An unnecessary hospital readmission is any time a patient is admitted to a hospital within a short period of time after being discharged previously following an initial hospitalization. This time allotment for Medicare patients is 30 days. This does not include planned readmissions or visits based on illnesses or injuries unrelated to the first visit. For example, what if one of your elderly patients breaks his hip and due to improper treatment he develops a pressure sore after he is discharged, which worsens while he is living at a nursing home? As a result, he must be readmitted to the same hospital for treatment. It is this detrimental cycle that many health care professionals are seeking to cease at their hospitals and long-term care facilities.
What is the Hospital Readmissions Reduction Program?
Patients with Medicaid, the elderly and those without insurance are the most vulnerable for preventable hospital readmissions. The Affordable Care Act (ACA) created the Hospital Readmissions Reduction Program (HRRP) to urge hospitals to emphasize quality of care, not just quantity. Hospitals can reduce costly patient readmissions overhead by improving the quality of care given to each of their patients.
"Most readmissions can easily be avoided by improving quality of care."
Hospital readmissions are estimated to cost the Medicare program more than $17 billion each year. Since the creation of the HRRP, the Centers for Medicare & Medicaid Services revealed that 49 states plus Washington, D.C. have reduced their avoidable hospital readmission numbers. For 11 states, this rate fell by over 10 percent. While these new standards help protect patients, hospitals and long-term care facilities can do more to ensure their patients and residents recover without any complications.
How can you reduce unnecessary hospital readmissions?
Most readmissions can easily be avoided by improving overall quality of care, in that patients are instructed on follow-up care, leave with appropriate medications and have additional appointments scheduled to ensure that their road to recovery is problem free. Moreover, as a long-term care facility, there are many ways you can keep your residents from being readmitted to the hospital after they are initially discharged.
The Medicare-Medicaid Coordination Office established an initiative to improve the quality of care at LTC facilities in 2012. For elderly residents, especially those suffering from dementia, hospitalizations can be disorienting and even dangerous. Since the initiative was announced, phase one – known as Improving Clinical Care – of the plan has been well under way by implementing "evidence-based clinical and educational interventions" to reduce costly hospital readmissions.
The second phase was announced Aug. 27, 2015, and allows organizations that participate in the initiative to improve their quality of care with a new payment model. Under this phase, LTC facilities receive funding to provide treatment for their residents. This funding can be used to invest additional resources to begin programs and hire skilled staff members to improve the service offerings.
The ACA also requires each facility to have a Quality Assurance and Performance Improvement (QAPI) program to prevent these readmissions. For your facility, the main tenants of this QAPI program are to meet quality standards in quality of care (QA) and continually analyze your performance and create efforts to improve it (PI).
To learn more about reducing costly hospital readmissions at your long-term care facility, take one of Mariposa Training's long-term care courses today!