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Home Care Opportunities Accelerate as Most Hospitals Face Readmission Penalties


Attention, home care leaders!  Your current and potential hospital partners have more reasons to seek help with their goal of preventing inpatient readmissions. Maybe it’s time to approach them and revisit this goal with a more specific game plan that addresses key diagnoses in your market?  According to a report inModern Healthcare last month, most of our nation’s hospitals will get even less money from Medicare in fiscal 2016 because too many patients return within 30 days of discharge. 

Based on the newly posted CMS data, a full 77% of the 3,400 hospitals subject to the CMS 30-day Hospital Readmissions Reduction Program performed poorly and face some penalty, and more than 1% will be subject to the maximum 3% reduction in 2016.

Julia H. Maroney, RN, MHSA, Director, Simione Healthcare Consultants, concurs that it’s time for home care organizations to seize the day.  “Home care agencies should consider stronger efforts and build new relationships to identify the kinds of patients they are getting from hospitals, while developing a clearer picture on their own readmission rates in the disease categories that are subject to this increasing scrutiny,” Maroney says. “Additional work with hospitals can help better identify the typical 20% of hospitalized patients who are eligible for home health services, as well as establish shared goals for quality of care throughout the course of each patient’s experience.”

“Home care has come a long way when it comes to partnering with hospitals for better patient management,” she says, “yet, we still have a lot to accomplish.  We need to consider more integrated efforts based on a case management model, where the focus is managing patients rather than managing visits. Our relationships need to improve across the continuum.”

The CMS readmissions program, created under the Affordable Care Act, initially evaluated how often patients treated for heart attack, heart failure and pneumonia had to return to the hospital within 30 days of discharge. For fiscal 2015, CMS added two conditions — chronic obstructive pulmonary disease and total hip/total knee replacements.  Penalties for exceeding permissible readmission rates reduced Medicare payments by up to 1% in fiscal 2013, increasing to 2% and 3% in fiscal 2014 and 2015, respectively. An increasing majority of hospitals face fines in fiscal 2016 as well.

Since the July 2015 issuance of the final rule for Medicare's hospital inpatient prospective payment system, the hospital readmission reduction program has faced increasing criticism by health policy and industry groups representing hospitals. They argue that many factors affecting whether a patient needs to be readmitted are beyond a hospital's control.

Home care providers are painfully aware of the potential impact of socio-economic status and other factors on patient outcomes. With many home care organizations operating longstanding programs to improve community health status, they have great opportunity to break new ground in collaborative efforts to improve patient outcomes, according to Maroney. 

“Readmissions remain a problem in every community.  Each community has specific factors and solutions, but the bottom line is that some patients go home from the hospital and don’t do well,” Maroney explains.  She recommends these considerations for home care agencies to revisit the issue of preventing hospital readmissions: 

  • Enhance or create a clinical liaison role for facilitation of referrals (this position is often cut when finances are tight, yet it is critical to referral management)
  • Assess your interdisciplinary team case review efforts for performance improvement opportunities with specific diagnoses
  • Develop and/or enhance disease-specific programs within your agency and as part of collaborative efforts with hospitals and other providers (cardiovascular, diabetes, COPD)
  • Evaluate and expand community-based efforts for adult immunization, telemedicine and other wellness programs focused on prevention
  • Assess training needs to improve staff competency for managing specific diagnoses
  • Evaluate recruitment needs for staff by discipline/area of expertise
  • Invest in quality reporting resources that will give you the data you need to approach hospitals in meaningful ways to improve the readmission picture.  Are your agency’s readmission rates higher than regional or national benchmarks reported by Medicare (OBQI)?  You need to understand why.
  • Know what hospitals are up against; develop an understanding of the Value-Based Purchasing (VBP) requirements that rate the process-of-care, dimensions of the patient experience, outcomes and efficiency. How can your agency contribute to improve these measures?

For more information about ways that Simione can help with readmission prevention efforts, call 844.215.8822.