Navigating the Hospital Readmission Reduction Program

By Kindred Healthcare

Navigating the Hosptial Readmission Reduction ProgramReducing Rehospitalizations: What to Focus on Next
Here is a mini-roadmap on what to focus on next for this important initiative. Reducing rehospitalizations is the right thing to do for patient care – we all know this. But with task forces on performance improvement initiatives ranging from infections to patient satisfaction, it can be difficult to know where to focus efforts for the greatest impact.

Know How Your Hospital Measures Up
A critical first step in managing readmissions is to know how each hospital is performing in order to best target resources and improvement strategies. Kaiser Health News annually publishes a comprehensive list illustrating the current penalties assessed against each non-exempt registered hospital nationwide, as well as a comparison to the previous year’s penalty. The current list details the penalties – reductions in Medicare reimbursements – that are in effect through September 30, 2014.

Penalties Are Increasing for Key Diagnoses
In October of this year, hospital penalties will increase to 3% for hospitals with “excessive” rates for three of the most common and expensive conditions for Medicare beneficiaries – heart attack, heart failure, and pneumonia. Solid clinical pathways, discharge planning and readmission tracking tools are imperative to address this high-risk population.

What About Rising-Risk Populations?
Most hospitals target high-risk, high-cost patient populations in seeking to reduce excessive readmissions and prevent reductions in Medicare reimbursements. However, evidence indicates that best-in-class organizations expand their focus to include “rising-risk” populations. These are defined as the 15-35% of a patient population who have two or more chronic conditions. By targeting interventions to this group, organizations are able to effectively prevent escalation into the high-risk, high cost population.

Want to get ahead of the penalties? Here are the next diagnoses to address.
Beginning on October 1, 2015 the conditions will expand to include:

  1. patients admitted for an acute exacerbation of chronic obstructive pulmonary disease (COPD)
  2. patients admitted for elective total hip arthroplasty (THA) and total knee arthroplasty (TKA)

Thoughtful planning around these patient populations will put you and your team in a good position to address coming pressures.

Time to Prepare for the Future
Effective October 1, 2018, skilled nursing facilities will also be on the financial hook for high hospital readmission rates – for all causes.

  • At that time, 2% of every facility’s Medicare reimbursement will be withheld to fund an incentive pool
  • Beginning October 1, 2019, the top-performing locations will be able to earn back incentive payments – potentially more than the 2% withheld
  • The 40% of lowest performers (ranked by highest readmissions) will not be able to recoup any of the 2% withheld

Why is this new program important to hospitals? It illustrates the need for hospitals and post-acute providers to work collaboratively and deliver enhanced care management with improved transitions to create a mutually beneficial relationship.