Value-Based Care Trends: Hospital Readmission Reduction

Hospital readmission reduction is one of the fundamental goals of value-based care.

Returning to the hospital soon after an initial discharge is hard on a patient’s health. It greatly increases the risk they’ll develop new problems, such as infections, bed sores or blood clots.

It’s also costly. The federal government estimates that nearly 1 in 5 Medicare patients are readmitted to the hospital within 30 days of their initial discharge, costing Medicare more than $26 billion annually.

However, the situation isn’t as dismal as it sounds. That’s because more doctors and hospitals are adopting value-based care models to help them deliver high-quality and efficient medical services. Two value-based care trends in particular — patient-centered medical homes and accountable care organizations — are positioned to help mitigate hospital readmissions.

Why Hospital Readmissions Occur

Often, patients are readmitted to the hospital because of mismanagement during their transition from hospital to home. For example, nurses might speed too quickly through discharge instructions and guidelines regarding discontinued medications, leaving patients confused about what they are being asked to do. Hospital staff might also neglect to inform patients’ primary care doctors of the hospitalizations. Without this knowledge, these doctors may not realize that they should follow up with the patient.

Of course, problems can also occur for other reasons. Sometimes, patients simply don’t have the resources they need to heal, such as transportation to a doctor appointment, money to pay for medications or someone at home capable of helping them recover.

The Role of Medicare

The Centers for Medicare and Medicaid Services is a major player in the efforts to reduce hospital readmissions through its Hospital Readmission Reduction Program. Launched in 2012, the program levies penalties of up to 3% of a hospital’s payments from Medicare if its readmissions are higher than expected for six conditions: heart attack, congestive heart failure, pneumonia, chronic obstructive pulmonary disease, hip and knee replacements, and coronary artery bypass graft.

How Providers Are Addressing Hospital Readmissions

Several value-based care trends, including patient-centered medical homes and accountable care organizations, may be able to help reduce hospital readmissions. These organizations rely on two key strategies — patient care coordination and digital sharing of patients’ medical records — to deliver high-quality and efficient patient care.

In a patient-centered medical home, primary care doctors direct all care for their patients, coordinating with medical specialists, hospitals, rehabilitation facilities and home care agencies in the process. Physicians and support staff also coach patients on managing chronic diseases and adopting healthy behaviors. Sharing this kind of information in patients’ electronic health records helps providers collaborate efficiently.

In an accountable care organization, hospitals and doctors form an integrated network to share the financial risk of providing high-quality care at a reasonable cost. They collaborate as a team and share access to patients’ electronic health records to facilitate their work.

When patients in these models are hospitalized, providers ideally coordinate their medical care after discharge to reduce the risk of unplanned readmissions. This may involve follow-up phone calls, office appointments and in-home visits — whatever’s necessary to ensure patients are taking their medications correctly and have the right resources to recover from their illnesses.

Through patient care coordination and digital information-sharing, these value-based delivery models could help decrease hospital readmissions. This means your employees could make speedier recoveries, and your business could make larger leaps to its next stage of success.

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