60 | Efforts to Reduce Readmissions
BACKGROUND As a part of its strategic plan for 2010–2014, Adventist HealthCare (AHC) has employed a strategy of providing population-based care to the communities it serves. Through the use of innovative and patientcentered discharge processes and the cultivation of community partnerships, AHC has become a leader in its efforts to ensure patient wellness after discharge from its hospitals. “Nearly one in five Medicare patients discharged from a hospital—approximately 2.6 million seniors—is readmitted within 30 days, at a cost of over $26 billion every year.”55 While not all readmissions can be predicted or prevented, it is estimated that more than $17 billion each year pays for readmissions that are in fact preventable.56 Adventist Rehabilitation Hospital of Maryland (ARHM) and AHC’s acute-care hospitals—Shady Grove Adventist Hospital (SGAH) and Washington Adventist Hospital (WAH)—participate in the Partnership for Patients, a CMS program with goals to improve patient safety and support effective transitions from hospitals to other settings.57 Our hospitals are part of Premier’s Hospital Engagement Network (HEN), a collaborative of 450 hospitals and the largest CMS-approved HEN in the nation. The HEN focuses on multiple areas that affect patient safety including preventable hospital readmissions. HEN rates are calculated using the Admission-Readmission Revenue (ARR) method, giving credence to Maryland’s modernized all-payer rate-setting system for hospital services, an unprecedented effort to enhance care for patients, improve health care outcomes, and control costs across the state.58 Participation in the HEN provides significant opportunities to exchange best practices among hospitals across the country to address care and safety for Medicare program participants. Because of AHC’s commitment to quality and safety and its partnership with Walgreens, Premier invited WAH to present their efforts at their annual Breakthroughs Conference in November 2013. A CALL TO ACTION The need for action around reducing preventable readmissions has recently been reinvigorated with a sense of urgency due to new provisions in the Patient Protection and Affordable Care Act (ACA). The Medicare Readmission Reduction program, which went into effect October of 2012, reduced payments up to one percent for hospitals with excess preventable readmission rates related to heart failure, acute myocardial infarction, and pneumonia.59 This deduction will increase to two percent in 2014 and peak at three percent in 2015, while also expanding to conditions including chronic obstructive pulmonary disease and coronary bypass grafting. In addition to financial penalties for doing poorly, new Medicare policies have been instituted to provide financial rewards to those hospitals that are meeting or exceeding certain quality measures. Several of these quality measures focus on discharge practices such as informing patients of symptoms to look out for post-discharge and inquiring if they will have the necessary help and support once they return home.60 A high rate of preventable readmissions is often a complex problem stemming from multiple causes, and therefore requires a multifaceted approach to remedy. Over the past two years, WAH has successfully implemented programs to enhance the discharge process for all patients, adopted an added focus on high-risk patients and cultivated community partnerships to improve the continuum of care post-discharge. Through its efforts, WAH has seen a 4.5 percent reduction in readmissions, decreasing from 11 percent in December of 2011 to 6.5 percent in September of 2013. At the same time, SGAH has implemented programs to assist in the post-discharge care of high-risk patients, partnering with post-acute care providers and using a disease-specific model to address the most vulnerable patients. SGAH has seen a 1.07 percent reduction in readmissions, decreasing from 6.83 percent in December of 2011 to 5.76 percent in August of 2013. The hospital continues to work on other disease specific initiatives to reduce readmissions.