Hospital Readmission Penalties…Opportunities to Leverage Your EHR

Beginning October 1st, the federal government begins to assess financial penalties on organizations with higher-than-expected re-hospitalization rates.  The focus is clear – reducing unnecessary hospitalizations will improve quality care and reduce costs.  About two-thirds of the hospitals serving Medicare patients, or some 2,200 facilities, will be hit with penalties averaging around $125,000 per facility this coming year, according to government estimates.

For the first year, the penalty is capped at 1 percent of a hospital’s Medicare payments, though most penalized facilities will pay less. There are 3 conditions being measured for readmission – heart attacks, heart failure and pneumonia.  Under the health care law, the penalties gradually will rise until 3 percent of Medicare payments to hospitals are at risk.  With the expansion in penalties, hospitals can also expect to see other disease-specific readmission measures to come into play such as stroke, joint replacement, stenting and heart bypass.

The opportunity for penalty avoidance comes in a very thoughtful and methodical approach to coordinating teams and technology efforts already underway.

As hospitals and providers work toward Meaningful Use readiness, we begin to see alignment of the requirements and a significant opportunity, if taken, to begin to put in place processes and communications that can help in reducing readmissions.

The Stage 1 Meaningful Use requirements for medication reconciliation on transitions in care, the provision of an electronic copy of discharge instructions and care summaries to patients (upon request), and the various stroke quality measure provide for a foundation for data collection that can and should be used to improve care transitions and reduce unnecessary readmissions.

Organizations ready to begin Stage 2 Meaningful Use activities the evolution of the MU Stage 1 requirements as well as new requirements for online access to care summaries for patients, electronic sharing of care summaries on transitions in care, and electronic submission of an even greater number of quality measures (remember there are only 3 conditions for penalty for now, there are more to come), have a tremendous opportunities to use and apply data in a meaningful way to not only receive HITECH incentive monies but also avoid readmission payment penalties.

Time is of the essence, receiving MU incentives does not a balance to readmission penalties make!

Organizations must begin to move from the “collect the data” theme of Stage 1 Meaningful Use to “use the data” message of Stage 2 immediately.  Optimization of the use of the EHR across the continuum of care, in a coordinated, inclusive, methodical and expeditious manner is a MUST!

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