Recent studies indicate that high readmission rates often may be due to patient demographics, giving clinical laboratories an opportunity to use lab test results in ways that minimize the need for specific patients to be readmitted

Medicare’s efforts to reduce hospital readmission rates have left most hospitals facing reductions in Medicare payments. However, a recent ranking of hospitals by the Modern Healthcare Data Center indicates that influences other than inferior care—such as patient demographics—can affect 30-day readmission rates.

These findings are noteworthy for pathologists and clinical laboratory managers operating medical laboratories in hospitals and health systems. That’s because readmission rates impact a hospital’s budget. Thus, less revenue can cause hospital administrators to reduce spending for clinical laboratory and anatomic pathology services.

Among large hospitals—those with 4,000 or more admissions—institutions with the lowest rates include:

Hospital for Special Surgery in New York City with a 11.6% readmission rate;

Mission Hospital in Asheville, NC (12.7%);

St. Francis Downtown in Greenville, SC (12.7%);

Roper St. Francis in Charleston, SC (13.1%); and

St. Luke’s Regional Medical Center in Boise, Idaho (13.1%).

At the opposite end of the spectrum, the large hospitals with the highest 30-day readmission rates were:

Lakeland Regional Medical Center in Lakeland, Fla. (19.9%);

Mount Sinai Beth Israel in New York City (19.7%);

Cooper University Hospital in Camden, NJ (19.5%);

New York Methodist Hospital in New York City (19.4%); and

Florida Hospital in Orlando (19.3%).

Patient Follow-up and Monitoring Key to Lowering Rates

Under the Affordable Care Act, hospitals are penalized for excessive readmissions related to select conditions. According to an analysis of data from the Centers for Medicare and Medicaid Services (CMS) by Modern Healthcare, only 799 out of more than 3,400 hospitals subject to the Hospital Readmissions Reduction Program (HRRP) in 2015 avoided a penalty. Thirty-eight hospitals will be subject to the maximum 3% reduction in Medicare payments this fiscal year.

The readmissions program evaluates patients initially hospitalized for heart attack, heart failure, pneumonia chronic obstructive pulmonary disease, and total hip and total knee replacements.

Some of the hospitals rated among the best at minimizing 30-day readmissions have actively set out to monitor patients after discharge, or introduced programs to assist patients with medication compliance. In a December 2015 article, Modern Healthcare noted the steps taken by Roper St. Francis Healthcare in response to CMS’ various quality-based incentive programs, including establishing the Care Transition Program, in which elderly patients are provided assistance in managing their medications.

As part of the monitoring program, Todd Shuman, MD, Chief Physician Officer, at the Charleston, SC-based healthcare system, told Modern Healthcare that pharmacy technicians are conducting medication reconciliations with patients as well as making calls to local pharmacies to determine when patients last filled their prescriptions.

The Hospital for Special Surgery (HSS), meanwhile, developed a mobile app that enable staff to interact with patients remotely after discharge, stated Louis Shapiro, MS, HSS, President and CEO, in the Modern Healthcare article.

Value-based Care (Pay for Performance) Lowering Readmissions in New Jersey

Jeffrey Brenner, MD, Executive Director of the Camden Coalition of Healthcare Providers, a nonprofit organization working to develop value-based care models in New Jersey, believes the establishment of readmission penalties has accelerated healthcare’s transformation to value-based care as hospitals look to improve care coordination, build community partnerships, and make patients more active participants in their own health care.

“This is the most exciting moment of my career,” Brenner told HealthLeaders Media. “Partly because of the readmissions penalties, people are having discussions they have never had before … When everything is said and done, the whole health system is going to look different.”

Are Some Readmissions Unavoidable?

Several recent studies, however, have called into question the link between suboptimal care and high readmission rates. Becker’s Hospital Review reported on a study published online June 15, 2016, in JAMA Surgery that concluded many readmissions were unavoidable. “A large number of readmissions were not caused by suboptimal medical care or deterioration of medical conditions, but by confounding issues of substance abuse or homelessness,” the authors stated.

Another study published in the November 2015 issue of the JAMA Internal Medicine looked at 29 patient characteristics such as race, education, prescription drug adherence, and alcohol intake. It found that readmission rates at the best-and-worst performing hospitals could be attributed to differences in patient populations.

Michael L. Barnett, MD, MS

Michael L. Barnett, MD, MS, Assistant Professor of Health Policy and Management at Harvard Medical School, is the lead author of a JAMA Internal Medicine study that shows hospitals with high readmission rates may be penalized to a large extent because of the patients they serve. The study concluded that patients admitted to hospitals with the highest readmission rates were more likely to have characteristics that were associated with a higher probability of readmission. (Photo copyright: Harvard University.)

“By taking account of that disparity between the patient populations between the best- and worst-performing hospitals, we really narrow that range, and so the worst-performing hospitals don’t look nearly as bad,” stated the study’s lead author, Michael L. Barnett, MD, MS, Department of Health Care Policy, Harvard Medical School, in a Huffington Post article.

“And maybe the best-performing hospitals don’t look as good, because they’re taking care of patients that are much less likely to have been readmitted in the first place,” Barnett added.

Hospital-based clinical laboratories should consider it a challenge and an opportunity to identify ways that the lab team can contribute to reducing readmissions at their parent organization. For labs with an outreach program, that might mean monitoring the lab test results from recently-discharged patients so as to alert their physicians in a way that triggers a timely intervention to prevent the patient from being readmitted.

—Andrea Downing Peck

Related Information:

Most Hospitals Face 30-day Readmissions Penalty in Fiscal 2016

Keeping an Eye on Discharged Patients

Patient Characteristics and Differences in Hospital Readmission Rates

Analysis of Risk Factors for Patient Readmission 30 Days Following Discharge from General Surgery

Most Readmissions Aren’t Linked to Suboptimal Care, Study Finds

Is Obamacare Punishing Hospitals the Wrong Way?

How Bundled Payments Ratchet Readmission Rates Downward

Reducing Hospital Readmission: How Hospitals and Insurers Are Making Strides

Medicare Assesses More than $280 Million in Penalties to Hospitals with High Readmission Rates

Medicare Targets Avoidable Hospital Readmissions to Jumpstart Delivery Reform

Hospitals Mine Clinical Data to Help Reduce Costs and Avoid Readmissions, Creating Opportunities for Clinical Laboratory Pathologists to Contribute to Improved Patient Outcomes

Drive on to Motivate Hospitals to Prevent Avoidable Readmissions

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