Improving Patient Care to Reduce Hospital Readmissions

Did you know hospitals get penalized by the government for excessive patient readmissions?

It’s true. In 2012, Medicare established the Hospital Readmissions Reduction Program (HRRP). It’s essentially a pay-for-performance program that lowers Medicare payments to hospitals with too many readmissions. For 2018, 2,573 hospitals will be cumulatively penalized an estimated $564 million.

Now Medicare is turning its attention to skilled nursing and rehabilitation facilities (SNFs). Starting in 2018, SNFs will be subject to a penalty of up to 2% of their Medicare reimbursement for posting higher-than-average rates of hospital readmissions.

Why? One major reason is cost.  According to 2010 data, 23.5% of patients discharged from acute care hospitals to SNFs were readmitted to the hospital within 30 days, at a financial cost of $10,362 per readmission or $4.34 billion per year.¹ That’s what led to the HRRP.

So why does this matter to you?  If you’re a patient, it’s important to understand hospital re-admission is a major issue and that, according to the Protecting Access to Medicare Act of 2014, more SNFs are likely to be penalized than rewarded for having lower-than-average hospital readmission rates.

The problem comes down to communication, or lack thereof, between the hospital, physicians and post-acute care providers, like SNFs.  Medicare wants these providers to work together better to improve patient outcomes – and it’s using money as the whip.

Increasingly, patients are taking matters into their own hands. Rather than hope nothing bad happens, they are hiring personal care managers or patient advocates to get the right care in the first place.  These individuals are typically nurses or social workers who know how to navigate the healthcare system.

From attending care plan meetings to assisting with advance directives, personal care managers help patients and their families with all aspects of care.

Ultimately, they are a boon to the healthcare providers, too. By facilitating communication, personal care managers help improve patient care which, in turn, leads to fewer hospital readmissions.

1. Mor V et al. The revolving door of rehospitalization from skilled nursing facilities. Health Aff (Millwood). 2010 Jan-Feb;29(1):57-64.