Community Resources a Key to Reducing Readmissions
Amidst all the changes in the United States healthcare system, many hospitals are heavily focused on reducing readmission rates. Under the federal Medicare program, the government reimburses hospitals for reducing their 30-day readmission rates—and penalizes hospitals if they have high readmission rates. Jianhui Hu, a research associate at Henry Ford’s Center for Health Policy and Health Services Research finds this policy problematic. He asserts, “… the use of readmission rates as a basis for financial penalties to hospitals assumes that readmissions are a result of poor-quality care.” Hu has a valid argument, as many recent studies have demonstrated that hospital location and community demographics have an immense effect on readmission rates.
A recent study conducted by Health Services Research found that hospitals in the same area had similar readmission rates as others in the area, indicating that a hospital may not have as much control over readmission rates as they previously thought. In fact, nearly 60% of variation in readmission rates is associated with hospital location rather than individual hospital performance. To determine this, researchers matched data on hospital readmission rates collected by the Centers for Medicare and Medicaid Services with information about hospital location and performance. They looked at 4,073 hospitals in 2,254 counties from July 2007 – June 2010 and gathered data about hospitals such as ownership type, teaching status, number of beds and percentage of patients covered by Medicaid. Researchers also collected county demographics including population, number of Medicare beneficiaries, number of general practitioners and specialists and poverty and education levels. The study yielded the following results:
- 58% of the variation in 30-day readmission rates was at the county level before any information about the hospital or county was taken into account. Meaning, individual hospital performance may account for only 42% of variation in readmission rates.
- Having more general practitioners and more nursing homes per capita in a county was associated with lower readmission rates.
A different study conducted by Henry Ford Health System found similar results demonstrating the link between readmission rates and social factors. They analyzed a controlled population of patients from their hospital data bank and found that patients living in poverty were 24% more likely than others to be readmitted to the hospital. Researchers say that whatever happens after the patient is discharged in the home or community is putting some patients at risk for readmission. The results of these studies demonstrate that readmissions are a product of acomplex set of factors— only one of which is hospital quality of care. Hospital readmission rates must be addressed with a combination of community-based programs and improvements in the hospital, especially in medically underserved areas.
Community-based programs such as Information Referral and Assistance (IR&A) programs have huge potential to help reduce hospital readmissions. From a healthcare perspective these programs are designed to refer people to the appropriate service or resource that can help them with their post-discharge needs. A key goal of IR&A activity is to reduce Medicare and Medicaid spending by helping people stay in their community by utilizing community services rather than moving to institutionalized care facilities. IR&A specialists can schedule outbound follow-ups with discharged patients and capture data related to met or unmet needs, refer alternative services, and proactively manage cases to reduce the risk of readmissions. In addition, IR&A organizations report on demographics of the calls handled and can even track outcomes of those callers, which can be extremely useful information for hospitals to reduce their readmissions. North Light Software’s Resource House platform makes it easy for IR&A programs to record and track this data, and ultimately makes access easier to get people the help they need, when they need it most.
When IR&A activities are leveraged as part of a patient’s post-discharge and care coordination efforts, significant benefits can be achieved. Patients can receive the non-clinical help and support they need to aid in their recovery, and these supports can help them stay in their homes and communities longer. Health systems and hospitals can utilize existing resources to assist them in achieving better outcomes for their patients and in reducing readmission rates and costs. North Light Software’s parent company Revation Systems specializes in the advanced communication and collaboration tools to simplify and streamline the communication and care coordination necessary to make this community health vision a reality.