7 Steps to Reducing Hospital Readmissions

Recently mandated healthcare reforms require United States hospitals to curtail repeated patient visits. Healthcare administrators follow several steps to meet this objective. Completing discharge reports shortly after patient release is the first in a series of steps to meet this end. Next, detailed analysis of community hospital readmissions gives administrators insight into repeat visits. This information informs organizations where to focus readmission reduction efforts. Resource expenditures are a telltale sign of high-risk clients. Due to the complex nature of service delivery, organizations sometimes deploy multiple readmission reduction plans. Improving the transition from the caregiving setting to clients’ residences plays a critical role in most reduction processes. Once administrators develop a plan, cooperation with community health organizations considerably bolsters local wellness initiatives.

Readmission Reduction in the United States

The Affordable Care Act requires hospitals to reduce patient readmissions. [1] The act defines a readmission as a repeated patient hospitalization within a 30-day period, with special amendments applying to conditions such as heart failure and pneumonia.

The act provides an algorithm to assess readmission ratios in relation to national averages and outlines practices to adjust risk assessments based on client characteristics. Caregiving facilities must store and use three years of past data to calculate the readmission ratios.

Non-compliant institutions face significant financial penalties, while compliant organizations save expenses beyond those fines and improve patient outcomes. [2] Before the act, over 20-percent of all patients re-entered care in 30-days and almost twice as many returned in 90-days.

While care providers find challenge in improving these outcomes, they now recognize readmissions as a serious problem warranting administrative attention. Readmission reduction is a large-scale initiative capable of saving United States medical institutions billions of dollars. Improving this circumstance is a boon for patients and caregivers. The medical community is still discovering the best way to meet this goal. Among other practices, healthcare administrators implement the following seven steps to reduce preventable patient readmissions.

Step 1: Deliver Discharge Information Faster

Caregiving facilities traditionally require discharge report completion within 30-days after patient departure. Shortening the deadline from this standard interval to 24-hours increases data relevancy drastically and provides timely insights into readmission occurrences.

With the lengthy, 30-day deadline, caregiving facilities miss opportunities to reduce or eliminate issues leading to readmission. When patients leave a facility and have questions or concerns, they are likely to direct inquiries to their primary care provider. At this point, the patient begins treatment through an unrelated source, increasing potential medical errors.

Some modern treatments leave little room for error and misinterpretation. Patients and care providers need medical information quickly to avert readmission events. Additionally, readmission reduction initiatives typically focus on patient transitions from facilities to client residences. [3] However, various facility readmissions originate for reasons occurring outside of this window. For these conditions, such as chronic illnesses, readmission reduction efforts aimed solely at the discharge process do not improve patient outcomes.

Not all chronically ill patients seek medical attention outside of health threatening events. These patients require separate, dedicated initiatives to identify and resolve trouble areas. Nevertheless, expedient discharge summaries also reduce errors and oversights leading to readmissions among chronic patients.

Step 2: Review Current Data Stores

Intuitively, medical institutions begin readmission reduction by developing initiatives to generate financial rewards through the Affordable Healthcare Act. [4] While legislators engineered the act to evoke this response, this practice does not fit every scenario. Incentive-based initiatives ignore definitive community readmission factors.

A community specific response requires in-depth analysis generated from local data. This kind of detailed research produces actionable information relevant for specific care networks and typically requires a dedicated, month-long initiative.

This stage begins with a current readmission volume review. Healthcare administrators begin the process by sourcing information from internal data, patient interviews and third-party partners, as well as any sources producing relevant data. This information provides insights into specific patient readmission factors.

Healthcare administrators source third-party information cautiously, as the provided data does not comprehensively represent the entire readmission population. Therefore, initiatives require critical internal data evaluations. When executing this step, it is important to focus on improvement opportunities rather than departmental shortcomings.

Step 3: Identify Readmission Characteristics

Before launching a readmission reduction initiative, it is vital to identify where to focus organizational efforts. Healthcare administrators divide readmissions into three broad classifications, which are:

• Chronic conditions
• Poor transitions
• Readmissions due to complications

Readmissions due to chronic conditions comprise the most frequent recurrences. The medical community recognizes this small, but costly, client population as a high-risk group. They require “enhanced services” to ensure their well-being after discharge. The service requires organizations to reallocate resources to prevent readmissions, and include – but are not limited to:

• Family/ caregiver consulting
• IT readmission warnings
• Managed care services
• Pharmaceutical re-evaluations
• Research
• Training

Enhanced service offers value by reducing costs compared to readmission occurrences. Healthcare administrators consider this savings when evaluating enhanced service financial viability. By providing this feature, organizations meet objectives supporting new payment models designed to improve service delivery cost-effectiveness and patient outcomes.

Step 4: Classify Readmission Candidates

Readmission reduction initiatives target high-risk clients that expend the most organizational resources. [5] The American Academy of Family Physicians (AAFP) offers a popular framework for classifying the at-risk patient population into six numerical categories, with category number six representing the most at-risk population. The process is time-consuming and typically takes around six months to complete. However, Medicare provides financial incentives to help organizations manage service delivery among chronically ill patients.

Using this framework, healthcare administrators classify clients as low, moderate, high or extremely high resource consumers. Under each level lie six risk levels. Care providers devote resources to patients based on their risk level, which includes assets such as support staff and longer physician sessions.

After identifying these groups, healthcare networks implement programs to educate patients on wellness matters. The programs cover topics such as chronic illness management or available outpatient resources. As more organizations implement strategies similar to the AAFP framework, the results reveal classification effectiveness.

Step 5: Build Applicable Strategies

Some organizations require multiple reduction strategies, because it is difficult to definitively pinpoint the reasons behind readmissions or predict how solving one problem creates another. [4] Multiple strategies increase readmission reduction success probability.
Healthcare administrators determine whether this strategy is necessary after amalgamating data from all available sources. By examining how current readmission reduction practices perform, healthcare administrators determine appropriate program objectives and responses. Organizational objectives, in part, define these criteria.
This information clarifies the variables contributing to readmissions and helps administrators interpret the appropriate organizational response. After formulating a strategy, administrators calculate how the overall initiative improves operations. This estimate consists of improvements produced by all combined strategies.

Step 6: Reform the Client Transition Process

Improving patient transitions contributes to reducing hospital readmissions. The emergency room is a prime department to establish warnings for when patients return more than once in a 30-day period. Due to high patient volume, this department requires a dedicated readmissions specialist to monitor for and liaise with emergency room clients requiring high-level service.

Readmission specialists clearly identify and record patients returning within a 30-day period and the reason for the return visit. The specialists also identify readmission risk candidates during the client intake interview and investigate whether clients have visited the ER in the last 6 to 12 months.

The specialists document all factors contributing to readmissions, monitor patient records internally and externally and inquire about external issues that limit a client’s ability to maintain their health.

Specialists also identify patient and caregiver needs. The specialists are expert communicators and ensure information flow to and from the client with clarity and comprehension. When necessary, readmission specialists secure translators to ensure effective communication and confirm that at least one capable external care provider receives pertinent information.

Step 7: Develop Community Support

Collaboration among multiple disciplines reduces readmission occurrences. Healthcare administrators begin this process by reaching out to large community groups. These groups include insurers, government agencies, labor unions, civic associations and other enterprises promoting community well-being. After establishing alliances, provider networks reach out to individuals in the organizations to work together in developing group care plans, such as formulating discharge procedures to help reduce readmissions among group members. Collaboratively, these relationships form a network that improves population well-being and reduces hospital readmissions.

Healthcare organizations maintain relationships with the partners through regular meetings to discuss current community readmission statuses and evolving group needs. As a best practice, a designated individual within each organization facilitates this ongoing professional relationship. By building local connections, care providers develop community resources to help reduce readmission occurrences.

Legislators developed the readmission reduction agenda to improve patient outcomes and reduce caregiving expenses. Caregiving organizations must comply with this agenda to avoid financial penalties. Healthcare administrators begin compliance initiatives by drastically shortening patient discharge summary deadlines. They then perform a detailed discharge history review, which identifies the patients most frequently returning for healthcare services. These high-risk candidates consume the bulk of institutional resources. When high-risk clients fall under numerous classifications, healthcare administrators pursue multiple strategies to reduce readmissions. These efforts reduce costs and service quality for patients and medical institutions. Healthcare administrators also enhance readmission reduction strategies by working with local civic organizations. As healthcare demands rise, readmission reduction will continue to play a crucial role in making the best use of limited caregiving resources in the United States.

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Sources

[1] Centers for Medicare & Medicaid Services
[2] Health Leaders
[3] http://www.chqpr.org/readmissions.html
[4] Agency for Healthcare Research and Quality
[5] AAFP.org