Tennessee hospitals coping with readmission reduction mandate

State facilities putting processes, systems in place

Health care providers are coping with hospital readmission penalties as the number of offending conditions grows.

Those fines, assessed in the form of fewer Medicare dollars reimbursed to providers (mainly hospitals), are applicable to facilities that readmit patients with recurring problems within 30 days of original discharge.

“The way it’s set up now, we can learn while the penalties are lower and establish systems and processes that directly deal with readmissions,” said David McClure, senior vice president for finance and Medicare for the Nashville-based Tennessee Hospital Association. “We need to have these in place before penalties increase and before the maximum penalty caps rise.”

The penalties are delineated by the 2010 Affordable Care Act and, for now, are applicable only to myocardial infarction, heart disease and pneumonia. In 2015, chronic obstructive pulmonary disease will be added, and as the list of conditions lengthens, the ceiling for maximum penalties assessed will rise from 1 percent this year to 3 percent in 2015.

Nationally, reduction programs are also working, and the changes are significant compared to previous years’ numbers.

According to the Centers for Medicare and Medicaid Services, readmission rates fell to 17.8 percent in 2012 after averaging 19 percent for the past five years. The decline translated to 70,000 fewer Medicare patient readmissions in 2012.

“This just shows that our hospitals are paying attention and starting to focus on making the necessary changes to their post-discharge procedures,” McClure said.

The success of these programs is no surprise to Medalogix CEO Dan Hogan, whose Nashville-based company provides home health agency clients a predictive modeling software package designed specifically to lower readmission rates.

After a recent nine-month analysis, he said 11 Medalogix clients reduced their readmission rates by 36 percent.

“The aggregate readmission rate dropped from 21 percent to 16 percent,” Hogan said, adding that despite the relatively small sample size, the results were meaningful as compared to nationally derived statistics. The rates are updated every 30 days. As time passes, the more relevant and accurate the numbers become — giving even more credence to the “predictive” aspect of Medalogix’s approach, Hogan added.

One factor in the reduction? Post-discharge contact, even by phone.

Medalogix officials said numerous studies have confirmed the effectiveness of following up with patients via automated phone calls to improve patient outcomes and reduce readmissions.

The telephone component of the Medalogix readmission reduction effort connects to the top 25 percent of patients most at risk of readmission, according to calculations made by a home-health-specific algorithm. If the patient answers positively to any of the risk questions, the patient’s record is flagged and a clinician is notified to contact the patient personally.