Reducing Readmissions Leads to Higher Medicare Reimbursement for Hospitals

Often times, intuitive solutions to clinical problems do not lead to actionable efforts until either the carrot or the stick are applied.  Reducing hospital (or Skilled Nursing Home) readmissions is a good example.  When a patient comes to the point of discharge, many institutions have already fallen well behind the line which defines the opportunity to prevent the patient from returning.  This occurs because of lack of communication, lack of preparation, and lack of thoroughness.  

Take the example of the patient who was admitted recently for a COPD exacerbation.  After a brief intubation, the patient responded to corticosteroids and nebulizers, as well as antibiotics, but not before the complication of c.diff colitis developed, which necessitated another week in the hospital for Vancomycin.  The patient was largely confined to bed and began to develop a sacral decubitus ulcer.  Once the respiratory and colonic issues resolved, the patient was hastily discharged to a SNF.  Upon arrival at the SNF the admitting provider noted the patient had a low grade fever and a Stage V sacral pressure ulcer.  Labs were done and the WBC was 12,000.  The patient was immediately sent back to the hospital for debridement. Lost opportunity, lost revenue.

Medicare recognized the dilemma well after physicians and hospitals, and it chose to wield the stick.  HRRP (Hospital Readmissions Reduction Program) was developed which reduces reimbursement when readmission occurs for various medical conditions including Acute MI, COPD, heart failure, pneumonia, among others.  So now It is financially important, as well as clinically important, to improve the discharge process.

Here is where our services fit in nicely.  With transitional care and wound care services, we work directly with the hospital and SNF to reduce readmissions.  Our providers gather the vital health details that are often missed, putting the big picture together. Our social workers facilitate communication by gathering information, and following up on arrangements for  home care services.  Readmission rates already start to decrease. Then we see the patient within 2 days of discharge for an exam and review of medications. Further reduction in readmission.  Any wounds are addressed by our surgical team, and these skilled eyes and hands can manage many wounds which otherwise would require return to the hospital. Consider involving Home Life Primary Care and Social Services early, and keep the revenue for which your institution worked so hard.