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The Facts Behind Avoidable Hospital Readmissions in Senior Care

Since October the 1st hit, I’ve been bombarded with stories, briefs, presentations, newsflashes, and water cooler discussions about impact of unnecessary rehospitalization across the long-term care and senior living industry. One thing is for certain, it is a big deal. Why? Because the hospitals are the big dogs, the gate keepers, in the continuum of care that most patients pass through before ending up in one of the various post-acute care settings. If it affects them, it’s certainly going to affect everyone else. So I decided to weed through all the now available fodder and get the facts. Let’s get started with the definition:

  • Affordable Care Act (ACA) definition of “rehospitalization” is an individual who is admitted at the same or different hospital within a 30 day period for the following conditions: (1) Heart Attack (AMI), (2) Heart Failure and (3) Pneumonia. A few additional conditions will be added to the list in 2015
  • The penalties are straightforward. Hospitals in the bottom quartile for readmissions will have a % of total Medicare payments withheld (Up to 1% in 2013, up to 2% in 2014, and up to 3% in 2015). MedPAC also estimated the average penalty for hospitals will be about $125,000.

And now to the stats…

60% - top range of hospitalization of SNF residents in any given year. The range is between 25%-60%. (JAGS 2002; vol 48, 154-167)

90% - readmissions that are unplanned appear to be the result of clinical deterioration. "We estimate that about 10% of rehospitalizations were likely to have been planned," Dr. Jencks and colleagues said. (2009, New England Journal of Medicine).

75% - readmissions considered preventable, adding $12 Billion/yr. to Medicare spending, according to the Medicare Payment Advisory Committee (MedPac).

44% - top range of emergency room transfers that were identified as inappropriate (avoidable), citing poor care in the nursing homes. (JAGS 2002; vol 48, 154-167)

25% - Medicare beneficiaries discharged from the hospital to a SNF that are readmitted to the hospital within 30 days. (MedPAC)

It’s no surprise that most of the organizations have launched initiatives to improve this situation. AHCA wants to lower readmissions by 15% by March 2, 2015 at 12:00 p.m. (not sure if 12:01pm will be acceptable). Partnership for Patients, a national public–private initiative, wants to reduce this 20% by 2013. Many state organizations have followed suit by setting similar standards.

But let’s face it, it’s easier said than done. To truly be effective, here are some areas that are getting focus across the entire care spectrum.

  • Education for clinical workers – cross training and advanced training that is needed to care for higher acuity residents. That’s where the trend continues to move. This includes putting policies and processes in place that will help to identify residents’ change of condition, and balance staff assignments to ensure residents are getting the care that they need to improve outcomes. Read this whitepaper, "Staffing to Acuity: 5 Reasons To Make It Your Top Priority", for strategies to deliver higher quality care and reduce hospital readmissions.
  • Retention of clinical workers – turnover is rampant which leads to understaffing and makes it challenging for the remaining staff to do an effective job. Nursing staff consistently report being overworked and under appreciated. It is important that your staff feel valued and a part of the organization and not just another headcount on the floor. I welcome you to read the whitepaper "Turning Around Turnover", for staffing strategies that will help you build a happier and more stable employee base.
  • Community outreach – ensures your ecosystem, including hospitals and physicians, understand your capabilities and your track record, otherwise they may not trust your ability to manage complex clinical conditions in house.
  • Data sharing – this is the big one. The key will be to have a system in place where the clinical condition and needs of the patient are transferred to their new destination automatically, and correctly. Incorrect or lacking data on medications, diagnosis, and stability of the patient does it’s part to contribute to the problem. These sound small but they happen, or don’t happen, on a regular basis. The last thing a nursing home needs is to accept a resident that they are not equipped to care for.

I’ll continue to build on these topics in the coming weeks.