Transitions Of Hospital Readmission Rates

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Transitions of Care There is a problem of avoidable hospital readmission rates for the Medicare and Medicaid populations that lead to adverse consequences not only for the patient, but also the payer and hospital. In order to decrease these avoidable readmission rates it is important to identify processes that can be implemented at the health plan level such as pre-discharge hospital visits by health plan staff, and post-discharge care coordination. Hospital readmissions are of great concern to the Centers for Medicare & Medicaid Services (CMS), medical providers, hospitals, and health plans as well. Decreasing 30 day readmission rates for CMS is part of the scorecard utilized for setting health plan Medicare rates and for Star ratings…show more content…
The State of Washington has applied these rules to their Medicaid population with the caveat that the readmission would be considered an avoidable readmission if it fell within 14 days of the previous stay at the safe or affiliated hospital (Payment Limits - Inpatient Hospital Services, 2011). These rulings detrimentally affect hospitals with high readmission rates among the Medicaid cohort and the actual readmission for the patient puts them at increased risk for infection and injury. The Robert Wood Johnson Foundation’s report on this conundrum (2013), notes that one in eight Medicare patients will readmit within 30 days of a previous hospital discharge; the reasons include the patient not being able to find their discharge paperwork, not understanding their discharge paperwork, and poor discharge planning. Working to resolve these issues could therefore decrease avoidable readmissions. Concept Quantitatively this issue can be documented in readmission rate statistics alongside the morbidity and mortality rate among the readmission cohort. By identifying the number of patients with preventable readmissions, and then categorizing the increased incidence of infection and/or injury in this cohort compared to like populations without avoidable readmissions one could show the burden of readmission. The Gap The difference between a successful discharge and an avoidable readmission comes down many times to poor care coordination on
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