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 New CMS Data Show Across-The-Board Reductions In Avoidable Hospital Readmissions

Potentially avoidable hospital readmissions that occur within 30 days of a patient’s initial discharge are estimated to account for more than $17 billion in Medicare expenditures annually, according to the Centers for Medicare & Medicaid Services (CMS).
 
Not only are readmissions costly, but they are often a sign of poor quality care,” says Patrick Conway, MD, principal deputy administrator and chief medical officer at CMS. “Many readmissions can be avoided through improvements in care, such as making sure that patients leave the hospital with appropriate medications, instructions for follow-up care, and follow-up appointments scheduled to make sure their recovery stays on track.”
 
To address the problem of avoidable readmissions, the Affordable Care Act created the Hospital Readmissions Reduction Program, which adjusts payments for hospitals with higher-than-expected 30-day readmission rates for targeted clinical conditions such as heart attacks, heart failure, and pneumonia.
 
CMS also has undertaken other major quality improvement initiatives, such as the Partnership for Patients, which aim to make hospital care safer and improve the quality of care for individuals as they move from one health care setting to another.
 
The American Health Care Association (AHCA) promotes a Quality Initiative for its members in which reduction of avoidable hospital readmissions is a key objective.
 
These programs are paying off. Between 2010 and 2015, readmission rates fell by 8 percent nationally.
 
CMS has released new data showing how these improvements are helping Medicare patients. The CMS data show that since 2010:
 
  • All states but one have seen Medicare 30-day readmission rates fall.
  • In 43 states, readmission rates fell by more than 5 percent.
  • In 11 states, readmission rates fell by more than 10 percent.
 
States with the greatest reductions in readmissions include Hawaii, New Jersey, Illinois, South Dakota, Arizona, New York, Ohio, Rhode Island, Maryland, Delaware, and Oklahoma.
 
CMS says that Medicare beneficiaries avoided almost 104,000 readmissions in 2015 alone, compared with 2010 levels. Cumulatively since 2010, it is estimated that Medicare beneficiaries have avoided 565,000 readmissions.
 
“Hospital readmissions not only have the potential for negative physical, emotional, and psychological impacts on individuals in skilled nursing care, but also cost the Medicare program millions of dollars,” says David Gifford, MD, AHCA senior vice president of quality and regulatory affairs and a board-certified geriatrician.
 
“Preventing these events whenever possible is always beneficial to patients and is an opportunity to reduce overall health care system costs through improvements in quality.”
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