The Hospital Readmission Reduction Program (HRRP), which is managed by the Centers for Medicare and Medicaid Services (CMS), reduces payments to hospitals with excessive readmissions. High readmission rates can contribute to significant damage to a hospital’s financial health. What actions can hospitals take to lower readmissions?
The Agency for Healthcare Research and Quality estimates patients readmitted within 30 days cost the healthcare system more than $41 billion. Medicare beneficiaries account for more than half of this expense, including $17 billion spent on unnecessary hospital visits, according to the Center for Health Information and Analysis.
A significant contributor to hospital readmissions is inaccurate diagnosis and inappropriate treatment, including the use of excess antibiotics, unsuitable treatment, and poor selection of medication or treatment.
The Hospital Readmission Reduction Program (HRRP), which is managed by Centers for Medicare and Medicaid Services (CMS), reduces payments to hospitals with excessive readmissions. When assessing hospital performance, CMS puts particular focus on several conditions, including:
- Acute Myocardial Infarction
- Chronic Obstructive Pulmonary Disease
- Heart Failure
Why those conditions? Because they contribute significantly to hospital readmission rates. Studies have shown that 35% of heart failure patients are readmitted within 30 days. Ten percent of patients diagnosed with Acute Myocardial Infarction (AMI) are readmitted in that timeframe. While 22% of patients treated for pneumonia return to an inpatient hospital setting within a month.
Of all readmissions for those conditions, 61% occurred within 15 days of hospitalization. Longer term, the yearly rate of rehospitalization was even higher for heart failure, myocardial infraction and pneumonia.
Proper Prescription Diagnosis
One of the biggest causes of readmissions is the mis-prescribing, over-prescribing or under-prescribing of medicines. As just one example, patients hospitalized with pneumonia often receive more antibiotics than needed to treat their condition. Overuse of antibiotics often leads to antibiotic-resistant bacteria. When a patient is suffering from pneumonia caused by an antibiotic resistant bacteria risk of readmission within 90-days increases.
Reducing adverse drug affects and proper antibiotic selection leads to fewer readmissions. This happens when healthcare providers collect better patient data on the front end and document all of that information in the patient’s medical record.
It’s critical that the patient, or the in-home care provider, understands the importance of following the course of treatment. Confirming that the patient or a member of the household is able to manage medications greatly reduces the likelihood of readmissions. One study found that patients with low or moderate adherence to post discharge drug treatment had readmission rates of 20% compared to a readmission rate of 9% for patients with high adherence.
Benefits of Telemedicine
Patient Retention: Telemedicine can reduce patient referrals, increase patient preference, and improve the overall quality of care.
Staffing Solutions: Telemedicine offers a solution to physician shortage and where onsite staff are struggling to maintain an appropriate level of patient care.
Specialist Access: Telemedicine allows patients to receive care when the hospital lacks a specialist, or if local specialist requires night or weekend coverage.
How can an inpatient telemedicine program help?
Numerous studies have demonstrated that in-hospital consultation with the appropriate specialist is improves outcomes for hospitalized patients and lowers the possibility for readmission. For example, patients who received early intervention from an infectious diseases specialist were less likely to be readmitted after discharge. These patients also had lower total healthcare spending.
Many smaller hospitals can’t justify a fulltime onsite specialist in infection diseases, pulmonology or cardiology. These hospitals either do not have the patient volume to support specialist care 24/7/365 or the hospitals can’t afford to attract and retain these providers. This is where telemedicine can save the day.
Telemedicine can provide access to these specialists. Eagle telespecialists act as members of the medical team, consult directly with the patient, and respond on-demand. Since the telespecialist is shared among several hospitals, often within the same health system or region, the cost of retaining the provider is reduced. By implementing a telemedicine program, hospitals can provide a sustainable, cost-effective solution and offer needed specialist patient care.
Remote physicians are able to access all the information required to diagnose and treat the patient including patient medical records, vital information and diagnostic scans. Eagle’s providers interact face-to-face with the patient. This on-demand access to specialists enables hospitals to reduce physician burnout, nighttime staffing issues, and specialist shortages.