By Tom Cox
Reducing congestive heart failure readmissions is a tricky business for hospitals across the United States. According to the American Heart Association, one million people in America will be hospitalized for heart failure and about 250,000 will be back in the hospital within a month. The Affordable Care Act ushered in Medicare’s Hospital Reimbursement Reduction Program, which is just beginning to lower the number of preventable hospital readmissions across many categories, perhaps most notably for CHF.
However, CMS is now withholding up to three percent of reimbursements from facilities that experience higher-than-desired readmissions within 30 days. It’s well documented that as many as 20 percent of Medicare patients discharged from the hospital are readmitted in this timeframe.
In 2015, 2,592 hospitals, nearly half of all hospitals in the United States, faced penalties to their Medicare reimbursements for a high number of 30-day readmissions. The projected fees of these penalties are expected to cost hospitals a combined $420 million.
Kentucky Not Immune
Like many other states, Kentucky hospitals aren’t immune to this problem. Of the 38 hospitals nationwide currently facing the highest Medicare penalties for readmissions between October 1, 2015 and September 30, 2016, 20 percent are based in Kentucky. (See sidebar for the ten Kentucky hospitals with the highest ratios.) While some of these readmissions may be unavoidable, without a doubt some of them can be prevented.
Hospitals need to turn to new solutions to reduce or eliminate these penalties. The key to reducing readmissions is helping hospitals alleviate too many post-discharge patients having poor outcomes that require re-hospitalization. How can the health systems communicate more effectively with providers? How can they seamlessly schedule post-discharge CHF patient appointments with specialists?
Scheduling Tools Are Key
The answer lies with care coordination tools and their power to help hospitals lower the rate of readmissions. By providing an easy-to-use answer to the complex problem of aligning hospital discharge flow with cardiology practices’ scheduling process, technology can help hospitals realize improved patient outcomes and higher reimbursements.
Scheduling and referral management tools create vital linkages between hospitals and provider offices that often run disparate systems or still use paper records. By aggregating appointments from disparate systems, discharge staff can easily find and book follow-up appointments in just a few minutes – before the patient gets released. Scheduling tools also make it easier to book follow-up visits within the time windows required for Medicare reimbursement. I’ve seen a 300+ bed hospital reduce readmission penalties by 98 percent after implementing improved cloud-based scheduling technology across their network of employed and affiliated providers.
While technology alone may be just a component of a holistic solution, scheduling improvements can play a critical role in bettering patient outcomes and reducing re-hospitalizations, improving patient experience and satisfaction scores and boosting productivity and efficiency. From a financial perspective, these tactics are critical to lowering CMS penalties while also improving quality and metrics for physician practices that are part of an ACO or shared risk model.
Proactive, Not Reactive
According to the Commonwealth Fund, hospitals with low readmissions rates are proactively identifying patients with the highest risk for readmissions, particularly CHF, and reaching out to them. Once identified, they provide individualized education and medication reconciliation to emphasize warning signs, to confirm follow-up appointments with community physicians and to receive post-discharge instructions that are fully understood. Most patients do enjoy being active in their medical care and want to feel empowered. Others may be more difficult to engage. Either way, adherence isn’t easy but it can be greatly improved with the help in part of scheduling solutions, improved communication and consumer-friendly access to care. The reality is that patients who stick to their treatment plans have better health results. In our work, we’ve seen engagement tools help get patients in for a wellness check where previous efforts had been unsuccessful for three years.
We have reached a pivotal time to help patients and hospitals thrive. More efficient practices can improve their post-discharge care coordination, boost provider’s bottom lines and improve care for the patient. Lowering preventable hospital readmissions is about creating better outcomes for all.
-Tom Cox is CEO of MyHealthDirect in Nashville, Tennessee.
Kentucky hospitals with highest Medicare penalties for readmission
As part of the Hospital Readmissions Reduction Program, CMS penalizes hospitals with excess 30-day readmissions by docking their pay for all Medicare patients. Of the 38 hospitals, eight – or more than 20 percent — are in Kentucky.
The following hospitals will be subjected to a three percent readmission penalty by CMS, affecting payments for every Medicare patient stay from Oct. 1 through Sept. 30, 2016.
Excess readmissions are measured by a ratio, by dividing a hospital’s number of “predicted” 30-day readmissions for heart attack, heart failure, pneumonia, hip/knee replacement, and COPD by the number that would be “expected,” based on an average hospital with similar patients. A ratio greater than one indicates excess readmissions.
Hospital Readmission Ratio
Harlan (Ky.) ARH Hospital 1.4563
Monroe County Medical Center (Tompkinsville, Ky.) 1.3136
Jennie Stuart Medical Center (Hopkinsville, Ky.) 1.2709
Hazard (Ky.) ARH Regional Medical Center 1.2638
Middlesboro (Ky.) Appalachian Regional Healthcare Hospital 1.2291
Whitesburg (Ky.) ARH Hospital 1.2281
Memorial Hospital (Manchester, Ky.) 1.1945
Tug Valley ARH Regional Medical Center (South Williamson, Ky.) 1.1278
— Hospital Compare: Hospital Readmissions Reduction Program and Becker’s Hospital Review