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Hospital Readmissions:  Suggested Strategies to Prepare for Hospital Readmissions:  Suggested Strategies to Prepare for

Hospital Readmissions: Suggested Strategies to Prepare for - PowerPoint Presentation

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Uploaded On 2016-12-07

Hospital Readmissions: Suggested Strategies to Prepare for - PPT Presentation

Linda Steffens BSN RN CCRN Stacy Jaeger MS APRNBC Susan Herrmann MSN RN Kimberly Thomas BSN RN MSM CCRN Katherine Barker MSN RN MSRN CPN Audrey Eggleston BSN RN Delnor Hospital Geneva IL The ID: 498522

readmission discharge time days discharge readmission days time patients baseline care plan real improvement readmitted review process reasons institution

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Slide1

Hospital Readmissions: Suggested Strategies to Prepare for The Move Toward Pay for Performance

Linda Steffens BSN RN CCRN

Stacy Jaeger MS APRN-BC

Susan Herrmann MSN RN

Kimberly Thomas BSN RN MSM CCRN

Katherine Barker MSN RN MSRN CPN

Audrey Eggleston BSN RN

Delnor Hospital Geneva, ILSlide2

The trend of more stringent standards affecting healthcare reimbursement is accelerating. Decreased reimbursement for some readmitted patients as well as bundling payment to include the thirty day time period post discharge have been proposed by CMS and

gained

congressional and administrative interest. This PowerPoint suggests possible strategies that nurse leaders might employ to pro-actively prepare for the likely consideration of readmission as a pay for performance indicator.

OVERVIEWSlide3

History

Medicare and third party payers have traditionally reimbursed healthcare providers on the basis of services rendered

Only a few restrictions applied i.e., readmission on the same day as discharge could not be resubmitted as a new episode of careSlide4

Current Proposals

The Senate Finance Committee has identified readmission within 30 days as a potential source of avoidable government expenditure

CMS has expressed interest in bundling payment for episodes of care to include a hospitalization and the subsequent thirty day time period.Readmission within 30 days of discharge is likely to be a future reportable pay for performance indicatorSlide5

Suggested Proactive Strategies for Nursing

1. Obtain baseline information regarding readmission rate/reasons for your institution

2. Initiate real time evaluation of patients who are currently being readmittedSlide6

Strategy One

Obtain baseline information regarding readmission rate/reasons for your institutionSlide7

Establishing Your Baseline

Perform a retrospective chart review of records patients who have been readmitted within 30 days of discharge

Provides baseline to gauge improvement effortsProvides data gathering proficiency for possible mandatory reporting

Audit strategy should include enough months to allow for seasonal variationSlide8

Basic Audit of Identified Readmission Record

Diagnosis

Provider

Payment Type—Medicare, Insurance, Private Pay

Days between discharge and readmission**

Probable reason for readmission

**

It has been suggested by IHI that examining readmissions that occur within 7 days of discharge may provide insight into the effects of tighter patient flow management and reveal over aggressive attempts to decrease LOS and possible premature dischargeSlide9

Possible Reasons for Readmission

Planned or Unplanned

(

ex chemotherapy or staged surgeries/procedures are planned)

Unrelated problem?

Secondary Infection?

Misdiagnosed on first admission?

Non Compliance?

Poor understanding of discharge plan?

Original discharge plan inadequate?

Premature discharge?

Error or Omission in discharge instructions?

Deterioration in a chronic condition?

Social Issues—deficient home resources to allow successful transition of care ?

On-going substance abuse issues?

Failure of outpatient care provider to follow through on discharge instructions?

Adverse Medication Reaction?Slide10

Make sure to record all readmission reasons that you discover—you may see patterns in your results that are specific to your institution. For example, our institution found that social factors were the leading reason for unplanned readmissions while other hospitals have noted infection, premature discharge, medication reactions, etc. as their leading cause.Slide11

Baseline Data Useful to

Identify institutional problems in the discharge process

Provide statistical basis to project potential revenue impact of proposed bundled paymentsInitiate a Plan for ImprovementSlide12

Planning to Improve

The Institute for Healthcare Improvement ( IHI .org) has free on line education and improvement trackers to help hospitals improve their processes and quality

Their step by step Improvement Tracker shows leaders how to set aims, define measurements, and measure performance.Trackers can be maintained online, anonymously if you wish, and provide graphing of your hospital specific data (example tracker provided in this supplemental digital content)Slide13

Strategy Two

Real-time evaluation of current patients readmitted within 30 daysSlide14

Real Time Evaluation

When retrospective chart review has been completed, move identification of readmission within 30 days to a real time activity

Perform standardized review of previous discharge paperwork and evaluate reason for discharge using methodology devised when performing baseline metricsNote Readmission within Thirty Days in the patient individualized care plan and nurse to nurse handoffSlide15

Discharge Planning

Utilize information yielded from review to improve discharge planning

Encourage collaboration of patients, discharge planners, physicians, direct care nurses, familiesSlide16

Discharge Process

Evaluate daily discharge process in real time

Consider “second pair of eyes” for discharge medication reconciliation and discharge instructionsConsider collaboration with CNS for all dischargesConsider eliminating standardized discharge call backsConsider individualized discharge callback plan as part of the discharge process with identification of patients at risk for readmission