Healthcare News & Insights

Hospitals with high readmission rates stand to lose 3% of Medicare pay

Medicare’s Hospital Readmission Reduction Program goes into effect Oct. 1, 2012. And hospitals with high readmission rates can lose up to 3% of their regular Medicare reimbursements.

That’s on top of any other penalties Medicare may be imposing and any possible cuts Medicare may make.

But the Centers for Medicare & Medicaid Services (CMS) is giving hospitals a bit of a break during the first year: Penalty limits will be capped at 1%.

As part of the Patient Protection Affordable Care Act (PPACA), the Hospital Readmission Reduction Program is part of CMS’s effort to reduce unnecessary healthcare costs, such as readmissions.

One study estimates that 19.6% of all Medicare beneficiaries discharged from a hospital were re-hospitalized within 30 days.

It’s imperative that facilities with high readmission rates do everything possible to lower these rates.

3 ways to reduce readmissions

Here are three techniques hospitals can use to reduce avoidable readmission rates, provided by Elliot Zemel, JD, an associate at Fenton Nelson, LLP, a firm that advises healthcare facilities on regulatory compliance requirements. All three give patients the tools and guidance they need to end the hospitalization cycle.

1. Nurse phone calls. Some hospitals have made strides in reducing their readmission by simply having their nurses call patients after they are discharged to see how they’re feeling once they return home. The nurses ask about any issues the patients are having and answer any questions that may have come up since their discharge.

2. Post-discharge clinics. Patients who have certain medical conditions  or who don’t have insurance or a primary care physician and might have trouble after discharge, are identified during the discharge process. These patients go to a post-discharge clinic for some one-on-one assistance, such as getting set up with a primary care physician and whatever other needs they may have. This process has been successful in helping to reduce readmissions.

3. Transition coach. The theory behind providing patients who are discharged with a transition coach is it encourages them to actively manage their own care. Transition coaches can do a variety of things during the first 30 days after a patient’s discharge. They can visit patients at their homes and provide them with a daily health record, monitor their weight, track medications, map out personal goals, review warning signs, and make follow-up calls.

 

 

 

 

 

 

 

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