Avoidable readmissions to the hospital result in numerous complications relation to hospital care and create billions of dollars in unnecessary health care expenditures. Readmissions can be especially disruptive for elderly patients with the potential for negative physical and psychological impacts.
Causes of preventable readmissions include therapeutic errors, often to do with medication reconciliation, failed handoffs, and absent or delayed follow-up. CMEC has identified key factors in association with readmissions to the acute, including: polypharmacy, unrecognized psychological issues, and a lack of patient support. CMEC is dedicated to reducing the incidence of these problems through the implementation of standards specific to each patient and their primary diagnosis.
Screening tools can be very useful in assisting providers with predicting which patients are at risk for readmission. Although no screening tool will be perfectly accurate, several tools have been developed and validated as methods for predicting risk of readmission. CMEC has adopted the modified LACE index tool which takes into account the patient’s Length of stay at the acute, the Acuity of their admission to the acute, the Comorbidities, and the number of Emergency room visits within the past six months.
As a direct result of our program, CMEC has lowered the readmission rate across (WORKING ON THIS DATA)
Clinical Recommendation Statements from CMS: January 13, 2016
Randomized controlled trials have shown that improvement in health care can directly reduce readmission rates, including interventions in the following areas: quality of care during the initial admission; improvement in communication with patients, caregivers, and clinicians; patient education; predischarge assessment; and coordination of care after discharge (Naylor etal., 1994; Naylor et al., 1999; Krumholz et al., 2002; van Walraven et al., 2002; Conley et al.,2003; Coleman et al., 2004; Phillips et al., 2004; Jovicic, Holroyd-Leduc, and Straus, 2006; Garasen, Windspoll, and Johnsen, 2007; Mistiaen, Francke, and Poot, 2007; Courtney et al.,2009; Jack et al., 2009; Koehler et al., 2009; Weiss, Yakusheva, and Bobay, 2010; Stauffer et al.,2011; Voss et al., 2011). Successful randomized trials have reduced 30-day readmission rates byas much as 20–40 percent(Horwitz et al., 2011).
Hospital readmissions of Medicare beneficiaries discharged from a hospital to a SNF are prevalent and expensive, and prior studies suggest that a large proportion of readmissions from SNFs are preventable; according to an analysis of SNF data from 2006 Medicare claims merged with the Minimum Data Set, 23.5 percent of SNF stays resulted in a rehospitalization within 30 days of the initial hospital discharge (Mor et al., 2010). The average Medicare payment for each readmission was $10,352 per hospitalization, for a total of $4.34 billion. Of these rehospitalizations, 78 percent were deemed potentially avoidable, and applying this figure to the aggregate cost indicates that avoidable hospitalizations resulted in an excess cost of $3.39 billion (78 percent of $4.34 billion) to Medicare (Mor et al., 2010). Several analyses of hospital readmissions of SNF beneficiaries suggest there is opportunity for reducing hospital readmissions among SNF beneficiaries (Mor et al., 2010; Li et al., 2011), and multiple studies suggest that SNF structural and process characteristics can impact readmission rates (Coleman etal., 2004; Medicare Payment Advisory Commission (U.S.), 2011).