Case Management

CMW sneak peek: How can I reduce my facility’s readmission rate?

Case Management Weekly, January 13, 2010

By June Stark, RN, BSN, MEd

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. Medicare has not established a target date for any changes in payment methodology, but some of the commercial payers are linking readmission prevention to pay-for-performance initiatives.

Dubbed “possibly preventable admission,” these return hospitalizations are associated 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 readmission prevention strategies originate from evidence-based practice and are predictors of successful and effective discharges. The following list of critical interventions can help prevent readmissions and is applicable 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).

  • Early appointment with PCP postdischarge. Schedule an appointment two to seven days after discharge.
  • Accurate medication reconciliation prior to discharge. Consider sending a copy of the medication reconciliation home with the patient.

Check out the January 2010 issue of Case Management Monthly to learn more. You also can discover the benefits of becoming a Case Management Monthly subscriber.

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