Since the Centers for Medicare & Medicaid Services (CMS) began reducing Medicare payments to hospitals with higher-than-expected patient readmissions within 30 days after discharge, readmission rates have dropped nationally. This is great news for improved patient care, but it has come at a cost to healthcare providers. Data shared by Strategic Healthcare Programs (SHP) in a recent Home Health Care News webinar showed that 77% of eligible hospitals were penalized in FY 2016 for failing to reduce readmissions. With changes to how CMS will measure readmissions in FY 2017, these penalties are expected to reach $528 million – about $108 million more than last year – according to a Kaiser Health News report.
Hospitals aren’t the only ones under scrutiny. A new CMS measure for Medicare Spending Per Beneficiary (MSPB) is coming to home health, holding Home Health Agencies (HHAs) accountable for Medicare payments during the period a patient is under their care.
As an HHA, your ability to identify patients at risk and prevent hospital readmissions will not only help you to support your referring hospital, it will put you in a better position to improve your overall scores and avoid penalties down the road.
Diving into the data
Home health plays a critical role in reducing hospital readmissions. According to SHP’s analysis of five years of data focused on 30-day rehospitalizations, increasing the number of home health visits in the first week following an inpatient discharge significantly lowered the average readmission rate – from 36.4% for one visit to as little as 11.4% for three visits, which is below the 12.5% national average SHP calculated for the five-year period.
By looking at available data, you can start to correlate patient characteristics with the occurrence of a rehospitalization – and incorporate it into your workflow to create strategies to reduce hospital readmission.
Identifying at-risk patients – three red flags to watch for in reducing hospital readmissions
SHP outlined three red flags you should consider when looking at your agency’s rehospitalization rates.
1. Missing the obvious: OASIS code M1034 – If a patient is coded a 3 (“the patient has serious progressive conditions that could lead to death within a year”), which happens 4.8% of the time according to SHP data, you’ll see an average readmission rate of 21.5% – almost double the national average. If you look at no other data points, this alone should indicate you have a patient at risk who requires a plan of action.
2. Not front loading visits – The data is clear, providing up to three visits in the first week post-inpatient discharge will significantly reduce your readmission rate. Best practices from the Visiting Nurse Service of New York suggest that you front load contacts for patients who score at high risk for rehospitalization and provide additional visits and/or contact for the first two weeks of care.
| # of visits | 1 | 2 | 3 | 4 | 5 | 6 | 7 |
|---|---|---|---|---|---|---|---|
| National Rate | 36.4% | 15.5% | 11.4% | 10.7% | 10.6% | 9.9% | 9.8% |
3. Not using available data/technology– Whether through SHP, your EMR vendor or another company, there is a wealth of information available that can help you identify patients at risk. Use the data to develop a plan of action and build it into your daily workflow so you can ensure patients stay out of the hospital.
For more information, be sure to watch our webinar, A Deep Dive into Readmissions Data – How Agencies Can Reduce Rates Further, and read the article by Home Health Care News, How Home Health Can Win the Readmissions Numbers Game.