  • Chronic obstructive pulmonary disease
  • Hip or knee replacement
  • Coronary artery bypass grafting

Proposed for FY 2021 program year:

  • Unplanned hospital readmissions for cancer patients

For more information on HRRP diagnosis measure areas, visit the FY 2019 proposed Medicare payment rule and readmissions reduction program pages on CMS’s website.

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