There were 6 major causes for readmission: Wound (23) – cellulitis, abscess, thrombophlebitis. Two thirds required surgery, and 4 required amputation.
What are hospital readmissions and how do they affect Medicare?
The term "hospital readmissions" has very different meanings for hospitals and government programs than it does for patients. Rehospitalizations are problematic for Medicare because they reflect a failure in care and subsequent hospital readmissions result in greater costs.
Does a readmittance for follow-up care count as a readmission?
However, a readmittance for follow-up care does not constitute a "readmission" for Medicare. When a patient is readmitted to the hospital, the associated costs are high and it can indicate shortcomings in treatment.
What are unplanned readmissions to the hospital?
Unplanned readmissions that happen within 30 days of discharge from the index (i.e., initial) admission. Patients who are readmitted to the same hospital, or another applicable acute care hospital for any reason. Readmissions to any applicable acute care hospital are counted, no matter what the principal diagnosis was.
How long does it take for a hospital readmission to occur?
However, for these same patients, the average number of days between their discharge from the initial hospitalization and their readmission was 12.2 days (SD 7.9 days). In other words, they were readmitted to the hospital before their follow up doctor appointment could have even occurred.
Why do patients get readmitted?
A study conducted by the Agency for Healthcare Research and Quality (AHRQ) on readmissions from 2018 identified septicemia as the top cause of readmissions among Medicare patients, followed by congestive heart failure, COPD, pneumonia and renal failure.
What does Medicare consider a readmission?
Since Medicare's readmission definition is any unplanned admission to any hospital within 30 days after discharge regardless of the reason for the new admission, even admissions unrelated to the original condition, or those that occur at different hospitals, count when CMS computes readmission rates.
What factors contribute to hospital readmissions among older adults?
The reasons which account for hospital readmission are generally related to health-care factors (such as sub-optimal health and social care), factors related to the patient (social and family environment or treatment adherence), factors related to the disease (such as its natural progression) or a combination of all of ...
What diagnosis has the highest 30-day readmission rate for Medicare patients?
Heart failure (for Medicaid and self-pay/no charge) and alcohol-related disorders (for self-pay/no charge) had high rates and high numbers of 30-day all-cause readmissions.
What is the 30-day readmission rule?
The HRRP 30-day risk standardized unplanned readmission measures include: Unplanned readmissions that happen within 30 days of discharge from the index (i.e., initial) admission. Patients who are readmitted to the same hospital, or another applicable acute care hospital for any reason.
How is readmission defined?
Definition of readmission : a second or subsequent admission : the act of readmitting someone or something readmission to the hospital five days after discharge college readmissions.
What is the highest risk for readmission?
Conclusion. Patients of poor health, using 10 medications or more regularly and living in the community with home care, are at greater risk of being readmitted to hospital within 30 days of discharge. Readmissions occur more often after being discharged on a Friday or from a surgical unit.
How do you avoid all cause hospital readmissions?
Patient education is an integral part of preventing readmissions. Education must start during the initial hospitalization and must continue during follow-up visits. Every future interaction with the patient should involve assessment and targeted education.
How can we prevent readmissions?
Let's examine 7 strategies to reduce hospital readmissions:1) Understand Current Policy. ... 2) Identify Patients at High Risk for Readmission. ... 3) Utilize Medication Reconciliation. ... 4) Prevent Healthcare-Acquired Infections. ... 5) Optimize Utilization of Technology. ... 6) Improve Handoff Communication.More items...
What is the most significant reason for healthcare staff to prevent readmissions?
Reducing hospital readmissions—especially those that result from poor inpatient or outpatient care—has long been a health policy goal because it represents an opportunity to lower health care costs, improve quality, and increase patient satisfaction at once.
What happens when patients are readmitted within 30 days?
Medicare counts as a readmission any of those patients who ended up back in any hospital within 30 days of discharge, except for planned returns like a second phase of surgery. A hospital will be penalized if its readmission rate is higher than expected given the national trends in any one of those categories.
What is the most frequent cause of hospital readmission during the first 2 weeks of life?
The leading cause for readmission was respiratory tract infection (29.68%), jaundice (13.70%), feeding difficulties or vomiting (10.96%), urinary tract infection (9.13%), and umbilical cord issues (6.85%).
What is the Hospital Readmissions Reduction Program?
HRRP is a Medicare value-based purchasing program that encourages hospitals to improve communication and care coordination to better engage patients and caregivers in discharge plans and, in turn, reduce avoidable readmissions.
Why is the Hospital Readmissions Reduction Program important?
HRRP improves Americans’ health care by linking payment to the quality of hospital care. CMS incentivizes hospitals to improve communication and care coordination efforts to better engage patients and caregivers on post-discharge planning.
What are applicable Hospital Readmissions Reduction Program hospitals?
Section 1886 (d) (1) (B) of the Social Security Act defines applicable hospitals under HRRP.
What measures are included in the Hospital Readmissions Reduction Program?
We use the excess readmission ratio (ERR) to assess hospital performance. The ERR measures a hospital’s relative performance and is a ratio of the predicted-to-expected readmissions rates. We calculate an ERR for each condition or procedure included in the program:
What counts as a readmission under the Hospital Readmissions Reduction Program?
The HRRP 30-day risk standardized unplanned readmission measures include:
How does the Hospital Readmissions Reduction Program adjust payments?
For each eligible hospital, we calculate the payment adjustment factor. The payment adjustment factor corresponds to the percent a hospital’s payment is reduced. The payment adjustment factor is a weighted average of a hospital's performance across the six HRRP measures during the HRRP performance period.
What is the Review and Correction period?
The 30-day Review and Correction period allows applicable hospitals to review and correct their HRRP Payment Reduction and component result calculations as reflected in their HSR (i.e., Payment Adjustment Factor, Dual Proportion, Peer Group Assignment, Neutrality Modifier, ERR, and Peer Group Median ERRs) prior to them being used to adjust payments.
How long does it take for a patient to be rehospitalized after discharge?
As nearly 20% of Medicare patients are rehospitalized within 30 days of discharge, minimizing post-discharge adverse events has become a priority for the US health care system. Systematic problems in care transitions are at the root of most adverse events that arise after discharge.
What is the Patient Protection and Affordable Care Act?
The Patient Protection and Affordable Care Act of 2010 contains multiple payment reforms intended to promote hospital efforts to address and prevent adverse events after discharge. Chief among these is the Hospital Readmissions Reduction Program (HRRP), which financially penalizes hospitals with above-average readmission rates for target illnesses.
What is post hospitalization syndrome?
In addition, there is increasing concern that the stressful hospital environment may lead to post-hospitalization syndrome — a pathophysiologic syndrome of weakness and increased stress that may leave patients vulnerable to clinical adverse events such as falls and infections.
Is it dangerous to be discharged from a hospital?
Being discharged from the hospital can be dangerous. A classic study found that nearly 20% of patients experience adverse events within 3 weeks of discharge, nearly three-quarters of which could have been prevented or ameliorated. Adverse drug events are the most common postdischarge complication, with hospital-acquired infections ...
What is discharge to a nursing home?
Discharge to a location, e.g., home, visiting nurse, skilled nursing facility or nursing home that cannot support recovery. Recurrence or worsening of the original disease because of poor patient compliance, inadequate supervision or follow-up, or just bad luck. Although the hospital and its staff to can only control some aspects ...
Why is a hospital held accountable?
Although the hospital and its staff to can only control some aspects of these conditions, the hospital is held accountable. Because they only directly control some of the factors and have to coordinate the rest of the care with other institutions or individuals it is hard to improve quickly.
Is there a reward for lower readmission rates?
There is no reward for lower readmission rates, only a stick for poorer performance. [2] There were only four hospitals in this group, two remained unchanged with no penalties, two got worse and were penalized.
