Nationwide, hospitals have been feeling the burden of Medicare penalties for avoidable 30-day readmissions. In fact, a total of $280 million in hospital readmissions penalties will be paid by 2,213 hospitals this year as a result of the Hospital Readmissions Reduction Program administered by the Centers for Medicare & Medicaid Services (CMS).
In order to bring down their avoidable readmissions rates, hospital executives have been frantically searching for ways to pinpoint high-risk patients early on or ways to improve care coordination once patients are discharged. Just two examples of the many strategies hospitals are using to reduce 30-day readmissions are Project BOOST and a Californian program targeting elderly heart failure patients.
A program developed by the Society of Hospital Medicine and in use by 140 hospitals nationwide has shown the potential to improve the discharge process and prevent avoidable rehospitalizations, according to a study published in August by the Journal of Hospital Medicine.
According to Luke Hansen, study author and assistant professor at the Feinberg School of Medicine at Northwestern University, Project BOOST (Better Outcomes by Optimizing Safe Transitions) is a mentoring program that focuses on identifying patients at the highest risk for readmissions, communicating discharge plans effectively and ensuring close follow-up through phone calls and doctors’ appointments.
The researchers found that the average rate of 30-day rehospitalizations in BOOST units was 14.7 percent prior to implementing the program and 12.7 percent a year later, reflecting an absolute reduction of 2 percent and a relative reduction of 13.6 percent. The average absolute reduction in readmission rates in BOOST units compared with other units was 2.0 percent, or a nearly 14 percent relative reduction.
The BOOST program includes a discharge checklist for physicians and nurses, patient discharge instructions that are “very patient-friendly and readable,” user-friendly medication instructions and follow-up phone calls within 48 hours, said Hansen, who serves as a mentor in the BOOST program.
Another program aimed at reducing readmissions focused on elderly patients with heart failure at the University of California, San Francisco (UCSF) Medical Center. Utilizing the program in collaboration with the Institute for Healthcare Improvement (IHI), the hospital was able to reduce rates of heart failure readmissions over a two-year period by 46 percent within 30 days of hospital discharge and by 35 percent within 90 days.
According to a case study by The Commonwealth Fund, coordinators of the program were hired to provide enhanced patient education and follow-up care connections to promote the elderly patient’s successful transition to home or to skilled nursing care.
The program started out with a target population of Medicare patients age 65 and older (average was age 80) hospitalized with a primary or secondary diagnosis of heart failure (representing approximately 700 admissions during the year the program began).
According to Douglas McCarthy, senior research advisor at The Commonwealth Fund, the program consists of two heart failure program nurse coordinators, supported by a multidisciplinary team comprising a cardiovascular service line director, hospitalists, cardiologists, clinical nurse specialists, case managers, social workers, pharmacists, dieticians, chaplains, educators, primary care physicians, skilled nursing facility staff, home care nurses and outpatient nurse practitioners.
The hospital also created a virtual care team, McCarthy said. “They use email in a creative way to let everyone in outpatient care, including primary care physicians, know where their patients are at and when they were discharged so everyone is in the loop.”