Preventing Hospital Readmissions: The First Test Case for Continuity of Care, is a report that evaluates research on hospital readmissions, and examines the approaches successful hospitals have taken to reduce readmissions. The research suggests that while there is no one model that all hospitals can adopt that will magically decrease readmission rates, there is an opportunity to use electronic health records (EHRs) and other technology to support hospital discharge practices and procedures designed to follow patients more intensely after they've left the hospital.
The quest for hospitals to reduce readmission rates reflects both the desire to raise the quality of care, as well as the need to preserve reimbursement. Under the Patient Protection and Affordable Care Act, the federal government can withhold a portion of Medicare payments to hospitals that have excessive 30-day readmissions rates. Starting October 1, 2012, the maximum penalty will be worth 1% of a hospital's base Medicare reimbursement. In 2013, the penalty jumps to 2% of base Medicare reimbursements, then 3% the next year.
According to a report published Monday in Kaiser Health News, more than 2,000 hospitals will be penalized by the government starting in October. In total these hospitals will lose about $280 million in Medicare funds because many of their patients were readmitted to the same hospital that recently discharged them.
To avoid these penalties, hospitals are advised to include patient monitoring in post-discharge care plans to address any gaps in care--such as a patient forgetting to take medications or follow up with a physician--that may result in a patient's return to the hospital. Adopting an approach that continues to follow patients, the report said, "will only be possible with the assistance of health IT to accomplish communication and close loops."
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While technology will be a significant driver in post-discharge care coordination, however, hospital CIOs and other IT managers face many challenges as they seek to integrate different technologies and manage information both within a hospital network and with organizations outside of a hospital system.
The report also suggests that an increasing volume of information related to the patient's condition and circumstance must be captured, which ranges from data on medication reconciliation, scheduling appointments for clinicians to visit patients, tracking the completion of transition milestones, and providing online access to up-to-date contact information for clinical partners.
According to Jane Metzger, the report's author, post-discharge procedures and protocols must address the transition risks, as well as the medical condition of each patient, and EHRs can help make this possible. For example, the EHR can help build the transition care plan that might include a follow-up phone call on the first day after hospital discharge to a pneumonia patient who is at high risk of readmission, or on the second day for a surgery patient to make sure there is no fever and the wound is healing. While significant opportunities exist to reduce hospital readmissions, applying technology to support transitions in care is still in the early stages of development.
"We have not yet done a lot of work on enough extensions of the EHR, new enhancements to the technology, or possibly bridge applications that fit in between," Metzger said in an interview with InformationWeek Healthcare.
She added that many organizations are hampered because they have deployed different EHR systems across various departments within a hospital, which makes the task of integrating these systems more difficult. Metzger also said today many institutions depend on faxes, email, and phone calls to coordinate transitions in care, and noted that "unfortunately we are not at a point today where the EHR is going to do all this."
In the meantime, with the rapid adoption of EHRs and the advent of health information exchanges, healthcare providers can look forward to an advanced health IT infrastructure that will drive patient information to caregivers and help them improve their plans to coordinate transitions in care.
According to the report, "Meaningful use for HITECH will provide the critical foundation of much more complete patient information available in the EHR and the basic infrastructure for communicating with clinical partners through health information exchange."