High readmission rates cost hospitals money: The Centers for Medicare & Medicaid Services (CMS) penalize institutions when patients return quickly after discharge. And, according to the Center for Healthcare Quality & Payment Reform, 15–25 percent of patients discharged from the hospital will be readmitted within 30 days.
Modern Healthcare, citing CMS data, reported that in fiscal 2015, only 799 out of more than 3,400 care facilities met the standards of the Hospital Readmissions Reduction Program. Created under the Affordable Care Act, the program docks Medicare payments to hospitals with high readmission rates. It has faced intense criticism from policy researchers and industry representatives, who say it punishes hospitals for factors beyond their control.
No doubt there are a number of things that affect readmission, and many of them aren’t related to healthcare practitioners. But there are several that do rest in providers’ and facilities’ hands.
Follow Up Early for Reduced Readmission Rates
A recent Kaiser Permanente study published in Medical Care found that heart-failure patients who followed up early (that is, within seven days of discharge) with their physician or other care provider were less likely to be readmitted.
“We found that follow-up within the first seven days post-discharge — mostly done through in-person clinic visits — was independently associated with a 19 percent lower chance of readmission, whereas initial follow-up after seven days was not significantly associated with readmission,” Keane Lee, a research scientist with Kaiser Permanente and the study’s lead researcher, told The Hospitalist.
“Perhaps as important, we also observed that telephone visits, mostly done by non-physician providers, within seven days after hospital discharge were associated with a non-statistically significant trend toward lower 30-day readmission rates, even after carefully accounting for potential differences between patients,” Lee continued.
These findings regarding telehealth visits were among the first of their kind. Though telemedicine was met with skepticism at first, research continues to find it has potentially significant and widespread usefulness in healthcare. Contacting their care team by telephone or telemedicine seems generally more convenient for patients and their families. On a large scale, Lee said, it could become even more practical and cost-effective.
It’s clear that medical professionals’ involvement is key to successfully transitioning patients from hospital to home. Early follow-ups don’t just make fiscal sense — they have obvious health value as well. Asking patients to follow up early is just another way of advocating for great care.
Managing Care the Right Way
Perhaps the best way to reduce readmissions is to focus on providing the right care at the right place and time. This means understanding which patient populations are at the greatest risk. Healthcare Cost and Utilization Project research suggests Medicaid patients and uninsured patients (particularly those admitted for obstetrical, neonatal, and other maternal issues) are at greater risk for preventable hospital readmissions compared to privately insured patients.
Educating patients individually about managing their conditions and taking their medications, emphasizing warning signs, and scheduling follow-up appointments with community providers are all staples of high-quality care.
This means that to properly facilitate care coordination and discharge planning, hospitals need staff capable of educating and engaging with patients. That’s where locum tenens comes in. Physicians and other advanced practice clinicians are often in short supply, so it’s a tall order to expect full-time staff to manage care, follow-up, and coordination.
Luckily, locum physicians, nurse practitioners, and physician assistants can take the burden off of a hospital’s regular staff. For days, weeks, or months, locums can focus all their energy and talent on providing excellent care to patients, meaning full-time staff can devote more attention to educating patients, connecting with outside support facilities, and constructing a thorough care management plan that will cut down on readmission rates and bolster hospital revenue.