In 2018 (the most recent year for data), the Agency for Healthcare Research and Quality (AHRQ) reported a total of 3.8 million adult hospital readmissions within 30 days, with an average readmission rate of 14% and an average readmission cost to hospitals of $15,200.
In addition to the financial drain on the healthcare systems, readmission has been shown to correlate with the likelihood of adverse health outcomes, including increased patient stress and higher mortality rates. High readmission rates will also negatively impact the quality ranking of hospitals, which are considered a profit driver.
Conversely, lower readmission rates indicate better patient care, as patients generally experience fewer complications, are better prepared for discharge, and receive appropriate follow-up care. By reducing readmissions, hospitals can also use their resources more efficiently, providing care to more patients without needing to increase their staff's capacity or working hours.
In short, readmissions represent a high price to pay for a system lacking resources to spare while negatively affecting patients as well. These are reasons why the Centers for Medicare & Medicaid Services (CMS) established the Hospital Readmissions Reduction Program (HRRP).
The HRRP Program: Incentive for Change
As a means to help reverse the effects of avoidable readmissions and their causes, the requirements for HRRP were instituted by the Social Security Act in October 2012. Since the adoption of the HRRP program, by the states that are required to comply with its requirements (all but Maryland), readmission rates have seen a gradual decrease, although there are factors that cause the rate of improvement to vary.
Between 2007 and 2011, the rate of 30-day all-cause rehospitalizations sat at an average of 19%. In 2022, the all-cause percentage for Medicare discharges ranged around 20%, although the continued effects of COVID-19 likely influenced this number. This range does fluctuate, but overall, the HRRP program has created a standardized way to see more progress with hospital readmissions since its pre-adoption phases.
However, there’s still work to be done. Reducing hospital readmission rates for hospitals requires institutional change at global and patient levels. Success requires implementing change consistently and over a long period of time. Follow these five key strategies to help you get started on the path to lasting change and improvement.
1. Use Analytics to Uncover Improvement Opportunities
To reduce hospital readmission rates, it’s essential to first understand the factors that contribute to them and anticipate challenges. Predictive modeling is one of the top methods to make this possible. Predictive modeling uses artificial intelligence (AI) to forecast risk and reduce readmissions, which can help conserve essential resources, save time, and even increase patient engagement success. Predictive analytics can identify instances where targeted interventions may potentially prevent readmissions.
Data analytics can help identify patterns and trends in readmission rates, thus revealing areas where improvement is needed. By analyzing readmission rates for hospitals on a regular basis, hospitals can identify the root cause of issues, better track their progress, and adjust where needed.
2. Identify At-Risk Patients Early
A key step in reducing readmissions is to assess patients’ social needs during hospitalization and discharge planning. Identifying patients with unmet social needs can help ensure they receive the services they need following discharge (e.g., medication reconciliation post-discharge, or MRP). Social determinants of health (SDoH) are the conditions in one's environment where people are born, live, learn, work, play, worship, and age. SDOH affects a wide range of health, functioning, and quality-of-life outcomes and risks.
The five primary domains that cover the social determinants of health are as follows:
- Social context
- Stability of the economy
- Healthcare access and quality of care
- Access to quality education
These factors affect health outcomes and have been postulated to affect readmission rates. According to CMS, “Research has demonstrated — and evaluations of the HRRP to date have found — that minority and other vulnerable populations are more likely than their white counterparts to be readmitted within 30 days of discharge for chronic conditions, such as congestive heart failure.”
By focusing more on social determinants, hospitals and health systems can better avoid a portion of unplanned readmissions by addressing the barriers patients face prior to, during, and after admission and discharge by planning interventions that can help reduce inequities in healthcare.
3. Enhance Patient Communication
To execute this strategy, better ensure patients understand their condition, medications, and self-care instructions, including follow-up appointments and warning signs they should watch for upon discharge. Involve families and caregivers to help patients follow their care instructions and have a support system after they leave the hospital.
Consider using patient education handouts to help strengthen medication adherence and discharge care. Having a nurse or care coordinator review instructions with the patient and family gives sufficient time for patients and caregivers to ask questions and for clinicians to correct any misunderstanding. Many health providers employ the information teach-back method, whereby clinicians explain conditions, treatment options, and self-care instructions to patients and ask them to repeat the information back.
4. Strengthen Your Discharge Process
Make sure there's a clear care plan in place that involves all team members, including physicians, nurses, social workers, and the patient and their family or caregivers. In fact, it’s wise to begin the care planning process at admission. Identifying the post-acute care issues that will need to be addressed to reduce the risk of readmission early gives providers, patients, families, and caregivers time during the patient’s stay to be thorough with planning.
Post-discharge follow-up should include defined procedures for scheduling follow-up appointments or phone calls to check the patient's progress and address any concerns, ideally within a week of discharge.
Timely follow-up also provides a way to become aware of potential complications and correct them early on. Research shows that follow-up within seven days is strongly associated with reduced risk of readmission for patients with one or more of the HRRP priority conditions. CMS includes these six primary conditions in a 30-day risk measure for unplanned readmissions: pneumonia; heart failure; coronary artery bypass graft (CABG); primary total hip or knee arthroplasty, elective (THA/TKA); acute myocardial infarction (AMI); and chronic obstructive pulmonary disease (COPD).
5. Improve Medication Management
One of the most effective ways to reduce a hospital readmission rate is to streamline the facility's medication reconciliation process. Medication reconciliation is the process of comparing a patient’s current medications with their previous ones. This helps ensure the patient is taking the correct medications and that there are no drug interactions, duplications, or errors associated with dosing.
Recent research indicates that unintended medication discrepancy is among the primary causes of morbidity and mortality among hospitalized patients. This can better be avoided with a comprehensive and longitudinal medication management service provider.
One study of Medicare beneficiaries showed that nearly 54% reported cost-related medication nonadherence during a 15-month study period. When prescribed medications aren’t filled, refilled, and/or taken as they are prescribed, it can lead to higher treatment costs with the potential for patient readmittance. This could also lead to additional health issues or continued complaints from the initial diagnosis. Empowering clinical pharmacists to take the lead on post-discharge medication management, including MRP, can help eliminate these critical care gaps and reduce the risk of readmission.
Reduce Your Hospital Readmission Rate: Get Support
Improving one’s hospital readmission rate truly takes a village. It requires the right combination of tools, strategies, knowledge, and expertise. Cureatr supports patients with medication management services that leverage clinical pharmacists and transparent access to patient data. We offer a suite of services to assist with medication reconciliation and MRP, medication adherence, and deprescribing assistance. Learn more about how the right medication management approach can help your organization reduce avoidable readmissions and reap the clinical, financial, and operational benefits.