Preventing Hospital Admissions and Readmissions

Abstract

Since first established by the CMS initiative in 2017 to reduce hospice readmissions for acute myocardial infarction and heart failure, the program has subsequently been expanded to include readmissions for COPD, pneumonia, CABG surgery, and surgery for total hip arthroplasty and total knee arthroplasty, and in addition, to improve both patient outcomes and patient satisfaction at lower costs. In addition, CMS has introduced the Skilled Nursing Facility Readmission Measure (SNFRM) as part of a Value-Based Program (VBP) that tracks hospital readmissions of Medicare “fee-for-service” SNF patients within 30 days post hospital discharge. Under the SNF VBP, SNFs will receive a Performance Score and may be eligible for an incentive payment for a lower hospital readmission rate. Note that SNFs with lower hospital readmission rates are more likely to be chosen as a “preferred provider” by the hospital for patients being discharged.