August 02, 2016

4 Strategies for Further Gains in Reducing Readmission Rates

There’s a delicate balance between providing comprehensive care for high-risk patients and ensuring there will be beds free for such patients. The Centers for Medicare and Medicaid Services (CMS) want to make sure the balance tips in favor of comprehensive care — with the specific goal of reducing readmissions which should, in turn (and in theory), help keep beds free for new patients.

In essence, the Medicare Hospital Readmission Reduction Program (HRRP) is about encouraging higher-quality patient care from the start, rather than higher volumes of care episodes overall. The initiative has been rolled out for specified risk conditions, but readmission rates in these five areas could mean financial penalties that affect care for all inpatient admissions (see Figure 1).

Here are four strategies for enhancing patient care, safeguarding against mishaps, and preventing avoidable readmissions, to help avoid reimbursement reductions.

1. Enable accurate documentation

Electronic health records (EHRs) are only as good as the documentation entered into them. Therefore, all medical decisions, procedures, tests and medications ordered during the entirety of the patient encounter need to be documented thoroughly and, often, quickly. A complete record lets the various physicians, nurses and other clinicians who encounter the patient to make better-informed decisions about the next steps for treatment. However, physicians often find data entry a time-consuming task that takes their focus away from medical care of the patient. Certified, trained medical scribes can help save physician time and hone physician focus by documenting all details of patient encounters in real time, making it easier to transfer essential information between providers and departments, including onto the post-discharge phase of a patient’s care.

2. Coordinate and communicate between acute and post-acute care

As various CMS efforts around “episodes of care” make abundantly clear, patient care doesn’t end after discharge. The transition from acute to post-acute care poses a high risk of complications and, therefore, readmissions. Often, complications arise not due to a failure in acute care, but due to a lack of communication and coordination between acute care hospitals and home health care/nursing care/outpatient primary physician care. The accurate, thorough documentation produced by medical scribes is a crucial communication connection between acute and post-acute care that helps post-acute providers gain a clear understanding of the history and current state of the patient. Furthermore, using medical scribes in the outpatient setting can help speed and strengthen data integration, letting providers more effectively chart the progression of and manage the patient’s health condition.

3. Prepare stakeholders before discharge

Patients must be active stakeholders in their own care, and their preparation and education is key to preventing unnecessary complications and readmissions. Acute care hospitals should also take steps to include families and carers when developing well-defined goals for post-hospital care. Patients and their families/carers should be provided with clear instructions before discharge, education about their condition, and what signs do — and do not — require a hospital visit.

4. Follow-up of high-risk patients

After an acute-care episode, direct responsibility of patient care is passed on to the post-acute healthcare provider; however, this doesn’t mean that the hospital where the initial point of care occurred should be out of the loop. Follow-up not only helps patients be more satisfied overall with their care, but could be advantageous if the patient does need readmission for an acute episode down the line. Using nurses, for example, to check in on the patient at the one- and/or two-week interval could flag issues that may be appropriately treated in the outpatient setting, before they become serious enough to require readmission.

Developing service-delivery solutions that fit your hospital’s workflow is a relatively inexpensive way to help minimize preventable readmissions and the millions of dollars in penalties that can result. Even better, strategies such as these bolster patient satisfaction with their care, and communication between providers, departments and facilities, which can have lasting effects for successful patient care for all conditions.