Health Information Management

News: Hospital Compare releases readmission data for heart attack, heart failure and pneumonia

CDI Strategies, July 23, 2009

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One in five Medicare beneficiaries who leave the hospital today will re-enter the hospital within a month, according to readmissions data posted to CMS’ Hospital Compare Web site. The data encompass three full years of claims, from July 1, 2005 through June 30, 2008, regarding hospital readmission rates for Medicare patients treated for heart attack, heart failure and pneumonia. It shows how often patients with each of these conditions return to the same or a different hospital within 30 days of discharge, and how each hospital’s readmission rates compare to the average rates for the state and nation.
“When we reduce readmissions, we improve the quality of care patients receive and cut healthcare costs,” said Department of Health and Human Services Secretary Kathleen Sebelius in the CMS release.
But the information also underlines the importance of data capture and the clinical documentation improvement specialist position.
In a recent ACDIS blog post, Glenn Krauss, RHIA, CCS, CCS-P, CPUR, FCS, PCS, C-CDI, CCDS, an independent consultant in Janesville, WI, illustrated the importance of CDI specialist interaction with physicians on the floor. The case reinforces the opportunity for the CDI specialist to incorporate the concepts of risk of morbidity and 30-day mortality, risk adjustment of potential for 30 and 90 day readmissions, measurement of physician efficiency in the delivery of healthcare, and the MedPAC Commission’s proposal for Accountable Care Organizations as a strategy to slow the growth of Medicare expenditures.
“CDI specialists can capitalize upon the opportunity to bring relevant business developments in healthcare that directly impacts the physician’s business of the practice of medicine from an operational and financial standpoint,” Krauss says.
In another recent ACDIS blog post, Garri Garrison, RN, CPUR, CPC, CMC, director of consulting services with 3M Health Information Systems (HIS) and a member of the ACDIS advisory board discussed the importance of obtaining documentation to allow coders to report V15.81 (noncompliance with medical treatment). Hospitals can use this documentation and coded data to help prevent or appeal denials for readmissions.
“More data gives a clearer picture of the quality of care delivered at different hospitals over time, which ultimately increases the value of our mortality information to hospital patients, health care payers, employers, policymakers, and other healthcare stakeholders," said Barry M. Straube, MD, director of the CMS’ Office of Clinical Standards and Quality, in the release.

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