Monday, March 7, 2011
Source: Around WellSpan Online
The last thing most patients want to do after being discharged from the hospital is to return any time soon. Yet, 18 percent of Medicare patients discharged from the hospital have a readmission within 30 days. These readmissions account for $15 billion in spending.
In an effort to decrease readmissions within 30 days of discharge, the Centers for Medicare & Medicaid Services (CMS) will be able to penalize hospitals by withholding a percentage of reimbursement based on readmission rates, beginning in the federal fiscal year 2013. Pay for performance is specifically addressed in the 2010 healthcare reform legislation.
“On any given day, WellSpan has 60 patients who have been readmitted within 30 days,” said Ann Kunkel, director of case management. “That’s enough patients to occupy all of T-2 at York Hospital. “Eleven to 15 patients are readmitted daily.
Understandably, patients are not happy about being readmitted,” she added. The Medicare Payment Advisory Commission has concluded that two-thirds of all readmissions are avoidable.
While hospitals will have a financial incentive to reduce readmissions, Kunkel said the driving forces behind WellSpan’s efforts are patients’ increasing demands and expectations.
“Patients have clearly voiced their dissatisfaction with readmissions within 30 days of discharge,” said Kunkel.
She said multiple factors contribute to avoidable hospital readmissions. Factors include poor transitions among different providers and care settings, ineffective communication, incomplete or late discharge summaries, premature discharge or discharge to an inappropriate setting.
WellSpan is implementing changes to address the issue of readmissions. It is focusing on three conditions for which the most readmissions occur: congestive heart failure (CHF), acute myocardial infarction (AMI) and pneumonia.
“Our strategy is to improve communication from provider to provider and to tighten the management of the transition from inpatient to outpatient,” offered Kunkel.
WellSpan started working on improving the completeness and timeliness of discharge summaries last year. The discharge summary is a communication tool to the primary care provider about the patient.
In February 2009, only 14 percent of primary care providers were receiving discharge summaries within 48 hours. That percentage has jumped to 77 percent at Gettysburg Hospital and 63 percent at York Hospital.
Nationally, one in five discharges has some sort of adverse event related to an incomplete discharge summary, according to Kunkel. Patients are understandably anxious to be discharged from the hospital and staff members are busy. That often leads to a rushed experience. The average time spent on discharge instructions is only eight minutes.
“We are working on devoting more time to discharge plans and strengthening the transition from inpatient to outpatient,” said Kunkel.
Another effort is to make sure a discharged patient has a follow-up appointment with their primary care physician within five days of discharge. And, if a patient doesn’t have a primary care provider, he or she will be connected with one.
“Through the hard work of many staff members, we believe we’ll be able to decrease our readmission rates,” said Kunkel.