In Development: Hospital Readmissions Tracking Tool

In light of the recent Medicaid changes regarding hospital readmissions within a 30 day time period, HMS is working to create a tool which will allow facilities to track readmissions.

Beginning on October 1, 2012, section 3025 of the Affordable Care Act added section 1886(q) to the Social Security Act establishing the Hospital Readmissions Reduction Program (HRRP). The HRRP has imposed a financial penalty on hospitals with many readmissions during a certain timeframe. The HRRP defines readmission as a patient who is readmitted to the same or another hospital within a 30-day time period. It excludes certain readmissions, such as transfers to another hospital. The goal of this penalty is to encourage improvements to patient care and reduce Medicare costs.

According to a study by the Medicaid Medical Directors Learning Network (MMDLN), an average of 8 % of all adult Medicaid patients who were admitted to the hospital in 2009 for something other than childbirth were hospitalized again within a 30-day timeframe. The hospital payment for readmissions within 30 days amounted to $83,263,557 or 14 percent of the total Medicaid payment for acute hospital care.

Health Monitoring Systems receives emergency department registration and inpatient admission data via an HL7 feed sent to us by facilities. Using a patient’s unique encrypted identifier, we are able to query our data and produce a record of a patient’s admissions at a particular facility during a given period of time. We are in the process of developing a tool that will allow facilities to quickly look back at records and determine if there is some way to improve the patient care. The hope is that by identifying common issues that cause readmissions, hospitals will be able to make the needed accommodations to prevent them. Gaining access to this data will enable hospitals to derive critical information about the causes of readmissions. Having the ability to recognize trends in readmissions for patients who return with the same or similar chief complaints will empower hospitals to proactively work toward reducing their readmissions.

Ultimately, we hope that the Readmissions Tracking Tool will provide hospitals with meaningful assistance in providing improved patient care, avoiding financial penalties for high volumes of readmissions, and reducing their own internal costs associated with readmissions.