If you’re a Medicare (CMS) beneficiary, you might have wondered why you are required to have a face-to-face visit with your primary care physician within 30 days after hospitalization.
The reason is because the Affordable Care Act (ACA) requires this as a means of preventing costly, unnecessary readmissions.
Recent studies have shown that one in five (20 percent) of beneficiaries discharged from the hospital is readmitted within 30 days. Half of non-surgical patients are readmitted without having seen an outpatient doctor in follow-up. It is estimated that 75 percent of readmissions are preventable.
The ACA was enacted to improve care, patient satisfaction and lower delivery costs. The Hospital Readmission Reduction Program (HRRP), instituted in 2012, focuses on readmissions for selected conditions – namely heart attack, heart failure, pneumonia, COPD, elective hip or knee replacement, and coronary artery bypass graft (CABG).
The goal was to have less than 10 percent readmissions of Medicare beneficiaries, excluding those enrolled in Medicare Advantage plans. Regardless of the reason, there are penalties for readmission within 30 days to any acute care hospital, rural hospital or those serving economically disadvantaged populations, not just the hospital where the patient was originally hospitalized.
In 2013, readmissions above 10 percent were penalized up to 1 percent of the hospital’s Medicare reimbursement; 2 percent in 2014, and the maximum 3 percent in 2015.
Currently physicians, hospices and home health agencies are also under CMS scrutiny and, beginning Oct. 1, so will skilled nursing homes.
So how can readmissions be reduced? Prior to discharge, patients should be educated using a teach-back method specific to their condition and indicate their understanding of their medications and discharge orders.
An appointment with their primary care physician should be scheduled. Once the patient’s needs have been identified, a list of preferred providers should be available. Good communication should occur between all parties involved in the patient’s care.
The majority of seniors prefer to go home rather than a healthcare community. Home care has proven to be a vital key in preventing readmissions. It reduces risk of infection, improves patient satisfaction and reduces Medicare spending.
The importance of medication reminders, good nutrition, hydration, home safety, fall prevention and transportation to doctor appointments cannot be overstated. Agencies who provide non-medical assistance through licensed, bonded and insured caregivers are trained to note and report changes in the person’s status to their supervisors, usually an RN.
They also handle tasks around the house such as meal preparation, light housekeeping, personal care (bathing, dressing and grooming) and laundry, which can help seniors devote their energy to recovering.
In addition, caregivers provide respite for family members who might be exhausted after their loved one’s hospital stay.
In 2009, the New England Journal of Medicine highlighted the costs and health impact of rehospitalization. At that time, the cost to Medicare was $17.4 billion. Medicare (cms.gov) projects expenditures to reach $800 billion in 2018.
Rachel Carson is the owner of the local Home Instead Senior Care franchise serving The Lowcountry since 1997.