Strategies for reducing hospital readmission rates

Unplanned readmission rates are bad for hospitals, because this measure can negatively impact Medicare reimbursement.

Readmission rates were of particular concern during the pandemic, when hospital systems were overtaxed. But there are strategies hospitals can use to decrease at least some unplanned readmissions.

The problem with readmission rates

An Agency for Healthcare Research and Quality study found that 3.8 million adult hospital readmissions occurred within 30 days of admission in 2018; the average readmission rate was 14% at an average cost of $15,200 per readmission.^[] Patients on Medicare and Medicaid are more likely to be readmitted than those with other insurers.

Medicare uses hospital readmission rates to determine reimbursement via the Hospital Readmissions Reduction Program, which is part of the Affordable Care Act. (More specifically, hospitals can be penalized for higher readmission rates.)

The issue with hospital readmission rates is that they don’t adequately adjust for risk or other complications. Even before the COVID-19 pandemic, studies showed that only 25% of hospital readmissions are preventable. A Harvard Medical School study published in The Joint Commission Journal on Quality and Patient Safety conducted during the pandemic showed that only 25% of 30-day hospital readmissions of COVID-19 patients were preventable.^[]

“These findings have led to the development of interventions designed to reduce hospital revisits for patients with COVID-19 at our institution. These lessons could also be applied to help prevent revisits in the future, in both pandemic and non-pandemic conditions,” the authors added.

Lowering readmissions

Based on their research findings, the authors of the Harvard study adjusted their practices accordingly. For instance, they developed a hospital-wide interdisciplinary guideline for discharging COVID-19 patients in the context of the pandemic.

In particular, it offered strategies on how to enhance self-management planning at discharge, one of the most important factors identified as affecting readmissions both related and not related to the pandemic. These strategies include the use of videoconferencing with the care team, patient, and caregivers in attendance.

Other points made in the guideline included use of a standardized workflow for discharge medication, prescriptions, and patient education. It also had a checklist of topics for the team to discuss in interdisciplinary rounds to ensure that the patient had adequate resources available if they needed to self-isolate.

The researchers also highlighted the importance of chronic-disease management in COVID-19 patients. Many of the readmissions were due to exacerbation of conditions such as diabetes, renal disease, and heart failure. Worsened respiratory symptoms accounted for only 11.8% of hospital readmissions.

Interventions as solutions

In an effort to decrease hospital readmission rates, institutions could employ interventions that encompass multiple components, such as medication reconciliation, patient needs assessment, and timely outpatient appointments, according to authors publishing in the Annual Review of Medicine.^[]

The authors also recommended using checklists or models that identify high-risk patients. These patients frequently are characterized by advanced age, multiple comorbidities, functional impairment, and decreased healthcare utilization.

In addition, US researchers studying a family-medicine inpatient service found that high-frequency readmission cohorts were often diagnosed with psychiatric disease, substance use disorder, or chronic pain. They described their findings in an article published in the Journal of the American Board of Family Medicine.^[]

"A further evaluation of these characteristics," the authors wrote, "may provide additional information and allow the ability to intervene earlier with patients before the readmission.”