The federal government is reducing payments to hospitals that readmit too many patients, but improving your facility’s discharge process can help you avoid payment reductions. Staying on top of the latest programs and regulations from the Centers for Medicare & Medicaid Services (CMS) is crucial in this area.
The Feds Want Fewer Readmissions
Discharging patients from the hospital is a complex process that is fraught with challenges. Almost 20 percent of Medicare patients who are discharged from a hospital are readmitted within 30 days. Unplanned readmissions cost $17.4 billion in 2016 and accounted for 17 percent of total hospital payments from Medicare. Both Congress and CMS have made it a major priority to cut down on readmissions.
Research suggests that anywhere between 44 percent and 76 percent of hospital readmissions are preventable. Preventing avoidable readmissions can profoundly improve both the quality of life for patients and the financial wellbeing of health care systems.
Under the Affordable Care Act’s Hospital Readmissions Reduction Program (HRRP), CMS will withhold $528 million in payments in 2017—an all-time high and an increase of about $108 million from FY 2016. And the federal IMPACT Act has resulted in reduced payments to hospitals that have a higher than average readmission rate for a variety of conditions, including new ones in 2017. New evidence-based research is coming out every day on recommendations to help reduce unnecessary readmissions.
New Requirements for Discharge and Post-Discharge
Finally, the 21st Century Cures Act is now on the books. This federal law makes adjustments to the HRRP to account for socioeconomic status, which can impact patient outcomes, and will affect fiscal year 2019. MedPAC has been charged with conducting a study to review all hospitals’ admissions, including whether readmissions are related to any changes in outpatient and emergency services.
Hospitals need to understand how this new law will affect their discharge and post-discharge processes. A thorough review of your facility’s strategies at discharge is crucial, and should include, for example, a complete list of meds is provided, along with comprehensive information on hospital care and what needs to be done for continuity of care, per CMS requirements in discharge planning standards.
Reengineer Your Discharge Process
ProfEdOnDemand recently hosted the live audio conference “Preventing Hospital Readmissions Through Discharge Planning” with noted expert Sue Dill Calloway, RN, MSN, JD, who addressed strategies to prevent readmissions in light of the most recent programs at CMS.