Top Factors in Decreasing Hospital Readmission Rates
A new study evaluating CMS hospital readmissions programs was published by the University of Michigan (UM) in the August edition of the Journal of the American Medical Association. After CMS launched the Hospital Remission Reduction program in 2012, healthcare providers across the country have attempted to lower their readmission percentages—and keep them low.
For the most part, these measures appear to be working. The UM study analyzed data on patients treated between 2008 and 2015 for acute myocardial infarctions (heart attacks), heart failure, and pneumonia. According to the Kaiser Family Foundation, national Medicare readmission rates have fallen by at least two full percentage points for each of these conditions.
The UM study has linked these lower readmission rates to voluntary value-based CMS programs. Specifically, these three programs: meaningful use of certified hospital EHR programs, accountable care organizations (ACOs), and the bundled payments for care improvement (BPCI) initiative.
One of the most important findings from this study could be that hospital readmission rates were lowest when all three programs were used in unison. This may be the first research to suggest that harmonious value-based programs encourage efficiency and overall progress more than singular programs and penalties alone.
Top 10 States with the Highest Readmission Rates
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Fig 1 Data from Definitive Healthcare. Based on hospitals self-reporting average hospital-wide readmission rates.
UM researchers reported approximately 2,400 fewer hospital readmissions and Medicare savings of $32 million when all three programs were working simultaneously. Additionally, readmissions reductions were greater for value-based reward programs than for penalty programs.
Individually, the UM study states, meaningful use participation led to a 2.3% decrease in annual readmission reduction among the 2,837 hospitals evaluated. Involvement in an ACO led to a 2.1% decrease in annual readmission reduction. Involvement in all three programs led to a total decrease of 2.9% in annual hospital readmissions.
Along with CMS program participation, patient engagement is also a factor in reducing hospital readmission rates according to a new study by the journal Patient Experience.
The research team behind the Patient Experience study analyzed HCAHPS scores from nearly 25,000 patients between April 2011 and March 2014. Researchers then compared the scores to hospital readmission rates in order to examine associations between patient-provider communication and hospital readmissions within one year.
Top 10 States with the Lowest Readmission Rates
|State||Avg. All-Cause Readmission Rate|
Fig 2 Data from Definitive Healthcare. Based on hospitals self-reporting average hospital-wide readmission rates.
The specific HCAHPS questions researchers examined were related to patient involvement in treatment decisions, whether patients received written instructions when they were discharged, how well patients understood the purpose of their medications, patients’ understanding of their own responsibility in managing their health, and whether providers talked to patients about help they may need when returning home.
The study found that 18.6 percent of patients were readmitted to the hospital between 43 and 365 days after their initial discharge. Patients who reported they were not involved in their initial care were 34 percent more likely to be readmitted within one year, and patients who did not report receiving written information were 24 percent more likely to be readmitted. Combined, patients who reported both were 54 percent more likely to be readmitted to a hospital within one year.
However, of all the factors researchers measured, these were the only two that affected readmission rates.
In addition to treating patients as partners in their care, primary care physicians can also provide written instructions for post-discharge care and involve family members in the care planning process. This new data offers concrete opportunities for providers to improve care quality and communication with patients while simultaneously reducing readmission rates and raising HCAHPS scores.
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