Healthcare News & Insights

Are your readmission rates within the limits?

How are your readmission rates? If they exceed the national average for certain conditions, starting Oct. 1, the Centers for Medicare & Medicaid Services (CMS) will penalize you by withholding part of your facility’s Medicare payment.

It could get even worse. Many of the private carriers are following Medicare’s lead by  imposing the same penalties for preventable readmissions.

Here are the readmission rates you need to focus on:

  • congestive heart failure (CHF)
  • acute myocardial infarction (AMI or heart attack), and
  • pneumonia.

To reduce hospital readmission rates related to these conditions, the Health Finance Management Association (HFMA) suggests the following strategies:

  • Improve patient education and post-discharge care. Hospitals can do this by following initiatives such as Project BOOST (Better Outcomes for Older Adults through Safe Transitions) and Project RED (Re-engineered Hospital Discharge), which have been proved to be effective in the hospital setting.  Project BOOST is a national initiative developed by the Society of Hospital Medicine with the purpose of improving the quality of post-discharge care. Project RED gives nurse discharge advocates 11 specific steps to follow that have been used to improve the discharge process and reduce preventable readmissions.
  • Implement coordinated care models. Providing interdisciplinary care coordination to high-risk chronically ill patients is  what coordinated care models are designed to do. They monitor and assess a patient’s health status, provide education to the patient on his or her condition and mange services. Some coordinated care models, however, monitor patients’ care for a specific time period while they are transitioning to a different care setting, while other models monitor patients until they die or can no longer live at home, which can extend to months and even years.
  • Develop medical homes. This type of model gives patients a personal primary care physician or specialist and a team that offers guidance, and organizes and expedites care. The goal is to keep patients on their recommended treatments so further hospitalizations, office visits, tests and procedures can be avoided.
  • Embrace telehealth. Once a patient returns home, telehealth offers the patients and their healthcare providers the ability to get and provide continuous care and monitoring remotely from the patient’s home. It generally consists of collecting and transmitting clinical and vital sign data through messaging devices. Telehealth can be used alone or as a part of care coordination.

The goal of all four strategies is to provide patients with improved education and care as they transition out of the hospitals, so as to reduce unnecessary and costly  additional hospital stays.


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