Finding that you have to be hospitalized again has got to be frustrating enough, but learning that it could have been avoided has to spark a cocktail of emotions for all involved. It’s not rocket science that avoiding readmission is dependent on strong discharge planning practices; i.e. seamless transfer of vital information and strong communication between a hospital and post-acute care facility. Furthermore it’s hard to sidestep statistics; the cost of readmission for Medicare patients is over $26 billion a year and approximately 2.6 million seniors are readmitted within 30 days. What? As a tax payer and a friend of many Medicare patients, I am troubled… that is a lot of individuals and money!
So naturally my next question is: What is the government doing about it?! CMS published a proposed rule in the federal register last week that includes the implementation of the Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACT) and a revision of the discharge planning requirements (IT interoperability orientated). There are 21 discharge planning data requirements; these patient centered data elements are what a certified health IT system should provide to a PAC facility in order to enable seamless transition of care. I especially like the bullet: ‘patient’s goals and preferences’; I think this is very important for many reasons… one being that after a few patient interactions, clinicians will get a good feel of what is important to the patient through discussion. It takes time to build this knowledgebase because it requires that all important human ‘touch’.
Such patient and provider experiences are now being taken advantage of, therefore the idea of patient involvement during discharge planning provides better outcomes (therefore lower readmission) is not new, but the idea of assisting patients when selecting Post-Acute Care (PAC) providers by sharing data on quality and resource use measures, is relatively. The proposed provision also puts a time frame on when to start discharge planning; discharge planning must begin within 24 hours of admission/registration and discharge plan must be completed “before the patient is discharged home or transferred to another facility”. I have faith in our system and that this quoted remark is not new, but perhaps the first time formally written by the IMPACT committee!
I think it is also important to point out here the Community-based Care Transitions Program (CCTP) that was implemented by the Affordable Care Act in February 2012 allocating $300 million in funding to reduce readmissions. An annual report of the CCTP program success can be found here. The report concludes “Only one site had a significant reduction in readmission…” but goes on to say that not all sites entered the program at the same time, therefore this information isn’t reliable. With that said, I cannot help but wonder if the certified Health IT system would have been required already to contain the 21 data elements during electronic transmission during discharge planning (for several years mind you) these 46 Community Based organizations (CBO) would of had lower readmission rates. In 2017 when the CCTP initiative is over, I hope we learn of it’s effectiveness and it helps millions of Americans.