We’ll discuss the HRRP’s (Hospital Readmission Reduction Program) highest penalties and how telemedicine can use to address the challenges associated with these factors, which are structural in nature.
Centers for Medicare and Medicaid Services (CMS) payment reductions for hospital readmissions are based on patient characteristics associated with reimbursement penalties. This approach makes a lot of sense because the Hospital Readmission Reduction Program (HRRP) only reduces payment for readmissions associated with certain illnesses—acute myocardial infarction, heart failure, pneumonia, and several others.
We will discuss the HRRP’s most significant penalties, specifically the structural factors that lead to them, and how to overcome those issues by using telemedicine to access physician specialists.
There are Three Types of Factors that Influence the Success of Communities:
Community, Structure, and Performance.
Several studies have evaluated the community and facility characteristics most likely influencing the 30-day Risk-Standardized Readmission Rate (RSRR) since 2012. The first time improsed CMS payment reductions.
According to a study published in Health Equity, some structural factors play a greater role in readmissions. It is clear that a hospital’s metropolitan status or ownership is not among them. The risk of readmissions is higher if your hospital falls into one or more of these categories:
- Medium or large hospital
- For-profit and teaching facilities
- High average occupancy
- Serves a community with high Emergency Department utilization and high comorbidity rates
While the notion of a physician beaming into a hospital room may seem like science fiction, telemedicine is a well-established method of medical care. Would a face on a TV monitor be adequate to provide healthcare? Let’s look at the advantages of telemedicine.
Unfortunately, the categories of risk-adjusted readmission rates have morphed over time. Immediately after the HRRP was established, many rural hospitals had high penalties. Furthermore, a large portion of hospitals in all of these categories had little or no penalties for readmission. These factors suggest that changes within the facility may affect your hospital’s probability of receiving a penalty.
The geographic regions that impact readmission rates take more work to parse. However, the studies published by the Robert Wood Johnson Foundation and the Upper Midwest Rural Health Research Center show that:
- Prospective Payment System (PPS) rural hospitals and Critical Access Hospitals in New England, Mid-Atlantic and Pacific regions have lower readmission rates than urban hospitals.
- Southern PPS rural hospitals and CAHs experience higher readmission rates than urban hospitals in the same region.
Do these findings suggest that certain facilities are doomed by community, structural, and performance factors and that others are protected from penalties? No, of course not. However, reviewing your facility’s characteristics in light of this information may help you identify actions to reduce 30-day readmission rates.
Hospital Readmissions can be Reduced by Following the Data.
We discussed hospital readmission reduction programs earlier and looked at how improved diagnosis and prescription selection can reduce 30-day readmissions. In Reduce 30-day readmission rates by accessing specialist consults in the ED, we discussed how accessing specialists could prevent unnecessary readmissions through the Emergency Department.
You may ask your physician about the best treatment option for your specific condition. According to Mose and Kumar (2018), the following are some of the reasons why hospitals experience high rates of readmissions:
“The study emphasized that structural, performance, and community factors all contribute to penalty risk. In addition to reducing avoidable readmissions and mitigating unintended consequences, providers can mitigate penalty risk by addressing these three factors.”
What can be Done to Reduce the Number of Unnecessary Hospital Returns?
In-person or telemedicine consultations through secure video conferencing with specialists can help your hospital avoid premature discharge and improve admissions decisions in the ED. Specialists can also help reduce clinical factors that are highly correlated with readmissions, including:
- Use of high-risk medications
Accessing a specialist can address community factors, such as high ED utilization.
Patients Being Sent Home before they are Ready.
COVID has raised the issue of burnout being treated by hospital staff and physicians with specialty consults. According to Dr. David Fitzgerald, an infectious disease specialist, there were benefits to consulting an infectious disease specialist before COVID 19. Even after COVID, he says it is even more important to consult with one. “The doctors on the front line are stretched and stressed. I hear this in the voices of my patients. They have two ICUs full of COVID patients rather than one. In addition, many of these institutions only have one or two infectious disease doctors. Through telemedicine video calls, these doctors can focus on COVID patients.”
After the coronavirus is under control, hospitals with high average occupancy rates may benefit from consulting with specialists. These hospitals experience patient demand for care, which places a heavy burden on hospital staff. A Tele-Neurologist, Tele-Cardiologist, or Tele-Pulmonologist can provide Surge Protection TM if the ED is overloaded or patient floors are nearing capacity because these specialists can provide care remotely.
An excessively high readmission rate can cause severe financial damage to a hospital. To what extent can hospitals take steps to reduce readmission rates?
Patients Taking Multiple Medications are at High Risk.
In the study Redefining Readmission Risk Factors for General Medicine Patients published in The Journal of Hospital Medicine, two types of drugs, steroids, and narcotics, were shown to be correlated with higher readmission rates. Combining the expertise of another physician with drug knowledge may help reduce drug interactions and pinpoint what drugs are necessary after hospitalization. Adverse drug event (ADE) mistakes are frequent and costly.
It is crucial to remember that readmission rates are influenced by abuse and non-compliance with medications. Having fewer medications than typical at discharge minimizes the risk of complications and drug interactions that might require additional care. Medication reconciliation, which compares a patient’s medication orders with all the medications the patient is taking, is another method to reduce medication-related complications and improve care quality.
Having Multiple Illnesses at the same time is Known as Comorbidity.
Patients with comorbidities are often readmitted for reasons unrelated to their initial hospitalization. By identifying patients with comorbidities and coordinating care with their existing specialists or consulting with a specialist beforehand, hospitals can reduce emissions by determining how one health problem’s treatment and discharge might affect other health issues.
The higher readmission rates and HRRP penalties at medium and large hospitals may result from treating comorbid patients. These hospitals may also see higher average occupancy rates because they operate in densely populated areas, serve lower socioeconomic populations, and receive transfers from smaller hospitals. This results in treating sicker patients with more complex conditions.
Highly Utilization of Emergency Department.
High utilization of the emergency department (ED) is often associated with the use of the hospital for primary care services. This metric may also signify a lack of access to primary care. During the interview of the patient, a health issue or previously undetected comorbidity that needs to be dealt with during the hospital stay can be identified. It may lower the risk of readmission if proper follow-up care is provided.
Hospital HRRP payment reductions can be avoided by looking at community, structural, and performance factors in addition to clinical care to develop a comprehensive strategy. By using Hucu.ai HIPAA Tele-health application strategically may enhance access to the patients through secure video conference or text messages and reduce hospital readmissions. We conclude our discussion of HRRP payments by discussing how hospital patient transfers may affect your hospital’s reimbursement.