Readmissions: All things great and small

This week the federal government credited a program that penalizes hospitals for what it determines are excessive 30-day readmissions for heart failure, acute MI and pneumonia for a drop in all-cause readmissions. That may be hard to prove or refute.

Readmissions and strategies to reduce them have risen in prominence in recent years with a provision in the Patent Protection and Affordable Care Act that allows Medicare to withhold reimbursement to hospitals with higher-than-expected readmission rates for heart failure, acute MI and pneumonia. The program identified the three conditions as among the most costly.

As reported this week, the Centers for Medicare & Medicaid Services is putting the pieces in place to add CABG to the list in fiscal year 2017. Some hospitals have taken proactive steps to avoid those penalties by piloting initiatives focused on improving care for patients once they are discharged to home.

This month’s Annals of Thoracic Surgery includes the results from a pilot test of a post-CABG transitional care program that successfully sliced the 30-day rate for readmissions or death to 3.85 percent. The rate for patients who received usual care was 11.54 percent. The authors provided a financial analysis from the hospital’s perspective in their paper.

A wise move. The program’s success hinged on the use of home visits by experienced cardiac surgery nurse practitioners who had cared for patients in the hospital setting. The analysis showed that the cost was justified, which allowed its designers to expand the initiative into other hospitals.

Also this week, Mayo Clinic researchers detailed in Health Affairs how they folded a “factory-focused” model of care into their cardiac surgery program. The effort took many years to plan, develop and implement, and challenged the dominant culture in which individual surgeons make decisions based on their experience, training and judgment.  

The clinic determined that about two-thirds of patients could receive the standardized factory-focused care, which freed up cardiac surgeons for more complicated cases. The program did not increase readmission rates. Instead, it led to improved quality of care and lower costs.

All of these gains trickle into a funnel that becomes data analyzed by the federal government. Did its readmissions reduction program nudge hospitals to initiate the changes? Maybe or maybe not. The federal analysis was all-cause readmissions for Medicare beneficiaries; in other words, a large swath of readmissions for a select patient population.

Either way, these individual efforts to reduce readmissions are commendable. If you also have a proven strategy or one in the works, please be sure to share it with us.

Candace Stuart

Cardiovascular Business, editor