Hospital Readmissions Reduction Program: Keys to Success


hospital readmissions reduction programAvoidable readmissions are a major financial problem for the nation’s healthcare system. In fact, a single preventable return trip to the hospital more than doubles the cost of care for Medicare patients. For example, Medicare pays, on average, $15,000 for an episode of care without a readmission incident, but that number increases to $33,000 for a single readmission.

CMS first tried to tackle this problem back in 2009 by publicly reporting hospital readmission rates on the Hospital Compare website. CMS claimed the public reporting of readmission metrics would increase the transparency of hospital care, help consumers choose a care venue, and provide a benchmark for hospitals in their quality improvement efforts.

Then CMS pulled out the big guns in 2012 by launching the Hospital Readmissions Reduction Program (HRRP). Under HRRP, hospitals with high rates of readmissions for acute myocardial infarction, heart failure, and pneumonia will see a one percent reduction in Medicare payment in 2013. Penalties will continue to incrementally increase over the next two years—two percent in 2014 and three percent in 2015. In 2015, the rate caps at three percent. The penalty applies to the Medicare base rate.

Results of the Hospital Readmissions Reduction Program

For fiscal year 2013, Medicare levied the maximum penalty of one percent against 276 hospitals. The average penalty, though, amounted to a .4 percent reduction in payment—or as a Medicare Payment Advisory Commission (MedPAC) report estimates, about $125,000 per hospital.

As much as I’d like to have an extra 125K in my wallet, it’s a drop in a bucket compared to overall Medicare expenditures and the massive budgets of many of the health systems affected. Absorbing these losses may not be a challenge for some hospitals.

At the same time, there is no question that CMS’s readmissions program is going to accelerate. In fact, CMS already plans to add more conditions to the program. Beginning in 2015, CMS will expand the number of conditions to include chronic obstructive pulmonary disease (COPD) and elective hip and knee replacements.

Even if hospitals can absorb the financial hit, they still need to track reporting metrics—and doing so will become increasingly complex.

Keeping Pace with Rising Tracking and Reporting Demands

Hospitals face numerous tracking and reporting demands from many entities, not just CMS. State and federal regulations, licensing, private payer initiatives, and accreditation bodies all require reports. Plus, consumers expect more transparency in the Digital Age. In turn, the new standard of transparency provides additional reported metrics consumers use to make care decisions. Payers and providers also rely on these reports to make business decisions.

Enterprise Data Warehouse

So what can a hospital do to keep up with it all? The answer is straightforward: adopt a healthcare enterprise data warehouse (EDW) to meet the many reporting demands. Here are a few examples of how an EDW helps solve the reporting burden:

  • Users can access integrated views of financial, clinical, and operational data from throughout the enterprise.
  • Data collection and the analysis process become automated. Manual data collection and tracking simply won’t work in the future. These manual processes are time- and resource- consuming and often result in inaccurate or missing information.
  • Users can collect data from across the enterprise, integrating clinical, financial, and operational data from inpatient and outpatient settings.
  • Reports are generated automatically, ensuring that the right data gets to the right audience at the right time.

The benefits of an EDW don’t end with reporting, though. An EDW delivers the business intelligence tools a hospital needs to drive real cost and quality improvement initiatives. In specific, an EDW enables health systems to:

  • Establish a baseline for all quality measures
  • Perform analytics to pinpoint opportunities for improving quality
  • Track the success of improvement interventions
  • Measure and sustain results over the long term

Analytics Applications

Once an EDW is in place, the organization has a foundation in place to adopt analytics applications. Analytics are powerful tools that enable non-technical users to make sense of the data and discover the best areas to make changes.

From foundational to discovery to advanced applications, there are different types of analytics that provide varying depths of solutions. For example, foundational applications enable users to automate the distribution of reports. They also provide dashboards, reports, and basic registries across clinical and operational areas. Discovery applications go one step further by allowing users to discover patterns and trends within the data that inform prioritization, inspire new hypotheses, and define populations for management. Advanced applications provide deep insights into evidence-based metrics. Workers then use this knowledge to drive cost and quality improvement initiatives.

Even though there are many types of analytics solutions, they all share one important trait: non-technical users gain an easy and intuitive way to ask complex questions of the data stored within the EDW. Nobody needs to be a programmer or wait weeks or months in a queue for a custom-built report.

Reducing Heart Failure Readmissions with an EDW and Analytics

From improved reports to driving improvements, the benefits of an EDW and analytics applications are many. In fact, one large health system reduced heart failure readmissions by using an EDW as a foundation for their advanced analytics applications.

First, the system implemented an EDW to quickly pool financial, operational, patient satisfaction, and clinical data from the inpatient EHR and other major information systems. With the technology infrastructure in place, the team in charge of the initiative crafted a specific, measurable objective: to achieve and sustain a 30 percent reduction in the 30-day and a 15 percent reduction in the 90-day all-cause readmission rates for patients with heart failure by October 2014 and sustained reduction in readmission rates through 2016.

Next, the team outlined specific interventions based on best practices that would move them toward their goal. Interventions included:

  • Medication reconciliation. Within 48 hours of discharge, a physician reviews a list of the patient’s medications with explicit instructions to the patient about how to properly take them.
  • Post-discharge appointments. Before being discharged, nurses schedule patients for follow-up care. When possible, patients at high risk for readmission are scheduled to be seen within seven days of discharge.
  • Post-discharge phone calls. Within a specified time frame following discharge, a member from the care team calls patients to assess their condition and answer any questions.

An integrated dashboard was created in the healthcare EDW platform for each of the three interventions. This enabled clinicians and administrators to track where the interventions were and were not being applied. They could also track the impact the changes were having on readmissions. Even more, the EDW and analytics applications allowed the team to assess the impact of the interventions on costs and patient satisfaction.

The results have been impressive. Just six months after implementing the EDW, the health system achieved:

  • A 21 percent seasonally adjusted reduction in 30-day HF readmissions
  • A 14 percent seasonally adjusted reduction in 90-day HF readmissions
  • A 63 percent increase in post-discharge medication reconciliation

They are well on their way to meeting—and even exceeding—their objective.

Does your hospital have a readmissions reduction program in place? Which solutions do you have in place to help you track, drive, and sustain improvement initiatives?

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