When Is a Readmission Really a Readmission?

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Karen Utterback By Karen Utterback 
Former Vice President, Product Marketing and Strategy, McKesson (Retired)

Home Health Agencies Key Role in Reducing ReadmissionssmWhen the dust settled (and CMS had tweaked its formula twice), more than 2,200 hospitals were hit with penalties for readmissions related to heart attack, heart failure and pneumonia. But I wonder what CMS thinks about patients returning to the hospital within 30 days of discharge and not being readmitted.

A study published online in April in the Annual of Medicine sheds light on this readmissions gray area. The six-month study was conducted at an urban academic center in 2010. During that period, there were 15,519 inpatient discharges of just under 12,000 unique patients. Of those total discharges, nearly one-quarter of patients returned to the ED within 30 days. However, only half of those visits resulted in an admission.

“Excluding a return to the ED misses more than 50% of all returns to the acute level of care after discharge,” the study concludes. “Inclusion of ED visits as a return to the acute care setting may enhance providers’ efforts to identify opportunities to improve care transitions and intervene in a cycle of frequent rehospitalizations.”

Looking deeper into the report, the top two diagnoses among returning patients were congestive heart failure and diabetes complications, according to MedPage Today. Each accounted for roughly one-third of ED visits. As you well know, home health agencies are ideally suited to care for CHF and diabetes patients post-discharge.

I’ve been saying this, but our industry has a vital role to play as hospitals look to lower readmissions. The first year of the Hospital Readmissions Reduction Program resulted in 4% to 9% lower readmissions, Jonathan Blum, deputy administrator and director for the CMS Center of Medicare, testified before the U.S. Senate Finance Committee in late February.

Hospitals will continue to combat the revolving door of readmissions, underscoring the need for care transitions. You should have a place at the table in your local market to make sure that hospitals recognize how home health agencies can help.

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