What’s New on the Readmission Corner? Vol. 4

There have been many new developments on the readmissions front over the past several months. The past 3 issues of this News Letter highlighted some available information concerning readmissions. The prior News Letters have discussed a recent  advisory opinion that is related to readmissions, readmission statistics for year 2 of the Hospital Readmissions Reduction Program, and an overview of the new rule providing guidance on readmissions.lawyer-myla-r-reizen-photo-399379

This summary is meant to provide an overview of certain revisions to the guidance to the discharge planning for hospitals and its connection to readmissions. Why is this important to readmissions?  The State Operations Manual for Hospitals (the Manual) provides:

When the discharge planning process is well executed, and absent unavoidable complications or unrelated illness or injury, the patient continues to progress towards the goals of his/her plan of care after discharge. However, it is not uncommon in the current health care environment for patients to be discharged from inpatient hospital settings only to be readmitted within a short timeframe for a related condition. Some readmissions may not be avoidable. Some may be avoidable, but are due to factors beyond the control of the hospital that discharged the patient. On the other hand, a poor discharge planning process may slow or complicate the patient’s recovery, may lead to readmission to a hospital, or may even result in the patient’s death.

Jencks et al. analyzed Medicare claims data for a two-year period in an attempt to more accurately identify readmission (called “rehospitalization”) rates and associated costs. They found approximately 19.6% of Medicare fee-for-service beneficiaries were rehospitalized within 30 days of discharge and 34.0% within 60 days of discharge. 70.5% of those surgical patients subsequently readmitted within 30 days had a medical cause for the readmission. Only approximately 10% of rehospitalizations were estimated to have been planned.

The Manual cites to “Jencks, F. J., Williams, M. V., Coleman, E. A. Rehospitalizations among Patients in the Medicare Fee-for-Service program. The New England Journal of Medicine 2009; 360;14: 1418-1428” as authority for the second paragraph for the above quote.

The Manual further providers that,

[w]ith respect to the causes of the high rate of preventable readmissions, “Multiple factors contribute to the high level of hospital readmissions in the U.S…. They may result from poor quality care or from poor transitions between different providers and care settings. Such readmissions may occur if patients are discharged from hospitals or other health care settings prematurely; if they are discharged to inappropriate settings; or if they do not receive adequate information or resources to ensure a continued progression of services. System factors, such as poorly coordinated care and incomplete communication and information exchange between inpatient and community‐based providers, may also lead to unplanned readmissions.” The discharge planning [Condition of Participation] requirements address all of these factors.

The Manual cites to the “Modifications to the Maryland Hospital Preventable Readmissions (MHPR) Draft Recommendations, Staff Report, Maryland Health Services Cost Review Commission, December 1, 2010, accessed via the agenda for the December 8, 2010 Commission meeting” as the authority for the factors above.

As noted above, the guidance for discharge planning has been revised. For instance, under the Hospital Condition of Participation Section 482.43(b) that requires the evaluation to consider the patient’s likelihood of needing post-hospital services and the availability of such services, there is a new information paragraph in the Manual. This paragraph provides that although not required under the regulations, the hospital would be well advised to develop collaborative partnerships with post-acute provider to improve care transitions of care that might support better outcomes and provides certain examples.  There are many more revisions to discharge planning and discussions about readmissions in the Manual.

Please note that these legal principles may change and vary widely in their application to specific factual circumstances.  You should consult with counsel about your individual circumstances.  This News Letter should not be construed as legal advice or a legal opinion on any specific facts or circumstances. The contents are intended for general informational purposes only, and you are urged to consult your attorney concerning your own situation and any specific legal questions you may have.

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