Monitoring and Lowering the Readmission Rate

Abstract

Patient readmission, as defined by Medicare, is when a patient is admitted to a hospital within 30 days of being discharged from an earlier hospitalization, regardless of in which hospital the patient was originally hospitalized. Under the Hospital Readmission Reduction Program (HRRP), hospitals with readmission rates that exceed the national average are penalized by a reduction in payments across all their Medicare admissions—not just those which resulted in readmissions. There is no doubt that compared to the 1990s readmission rates have significantly come down in recent years. As a result of Medicare’s readmissions reduction program, hospitals are working hard to bring the readmission rate down. Avoidable readmissions are a strong indicator of a fragmented healthcare system that too often leaves discharged patients confused about how to care for themselves at home and unable to follow instructions or get the necessary follow-up care. Medicare reports spending $17.8 billion a year on patients whose return trips to the hospital could have been avoided. Readmissions are costly for a provider that doesn’t have enough resources to spare, not to mention the 2 percent readmissions penalty stipulated by the Affordable Care Act.