DIR Return Create A Forum - Home
       ---------------------------------------------------------
       Commissioning Forum
  HTML https://commissioningforum.createaforum.com
       ---------------------------------------------------------
       *****************************************************
   DIR Return to: Community Care
       *****************************************************
       #Post#: 55--------------------------------------------------
       Why the Focus on Readmissions?
       By: admini5 Date: May 11, 2015, 3:46 am
       ---------------------------------------------------------
       Hospital readmissions were one of the earliest targets of both
       quality measurement and performance-based incentives for
       Medicare and other insurance programs. Undoubtedly one reason is
       that claims provide data for measurement because the payer
       receives a claim (with some time lag) every time a patient is
       hospitalized. As a result, one party with a great interest in
       performance, the payer, also possesses a source of already
       structured data to measure performance — a rare situation in
       healthcare quality measurement.
       A readmission is defined as a return hospitalization to an acute
       care hospital that follows a prior acute care admission within a
       specified time interval, called the readmission time interval.
       Although policymakers and researchers sometimes use intervals
       such as 5, 60 or 90 days, current quality measures employed by
       CMS all use 30 days as the time interval between hospital stays.
       A second reason for the national public policy focus on
       readmissions is that they occur frequently in some populations
       and are extremely costly, in an era of great concern over the
       escalating costs of healthcare and a general lack of near-term
       achievable cost reductions. Most data about the extent of the
       problem in the United States is from the nation’s largest health
       insurance program: Medicare. According to one analysis of
       Medicare IPPS (fee-for-service) claims, 19.6% of patients
       discharged from an acute care hospital were re-hospitalized
       within 30 days and 34% within 90 days. MedPAC calculated that
       readmissions alone accounted for $15 billion in Medicare
       spending in 2005.
       Another reason that readmissions are an attractive target is the
       variability in rates observed between individual hospitals and
       among regions of the country, which offers hope that many
       hospitals can execute the transition from hospital care more
       effectively. That there is room for improvement in any hospital
       has been demonstrated over and over again in reports from
       individual hospitals in which systematic efforts targeted at
       high-risk patients have yielded significant and sustained
       reductions. Further gains seem possible if more hospitals adopt
       the practices used in the better performing ones.
       Judging improvement and estimating the potential savings that
       could be achieved nationwide if better practices were employed
       more uniformly requires understanding what percentage of
       readmissions is preventable. Despite several attempts to
       distinguish preventable from non-preventable readmissions, there
       is no consensus today about how many readmissions could be
       avoided if hospitals uniformly adopted better practices. Clearly
       not every readmission can be prevented, but estimates are high.
       MedPAC has estimated that as many as 84% of 5-day Medicare
       readmissions, 78% of 15-day readmissions and 76% of 30-day
       readmissions are potentially preventable. A more recent
       meta-analysis of studies estimating preventability found that
       the median proportion of readmissions deemed avoidable was 27.1%
       and varied from 5% to 79%, though criteria were often subjective
       and varied extensively.
       Whatever the actual upper limit, even a small decrease could
       achieve significant savings — not just in healthcare costs, but
       also in disruption and potentially dangerous deterioration in
       health status for the patients involved. From the perspective of
       the patient, any readmission is an adverse event.
       For further information, please visit :
  HTML http://assets1.csc.com/health_services/downloads/CSC_Preventing_Hospital_Readmission.pdf
       *****************************************************