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Readmission data can inform formulary decisions

Medicare & Reimbursement Advisor Weekly, July 8, 2009

by Bryan Cote

I’m toiling away in the field this week on a tracking study regarding readmissions involving plans, hospitals, primary care practices, and skilled nursing facilities, so this is an abbreviated issue of MRAW. I thought I’d share some of the initial data from a participating hospital because Medicare is now reducing reimbursement for preventable readmissions, which means hospitals are trying to track the data and create solutions before, at, and post discharge.

There are opportunities for support, particularly for the case management, admissions, and discharge staff members, who are key influencers in the process and closest to seeing the impact of medication-related problems (reimbursement or clinical).

St. Joseph’s Hospital of Atlanta requires an assessment of every patient readmitted within 30 days. “[We] assume that a 30-day readmission suggests something happened bad or wrong at the discharge planning stage of the previous admission,” says Anne Pedersen, RN, MSN, director of care management.

The numbers in this data are small since they come from just one institution; they are also focused only on certain diagnosis groups.

However, they give you a sense of the type of data hospitals are tracking and using to make decisions that affect everything from discharge plans to formularies.

Editor’s note: To access similar data or discuss these issues, feel free to drop me a line anytime. –BC (860/712-8960)

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