Readmission Prevention

CMS has recently imposed penalties of up to 1% of all CMS revenues for hospitals that have higher-than-expected 30 day readmission rates for three diagnoses: congestive heart failure, pneumonia and acute myocardial infarction. Over the next three years multiple other diagnoses will be included. The expectation is that by 2016 all diagnoses will be included in these analyses.

The Truven clinical team has done an extensive review of the medical literature on this topic and has compiled a list of proven interventions can help prevent 30 day hospital readmissions. Key techniques for readmission prevention include:

1.     Employ a discharge advocate/patient navigator that can guide the post hospitalization care the patient will require.

2.     Educate patients about their diagnosis during the hospital stay.

3.     Ensure that high risk patients have a follow-up appointment within seven days of discharge.

4.     Use IT and clinical decision support to expedite care transitions especially by digital transmission of discharge summaries and operative notes to primary care physicians, nursing homes and all clinicians involved in patient follow up care.

5.     Confirm medication plan and reconcile all discharge medications.

6.     For patients who do not speak English, ensure the availability of adequate translators.

7.     Consider affiliation with a patient centered medical home to provide follow up primary care for the sickest patients.

Based on our extensive experience in this area, we have devised successful readmission prevention programs, as well as a readmission risk assessment tool to help focus on types of patients who are most likely to be readmitted. While hospitals can ill-afford the penalties that CMS plans, neither can they afford to deploy all possible resources for all patients.