Executive Summary: Rethinking the Hospital Readmissions Reduction Program

Introduction

This report provides an analysis and evaluation of hospital readmissions and the effect of policy reforms in reducing the number of avoidable readmissions. The study seeks to identify ways of reducing avoidable readmission caused by factors such as clinical care practice and sociodemographic factors such as inaccessibility of supportive community services and poverty that reduce the rate of recovery after hospitalization and hence increase the rate of readmission.

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To address the issue of readmission, the report begins with an assessment of the hospital readmissions reduction program (HRRP). This program is a payment penalty plan that targets to reduce frequent, high-volume, and expensive readmissions. This program uses a formula mandated by the Affordable Care Act (ACA) to calculate "excess readmission ratio" specific for each hospital given the clinical conditions present. The report assesses the measures adopted in improving the HRRP such as the increment in the penalty and an increase in the number of clinical conditions covered under the program. Also, the study evaluates the effectiveness of the program in improving patient care.

The report identifies unavoidable readmissions and differentiates them from avoidable readmissions. The report follows the American Hospital Association (AHA) guidelines to create a framework for different types of readmissions. The identified readmissions include planned readmissions related to initial admission, a planned readmission unrelated to the initial admission, and unplanned readmission related/unrelated to the initial admission. The report states that hospitals should not be held accountable for unplanned and unrelated readmissions because they are highly unpredictable and unpreventable.

Additionally, the article examines the need for risk adjustment that accounts for readmission factors that are beyond the control of the hospital. In this regard, the author identifies clinical and non-clinical factors that are not in the control of the provider. The additional factors include sociodemographic factors such as poverty and community conditions that put patients at the risk of readmission. Upon identification of these factors, the report provides recommendations for support services that can be availed to disadvantaged patients such as improved transportation systems, social supports, and provision for grocery stores that supply healthy foods to cater for the dietary needs of the patients. However, the study addresses controversies surrounding risk adjustment for sociodemographic factors due to the argument that it would cause disparities in the provision of quality care. Policy makers recommend that sociodemographic factors should be included in the risk adjustments process as this will enable CMS to compare hospitals on a fair basis. Also, this inclusion will be an incentive for the hospitals to reduce avoidable readmissions.

Moreover, the article examines the proposals for the modification of the penalty program. The proposals revolve around the need to improve the effectiveness of the penalty formula to make it act as an incentive to reduce readmissions. Other proposals target the review of the penalty calculation program to differentiate the costs for big hospitals from those of smaller hospitals. Other recommendations include the identification of high risk patients, adequate after-care and follow up services, increased coordination of care, and enhancement of skills for self-management.

Conclusion

The report concludes that there should be adequate differentiation between the readmissions to identify the whether they were planned, unplanned, or avoidable. Also, the author recommends that the HRRP needs to be improved to shift the penalty to avoidable readmissions that are related to the initial admission. Also, there is need for adjustment to include the sociodemographic factors to increase fairness especially on hospitals serving populations at higher risks of readmission.

Reference

American Hospital Association. (2015). Rethinking the hospital readmissions reduction program. March, Chicago: American Hospital Association.