CMS Connect Login:

Login Assistance

Effects of 30-day Readmissions Policy

What hospitals and docs are saying

By Scott Warner

Is the Medicare Hospital 30-Day Readmissions Reduction Program (HRRP) a curse or a cure? Designed by policymakers and established in October 2012 as part of the Affordable Care Act (ACA), this controversial program is supposed to improve the quality of patient care and lower Medicare program spending, while providing a financial incentive to hospitals to lower readmission rates. While many health care professionals have praise for the program, they also fear unintended consequences, especially for safety-net hospitals that care for the sickest and most vulnerable patients. Many also question whether hospitals should be held accountable for things beyond their control, such as post-acute care information and patient behavior.

“It’s an all-cause policy,” says Danny Chun, spokesman for the Illinois Hospital Association (IHA). “It doesn’t matter why the patient returns within 30 days. Even if it has nothing to do with the condition they were originally treated for, the hospital will still be penalized.”

He gives the example of an elderly patient who is released after being treated for pneumonia, goes home weak, then falls and breaks a hip and comes back to the hospital, which is then penalized for the readmission.

“We don’t have any choice about the Readmissions Reduction Program,” says Robert Chase, MD, chief medical officer at both Westlake Hospital in Melrose Park, and West Suburban Medical Center in Oak Park. “We need to make the best of the program and look at it as an impetus for improving the situation.”

To help prevent readmissions, Dr. Chase, along with Ruth Matthei, RN, chief nursing officer at Westlake Hospital, point out that their facilities have put in place procedures to identify those patients most likely to be readmitted, so they can provide them with appropriate services and decrease their need for readmission.

For the pneumonia patient, for example, the hospital might prescribe physical therapy to strengthen the person before he or she goes home and thus reduce the chance that the patient will fall. And for all patients, the hospital makes sure that they receive clear instructions in their discharge papers, like when to take their medications; and that they receive educational packets. The hospital checks to see that patients have their own doctor; that they have access to home health care, if needed; or that they are set up with palliative care or hospice care.

“Sometimes everything is done for the patient, but he or she doesn’t want home health care, or won’t comply and take their meds, and end up being readmitted,” Dr. Chase says. “We analyze every readmitted case, but we may never be able to get zero readmissions.” “No one size fits all, when it comes to guidelines to prevent readmissions,” says IHA’s Chun. “Hospitals are diverse, but they all want the same thing—patient-centered care, and improved care—and not just to meet the new rules. The real focus is on care coordination to improve outcomes and that will help reduce costs.”

Several months ago, IHA issued a progress report on its Hospital Engagement Network, showing 100 participating hospitals in Illinois that have prevented 14,294 readmissions for a cost savings of more than $137 million since 2012.

Despite these figures, Chun says that no one knows yet if the program has proven to be cost-effective. Hardest hit are academic and teaching institutions, which serve more medically complex patients; and safety net hospitals, like inner-city hospitals that treat higher percentages of low-income patients and those on Medicaid, and are more likely to be hit with readmissions.”

What to do about the situation? “Physicians are key, and physicians and hospitals need to be aligned on readmissions,” Chun says. “It has to be a team effort across the board.”

Document Actions

Join CMS

Why join?  The Chicago Medical Society offers many benefits, including career placement, advocacy, networking, and member to member collaboration. Click here to explore all the benefits of membership.

CMS Connect

CMS Connect is an exclusive community that allows members to discuss the issues impacting their practices today. Visit CMS Connect today.