Heart Failure Readmissions were estimated to cost an additional $41.3 billion in 2011. This is a huge expense, but far from the emotional costs that many families had to go through, along with the discouraging fact that a family member was back in the hospital rather than at home recuperating. It is for reasons like these that CMS stepped in and instituted HRRP (Hospital Readmissions Reduction Program) to hold healthcare organizations more responsible.
I’m sure you’ve seen one of those commercials on TV that start out something like, “If you are one of the millions of Americans that suffer from heart disease or some other heart-related illness…” Many families are deeply affected by heart disease and illness and struggle with the fact that they feel like they are just another number or statistic within the healthcare system. Worse than that, medical professionals don’t always follow through with information about care, particularly after surgery, and the patient is back in the hospital within thirty days of initial admittance. This pattern hasn’t gone unnoticed by regulatory and reimbursement organizations like the Centers for Medicare and Medicaid Services.
The HRRP looks for hospitals and healthcare organizations that have high rates of readmissions for acute myocardial infarctions, heart failures and cases of severe pneumonia. Each year that a hospital didn’t meet established decreases in the number of readmission cases, that hospital would receive less reimbursement percentage from CMS. Specifically, the schedule looks like this:
- 1st year – 1% reduction in reimbursements
- 2nd year – 2% reduction in reimbursements
- 3rd year – 3% reduction in reimbursements (maximum percentage level)
No healthcare system wants to lose out on monies they could receive for services provided, however, even at the top percentage amount, many hospitals could absorb the costs and not be affected. The penalty may not be enough to deter some organizations from continuing their current course. This isn’t the situation with most, because most healthcare facilities want to stand out within their community, and the basic fact that a single readmittance usually doubles the cost of treatment. But the fact that finding and making necessary changes to the system isn’t an easy or quick fix. Most organizations have turned to utilizing and EDW (enterprise data warehouse) to ensure improvements are being made.
An EDW is pretty much what it sounds like, but it is much broader than might be expected. Within an organization, healthcare professionals may track and update a patient, no matter what office or location a patient is seen at or what procedure is done. The EDW tracks different kinds of information like:
- Financial costs
- Operational costs
- Patient satisfaction levels
- Clinical data from patient’s EHR (electronic health record)
With the insights and patterns defined and understood for a healthcare organization, it is much easier to identify hospitals that are struggling to improve their heart rate readmissions rate, and specific individuals who might be more at risk of falling into this category.
The Value of Evidence-based Medicine to Reduce Readmission Rates
Evidence-based medicine standards involves three components: the doctor’s personal expertise, peer-reviewed published research and the patient’s preferences and values. Physicians with plenty of experience in a specific discipline, such as cancer, heart surgery or diabetes, combine the things they have learned through their own clinical experiences with recent research published in medical journals to make more accurate diagnoses and to determine what recommendations to make to their patients. How effective different treatments are compared to each other is usually the first consideration. When multiple effective treatments are available, the doctor might narrow down the choices by considering costs or potential complications. The patient’s preferences also come into play, and a doctor who has a thorough understanding of the different treatments can give a patient information about things like side effects, projected outcomes, and further testing options. Doctors and healthcare facilities using evidence-based medicine typically develop comprehensive standards so that every physician in the office or hospital follows a similar protocol when faced with the same diseases or disorders.
To avoid letting the patient fall through the cracks after suffering from heart failure, and to reduce the chances of readmittance, hospitals can’t just rely on data but have a few things that will help ensure more success and better health for the patient.
- Patient education and management to instruct patients on what to expect during and after surgery or treatment and long-term expectations
- Medication reconciliation between doctor and patient allows the doctor to double check what is going to happen with the patient after discharge and takes the time to explain expectations with medications to the patient
- Follow-up appointment(s) scheduled before discharge because this helps to lay out the plan for the patient in their short- and long-term care and betterment
- Phone call or visitation with a patient after discharge provides a level of personal care that ensures a patient isn’t left in the cold and allows for questions to be answered that may not have been addressed or had been forgotten
Tackling the challenges that face healthcare organizations when it comes to heart failure readmissions is a multifaceted issue. Again, there aren’t simple and easy fixes, and as long as hospitals are not working to improve their readmission rates, they will be penalized. Patients are the priority and should not be just a statistic for or against the organization, but looked upon as important figure, no matter who they are. This may be the most important steps to improving health failure readmissions.