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July 01, 2011 11:57:07 am

Reducing Hospital Readmissions is a CMS Priority


According to the New England Journal of Medicine, 20% of elderly patients are readmitted to a hospital within 30 days after being discharged, resulting in more than $17 billion in annual Medicare costs. It’s estimated that 40% to 75% of those readmissions are “potentially preventable.” As a result, CMS has launched initiatives to reduce hospital readmission rates and the associated costs. 

Serious business 
The Patient Protection and Affordable Care Act (PPACA) authorizes CMS, starting Oct. 1, 2012, to cut hospitals’ pay by up to 1% if they exceed a yet-to-be-determined 30-day readmission rate for patients with heart failure, heart attack or pneumonia. The potential pay cuts will rise to 3% by 2014 for high readmission rates for an expanded list of conditions that include chronic obstructive pulmonary disease, coronary artery bypass graft and other vascular surgeries. It’s expected that private health plans will start imposing similar penalties. 

Under PPACA, $500 million also has been allocated for a readmissions-reduction Medicare pilot program starting in 2011. 

Jumping on the bandwagon
With dollar figures now attached to excessive readmission rates, hospitals are beginning to see the business reasons for taking action. They’re looking at two broad approaches for reducing the rates: 1) making sure patients understand how to care for themselves after they’ve left the hospital, and 2) giving patients follow-up care to track progress with their recovery. Strategies that have helped several hospitals include:

  •  Improving the medication instruction process by having a pharmacist conduct drug reviews with patients to avoid medication issues such as confusion, overdoses and drug interactions,
  • Identifying patients at high risk of readmission and ensuring they receive follow-up care, such as a physician visit within two weeks of discharge or a phone call within 72 hours, quizzing them about why they had been admitted to the hospital, what symptoms they’re watching for, and so forth,  
  • Improving communications among key members of the patient’s care team,
  • Offering up to 90 minutes of intensive bedside counseling before the patient is discharged (the national average is eight minutes), and
  • Providing the patient and family members a binder that explains the disease in question and how to manage it. 


Such strategies have produced impressive results for individual providers. For example, one hospital experienced:
  • A decline in under-age-70 patient readmission rates from 13.0% to 3.97%,
  • A decline in age-70-and-over patient readmission rates from 15.9% to 11.2%, and
  • A simultaneous fall in lengths of stay while illness severity of the overall population climbed. 

Another hospital enjoyed a cut in 30-day readmissions from 22% to 16%, and in 90-day readmissions from 44% to 26%. According to the April 2009 New England Journal of Medicine, conditions that have the highest 30-day readmission rates for patients 65 and older include heart failure, psychosis, vascular surgery, chronic obstructive pulmonary disease, pneumonia and gastrointestinal problems. As a result, these are some areas in which hospitals may wish to analyze their own performance outcomes. 

CMS means business
Regardless of the political fate of PPACA, it’s clear that policymakers won’t accept costly readmissions when encouraging results are being obtained from innovative and more effective protocols. So prepare for CMS oversight efforts to continue, and take the steps necessary to avoid Medicare pay cuts.


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