At the start of "New Strategies for Preventing Readmissions," part of the U.S. News Hospital of Tomorrow Forum, moderator Steven Sternberg warned the audience that it would be a "complicated, solutions-based" session. If audience members needed to stand up? "There will be no penalties for readmissions today," joked Sternberg, who's U.S. News's Deputy Health Rankings Editor.
[More Hospital of Tomorrow Forum coverage: usnews.com/hospitaloftomorrow]
Some key stats: About 2,225 U.S. hospitals will pay fines for excess readmissions this year; only a fraction will pay the top fines. Lower fines suggest hospitals are making progress. But is the progress real?
Among the highlights of the discussion:
• Joel T. Allison, president and CEO of Baylor Scott and White Health, explained how his hospital has achieved readmission success. The steps they took were driven by penalties (such as the Medicare Hospital Readmission Reduction program) and revenue (all condition and all cause readmissions). "We don't get any bonus for high-quality care, we only get a penalty -- all you can do is lose," Allison said. Among Baylor's strategies to prevent readmission: Patient education, medication management, making sure a follow-up appointment is scheduled before discharge, and doing a health literacy assessment. Tele-monitoring is successful, too: 11.8 percent of enrolled patients are readmitted, compared to 15.2 percent of those who are not.
• Allen S. Weiss, president and CEO of the NCH Healthcare System, is working to reduce acute care overall readmissions by 10 percent by the end of fiscal year 2013. "I think the secret sauce, if you will, is a very hearty IT system," Weiss said. His hospitals, for example, can tell six hours before someone is going to become septic, which prevented 230 deaths over the past year. "During a hospital stay, we can tell who is most likely to be readmitted. It's not rocket science." Once you identify the high-risk patients, take extra steps to prevent readmissions: Bring a pharmacist into the ER to help with medicine mix-ups; do tech-backs when patients leave the hospital. Readmission alerts have been very successful, Weiss said.
• Clifford Y. Ko, director of the Division of Research and Optimal Patient Care of the American College of Surgeons, said his organization is "trying to figure out how hospitals can get better, and readmission is a big topic." He shared lessons from hospitals doing well in preventing readmissions and emphasized the importance of accurate data. "If we use crappy data, we're going to work on the wrong things, and we see that in a lot of hospitals," Ko said. He also spoke to the importance of standardization.
When one audience member asked about incentives – rather than just focusing on penalties – Weiss said he's working with Blue Cross Blue Shield Florida so that hospitals "get reimbursed for keeping people out of the hospital." What's better than low readmissions? "No admission," he reasoned. "The best hospital of the future is no hospital. Keep them home and get paid for it."
As for whether the readmission measuring metric should be longer than 30 days: "There are definitely some diseases or procedures where a longer length would be more" appropriate, Ko said. "But that's just going to add to the complexity and accountability … While it might be true, we're probably going to stick to the 30 days, at least for now."
A final word from Allison: Hospitals ought to "compete on quality, safety and patient satisfaction. That makes us better."