Act on the front-end to reduce readmissions penalties

Nov. 16, 2018 / By Steve Cantwell

In my previous blog, I took a hard look at the impact of mental health and substance abuse on hospital readmissions, especially the torrent of patients with these issues coming through emergency departments. To be honest, I came away a bit discouraged, wondering how hospitals can ever control readmissions.

Well, Eric Sorenson, a 3M quality and CDI leader, talked some sense into me. He’s visited more than a few hospitals and seen them take decisive action on quality issues like readmissions—actions that work. Rather than being blinded by what appear to be unavoidable penalties, Eric suggests we see “payment adjustments” as an issue we can do something about—with accurate documentation up front and proactive discharge protocols on the back-end. 

One thing organizations can do up front is focus on the accuracy of their HCC (hierarchical condition categories) coding and the clinical documentation that supports it. Eric explained to me: “It’s crucial to make sure you’re measuring the problem accurately. Hospitals that do this have a far more accurate baseline for the expected vs. predicted readmissions ratio. We see many scenarios where by simply focusing on more accurate documentation up front, hospitals can get out of the penalty zone.”

If you have accurate data on patients at risk for readmission, you can be more proactive with clinical support on the back-end—such as precise discharge instructions and planning, support for prescriptions or intervention from a home health agency.

Eric also clarified for me some common misunderstandings about how Medicare determines penalties. “Predicted” readmissions are analogous to “observed” cases people are more accustomed to—the key difference being that “predicted” or unplanned readmissions are risk-adjusted for a hospital’s patient population.

So, if you’re feeling a little freaked out by readmissions and want to know how hospitals are reducing penalties, listen to my conversation with 3M quality and CDI expert Eric Sorenson.

Steve Cantwell is a senior marketing communications specialist at 3M Health Information Systems.