Efforts to reduce hospital readmissions appear to be working

Federal efforts to reduce costly hospital readmissions through payment incentives are paying off, according the Centers for Medicare and Medicaid Systems (CMS).

Data released by CMS on Tuesday shows hospital readmission rates fell in 49 states from 2010 to 2015. Overall there was an 8 percent decrease in readmissions across the U.S. in that time frame, with rates in 43 states dropping by more than 5 percent, and in 11 states by more than 10 percent.

Only Vermont’s readmission rate increased in that period – to 15.4 percent in 2015 from 15.3 percent five years earlier.

“Across states, Medicare beneficiaries avoided approximately 100,000 readmissions in 2015 alone, compared to if readmission rates had stayed constant at 2010 levels,” Patrick Conway, CMS principal deputy administrator and chief medical officer, and Tim Gronniger, CMS deputy chief of staff, said in a blog post. “That means Medicare beneficiaries collectively avoided nearly 100,000 unnecessary return trips to the hospital. Cumulatively since 2010, the HHS Assistant Secretary for Planning and Evaluation estimates that Medicare beneficiaries have avoided 565,000 readmissions.”

Conway and Gronniger credited several federal and private initiatives for the decrease in readmissions, including the Hospital Readmissions Reduction Program, which reduces payments to hospitals with higher-than-expected 30-day readmission rates for targeted clinical conditions such as heart attacks, heart failure, and pneumonia.

Reducing denials and increasing revenue with workflow design

CMS also has launched ambitious quality improvement initiatives, including Partnership for Patients, intended to make hospital care safer and improve the quality of care for individuals.

Despite the overall drop in readmission rates, CMS announced in August it would withhold $528 million in total reimbursements to nearly 2,600 U.S. hospitals that readmitted an excessive amount of patients for certain conditions within 30 days of their discharge between July 2012 and July 2015.

“Potentially avoidable hospital readmissions that occur within 30 days of a patient’s initial discharge are estimated to account for more than $17 billion in Medicare expenditures annually,” Conway and Gronniger wrote. “Many readmissions can be avoided through improvements in care, such as making sure that patients leave the hospital with appropriate medications, instructions for follow-up care, and follow-up appointments scheduled to make sure their recovery stays on track.”

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