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An Understandable View of the Hospital Readmissions Reduction Program

Even for the most experienced hospital teams, Medicare programs are difficult to unravel. There’s no question that the recent changes to Medicare are some of the most difficult, especially the initiative to reduce hospital readmissions. However, no matter if you’re a caretaker or a patient, if you work with Medicare your future depends on making sure you have n understandable view of the hospital readmissions reduction program.

One of our goals here at General Medicine is to help provide clarity about hospital readmissions, Medicare, and the hospital readmissions program, and even though this overview may raise more questions than it answers, we think it will get you started on the right foot.

leaving hospital with hospital readmissions reduction programThe Hospital Readmission Reduction Program began as part of the Affordable Care Act of 2010, which required HHS to implement a program that would reduce hospital readmissions, which studies had shown to be both excessive and preventable. Effective since on October 1, 2012, the Affordable Care Act sees re-hospitalization as an indicator of sub-quality care, and incentivizes hospitals to take action to improve the quality of patient care and prevent unnecessary hospital readmission.

The purpose of the hospital readmissions reduction program is to ensure that patients are only discharged from hospitals when they are healthy and prepared enough to continue their care at the same rate of improvement in their own home or at a lower acuity setting. It is expected to result in the improved quality and lowered costs of treatment for Medicare patients.

Hospital readmissions are defined as “an admission to a subsection hospital within 30 days of a discharge from the same or another subsection hospital,” and include short-term inpatient acute care hospitals. Studies show that twenty percent of Medicare patients are readmitted within one month of discharge. The Readmission Reduction Program seeks to reduce unnecessary readmissions by implementing tactics such as improving the coordination of patient transition and increasing the measurable quality of care provided to beneficiaries of Medicare.

One of the incentives offered to reduce hospital readmissions is to increase the quality of care patients receive during their initial hospitalization. This incentive is also part of a goal the CMS has to transition to a new kind of healthcare payment plan called value-based purchasing. In value based purchasing, care is paid for based on its quality as well as quantity, which is the current measurement of care compensation.

Another one of these incentives is an escalating penalization system that threatens to decrease payments from all of a hospital’s Medicare cases, should the hospital fail to follow the program. A hospital is considered to be out of the program’s limitations when the rate of hospital readmissions to discharging is deemed excessive. As a penalty, all payments made by the hospital’s IPPS for Medicare will be decreased up to one percent. The acceptability of a hospital’s readmission ratio is determined based on measurements from a complex National Quality Forum endorsed methodology.

In general, hospital readmissions are a complex topic to address, and a red flag that a patient did not receive the right kind of or high enough quality care before discharge. It is important to keep the public conversation about Medicare patients and hospital readmission so we can all stay in the know.

General Medicine, The Post-Hospitalist Company partners with facilities to enhance the quality of care and reduce readmission rates. For 2013, our partners achieved better readmission rates than 95% of CMS’ national peer group. Avoid penalties, meet regulations and improve care—partner with General Medicine.

Improve your hospital readmission rates. Partner with General Medicine.

Tom Prose

CEO at General Medicine, P.C.
As founder and CEO of General Medicine PC, the nation’s premier post-hospitalist care company,Tom Prose leads an exceptional team of internal medicine, geriatrics and healthcare administration specialists.