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Intro to HC

Susan DelGiorno-Ream

on 4 October 2012

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Transcript of Readmissions

Hospital Readmissions Reduction Program Readmissions defined:
readmissions that are unplanned but
related to index admission. CMS' plan CMS' Hospitals Readmission Reduction Program CMS' Hospitals Readmissions Reduction Program 20% reduction in hospital readmissions thus eliminating 1.6 million unnecessary rehospitalizations.
Foster a more person-centered health care approach
Integrated collaborative care reducing redundancies, needless delays and unwarranted referrals What are the goals? Hospitals, physicians and healthcare providers working together across the healthcare system to solve care challenges and improve safety. Improve care transitions by providing each patient with complex needs, a care plan that:
guides all care
moves with the patient across settings of care and time
reflects the priorities of patient and family and
meets the needs of persons living with serious chronic conditions. Rates were not outside norms, we had no penalty.
Vertical integration.
Physicians responsible also.
75% readmissions due to no follow up from PCP.
Shared savings module with all parties.
FY2013 Readmission Adjustment Factor = 1.000

PN cases = 97 = exc readmits 0.9625
HF cases = 96 = exc readmits 0.9767
AMI cases = 8 = 0.000 An interview with
an Administrator patient characteristics
home environments
lifestyle choices
access to primary care
complications Influential factors: Take a more proactive approach on index admissions.
Increase communication to referring provider.
Manage length of stay.
Improve efficiency
Foster a person-centered healthcare approach Increase Resource Management team The reduction in payment of readmissions to hospitals is estimated to be $10 billion through 2013 if CMS' goal of reducing readmissions and hospital acquired conditions are met. Partnership for Patients 2005 facts:
17.6% of admissions within 30 days
$15 billion spent on readmissions
$12 billion preventable
Approximately $7K per case. What's required for safe, effective transitions? Patient and caregiver involvement
Person-centered care plans that are shared across settings of care
Standardized and accurate communication and information exchange between the transferring and the receiving provider
Medication reconciliation and safe medication practices
The sending provider maintaining responsibility for the care of the patient until the receiving clinic and location confirms the transfer and assumes responsibility. Rate equals base operating
DRG + adjusted factor that
accounts for excess admits
starting 10/1/2012.
Full transcript