It’s been 12 years since the Hospital Readmission Penalty became the law of the land as part of Obamacare. But for many hospitals, it didn’t become “real” until 2 years later when the first penalties were actually assessed.
Between then and now, much has changed. The Affordable Care Act itself found itself in the political ICU. But it survived and now looks to be alive and well for the foreseeable future.
So given that it is the reality, what have we learned?
The most important lesson is that in order for a hospital, health system, or community to implement and maintain a successful hospital readmission program, it really needs to take a multi-prong approach.
For simplicity’s sake let’s identify the four critical pillars that are the bedrock of any successful readmission plan.
It’s a tired trope of any program rollout – without leadership it’s going to flop. We’ve all experienced what happens to so-called priority programs when they lose their change champions.
All the work and effort is often put aside in favor of a new priority. This is a costly mistake that happens in organisations of all sizes. In order for any hospital or healthcare provider to successfully create a readmission program there has to be an ironclad buy-in and commitment from the very top that creates a cultural commitment that influences every decision up and down the leadership chain,
Until leadership across the board truly buys in and considers the hospitals’ readmission rate a Key Performance Indicator it will always be vulnerable to the shifting winds. Leadership must make readmission a baked-in priority for every decision.
Re-program your emergency department
Despite the 12 years since the ACA became law, many emergency rooms are still stuck in the “heads in beds” mentality. In order for your readmission program to work, you need to get them on board with value based medicine.
This means educating your emergency department doctors that the game has changed. The emergency doctor’s job has transitioned from “justifying admission” to “analyzing and determining if the patient meets criteria.”
Your emergency department doctors must be all-in mentally and in daily practice before the real change occurs. Until you consciously remind them that they were not hired to put heads-in-beds, they will continue to sub-consciously operate as if that is their role – even 12 years after the implementation of value-based care in PPACA.
Preventing all avoidable and unnecessary hospitalizations, not just readmissions
It would be really difficult, laborious, and unnecessary to implement readmission prevention tactics that did not prioritize reducing overall avoidable and unnecessary hospitalizations as a whole.
Besides, that would be missing the point. The point of value-based care is to allow individuals to age and heal at home, self-manage, and only be admitted to the lowest level of care needed when appropriate.
Engage your community and post-acute provider in the process
One of the most important aspects of a successful readmission program is creating a strong network of partners – who are equally committed to reducing readmissions.
This network can include community organizations, caregivers, and post-acute providers. Look for partners who are Certified Readmission Fellows – as they will be knowledgeable about the penalty and how they can best help you avoid it.
The fact is that you can’t do this without actively engaging your third party providers.
However, community organizations and post-acute providers will not prioritize preventing readmissions if the referring hospital does not. Walk the walk! Refer back to pillar #1 above if you lose sight of what’s important.