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       #Post#: 297--------------------------------------------------
       Avoidable Readmissions – Punishing Patients and Providers
       By: Harald Braun Date: June 12, 2015, 4:07 am
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       [font=verdana]Avoidable Readmissions – Punishing Patients and
       Providers[/font]
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  HTML http://www.i5health.com/images/NHSbannerblog.png[/img]
       The 30 day readmission rule introduced in 2011/12 is an
       incentive for hospitals to reduce avoidable unplanned emergency
       readmissions within 30 days of discharge. Section 6.3.2 in the
       2014/15 National Tariff Payment System states that “Providers
       should not be reimbursed for the proportion of readmissions
       judged to have been avoidable”. Readmissions relating to
       maternity and childbirth, cancer, chemotherapy and radiotherapy,
       renal dialysis, organ transplant, young children, emergency
       transfers, cross border activity and where patients
       self-discharged against clinical advice are all payable to the
       provider.
       The scheme was designed to encourage providers and commissioners
       to manage emergency admissions through planned discharges,
       preventative initiatives, and greater involvement of experienced
       clinicians. Commissioners must reinvest money they retain from
       not paying in post discharge services that support
       rehabilitation and re-ablement. Commissioners are also required
       to identify patient groups that would most benefit from those
       services; they must discuss with providers where this money will
       be reinvested and must insure coordination with other
       commissioning decisions.
       Commissioners are required to set an agreed readmissions
       threshold and determine the amount that will not be paid for
       readmissions above this threshold. Setting a threshold requires
       measuring how many readmissions could have been avoidable, which
       is a challenge in itself. Separate thresholds can be set for
       readmissions following elective admissions and readmissions
       following non-elective admissions.
       To perform this process efficiently, a shortlist of patients
       that experienced an “avoidable readmission” should be made
       available to the review team. In this list, each patient should
       be categorised by the provider where an action could have
       prevented the readmission. This will inform the commissioner
       where a service gap exists e.g. hospital, primary care,
       community, social services etc.
       The disadvantage of setting a threshold is that if might put
       pressure on the provider to reduce readmissions but it does not
       accurately reflect clinical need of the patient or better
       outcomes. Instead a more advanced systematic solution should be
       used utilising algorithms that identify avoidable readmissions
       consistently, month-by-month, case-by-case that are not payable
       to providers. Also, it might not have been in the provider’s
       control where follow-up care failed to deliver or the patient
       did not adhere to the rehabilitation and an emergency
       readmission was required.
       Setting thresholds are a budgetary solution to a clinical
       problem where a lot of time and money is spent in discussions
       about what is over the threshold and not payable. Instead a
       short-list of patients should be compiled by clinical algorithms
       that are subsequently reviewed by a clinically led team to
       decide if the provider gets paid or not.
       Readmissions are generally indicative of ineffective patient
       management and call the quality of care provided across the
       continuum into question. However, while many readmissions are
       preventable, some are clinically necessary or unavoidable. Our
       research at i5 Health shows that over 10% of non-elective
       readmissions within 30 days are on the same day, over 20% on the
       next day and over 50% after 7 days of being discharged.
       Considering the short time-frames after discharge, those
       readmissions are unlikely to be caused by support services
       outside the control of the provider and are more likely to be
       due to low quality care.
       Readmissions within 30 days generally account for 12%-16% of all
       admissions whereby avoidable readmissions account for only
       2%-3%. If avoidable readmissions can be reduced, capacity can be
       released at the provider so that more patients can be treated
       for, the provider will be paid and the healthcare event will be
       a much more positive experience for the patient.
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