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'Since you asked' committee update

from ACMA

Q: What are the many methods organizations are using to prevent re-admissions?

In October 2012, the Centers for Medicare and Medicaid Services introduced a separate penalty program, which stemmed from the Affordable Care Act, that reduced payments to hospitals with excess 30-day readmissions for heart attack, heart failure and pneumonia patients. A readmission generally refers to an admission to an acute care hospital within 30 days of a discharge from the same or another acute care hospital.

Excess readmissions are measured by a ratio, by dividing a hospital's number of "predicted" 30-day readmission for heart attack, heart failure and pneumonia by the number that would be expected, based on an average hospital with similar patients. A ratio greater than 1.00 indicates excess readmissions. This data is risk adjusted, meaning it takes into account how sick patients are based on their age, gender and co-morbid conditions. The CMS readmission penalty is 2 percent of a hospital's Medicare base operating DRG (Diagnostic Related Groups) payments in 2014 and increases to 3 percent for 2015 and beyond.

Organizations across the country are using many different tactics to prevent re-admissions. One of the most common procedures is multi-disciplinary rounding in which patients are discussed with all team members and the best plan for sustaining discharge is discussed and put in place. The acute care case managers may include home health nurses and case managers, county social workers, transportation companies to ensure that the patient keeps a follow-up appointment, and family members in the care plan. more


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