Case Management

How can I reduce my facility's readmission rate?

Case Management Monthly, January 1, 2010

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The discharge process is in the spotlight again. All the major payers are preparing to alter or refuse payment for patient readmissions within 30 days of discharge. Although Medicare has not established a target date for any changes in payment methodology, some of the commercial payers are connecting readmission prevention to pay-for-performance initiatives.

Dubbed “possibly preventable admission,” these return hospitalizations are connected with insufficient or ineffective discharge strategies that may have opportunity for improvement. Payers may accept a “planned readmission,” however. Case managers often use planned readmissions to coordinate patient care while managing LOS.

Many of the readmission prevention strategies originate from evidence-based practice and are predictors of successful and effective discharges. Below is a list of critical interventions that help prevent readmissions and can be applied to all discharges. These strategies are especially useful for patients with chronic, high-profile diseases (e.g., MI, CHF, hypertension, diabetes, asthma, chronic obstructive lung disease, and acute/chronic renal failure).

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