We reduced our readmission rate from 9 percent to 5 percent in a very short period of time. We are happy to share our tips while continuing to learn and improve!
Our data indicated that from 2014 until June 2015, our readmission rate was 9 percent with no plan in place for improvement.
What We Tried
We began in June 2015 pulling data to see what we could find out about our readmissions. We wanted to know…Who are the patients that are being readmitted? What are their diagnoses? Who is their physician? Is there a trend? We were shocked to see the answers to those questions. It was obvious that our biggest problem (which coincidentally was the easiest to fix) was lack of knowledge on the part of the physicians regarding utilization. For one quarter, we had one single patient account for over 80 percent of the readmissions. Once we educated the physicians on the importance of utilizing the outpatient or even observation settings when possible (instead of automatically admitting), we saw an instant decrease.
We began physician education by labeling our chart stickers that we use for utilization review with “DOES NOT MEET INPATIENT CRITERIA” or “ADMIT OR D/C BY (DATE)” for patients in observation. We also began printing out the criteria from McKesson for the primary disease process to show whether or not a patient actually qualified for inpatient admission and why or why not. In addition, we encouraged the physicians to call us if there was ever a patient in question as to whether or not they would meet criteria and if they did not, we offered alternative options.
We saw a change almost immediately. Some physicians were quicker to pick up the phone and call us than others, but all of them do understand changes in reimbursement and want to find the balance between giving the best care and also getting reimbursed fully so that we can continue to provide our services.
Our percentage of readmissions for July 1 – December 31, 2015 is down to 5 percent.
In addition to our in-house efforts, we were very fortunate to be contacted by our local health alliance about participating in a 3-year grant program that will provide a health coach to educate patients in the hospital and to follow them for 45 days after discharge at no cost to our facility. We are very excited to see how much our rates will decrease with our health coach on board!
To be successful, you must have support from your staff, your physicians and your administration. Education is key and numbers ALWAYS speak louder than words!