News, Analysis, Trends, Management Innovations for
Clinical Laboratories and Pathology Groups

Hosted by Robert Michel

News, Analysis, Trends, Management Innovations for
Clinical Laboratories and Pathology Groups

Hosted by Robert Michel
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Reducing Hospital Readmission: How Hospitals and Insurers are Making Strides

After discharge, almost one in six patients land back in the hospital due to complications that could have been prevented with better follow-up care! According to the Institute for Healthcare Improvement (IHI), nearly 18% of Medicare patients admitted to a hospital are readmitted within 30 days of discharge, accounting for $15 billion in spending, according to the Medicare Payment Advisory Commission Now, regulators, insurers, employers, and quality-measurement groups are all considering methods to tie hospitals’ payment to lower readmission rates.

“The experience of multiple hospitalizations can take a devastating toll on the human psyche and the quality of life for patients and their caregivers,” said Mary Naylor, a professor at the University of Pennsylvania School of Nursing. There are about 5 million readmissions a year in U.S. hospitals, with approximately a third occurring within 90 days of discharge. IHI research suggests that transitional care programs, which follow patients for varying periods of time at home, reduce admissions by up to 46%.

IHI is working with hospitals to reduce readmissions by: 1) identifying patients at risk for return; 2) scheduling follow-up doctor’s appointments before patients are discharged; 3) sending nurses to patients’ homes within a few days of discharge; 4) monitoring patients at home; and, 5) educating patients and families on how to adhere to medication schedules and self-care regimens. Part of the problem in getting hospitals to adopt these types of discharge programs in the past was that hospitals did not get paid to coordinate care after a patient left. That’s rapidly changing, now that large managed-care groups and insurers are experimenting with programs to cover such services.

Both Aetna and Kaiser Permanente unveiled pilot programs this year that focus on congestive heart failure patients, a third of which are generally readmitted within 30 days of discharge with complications from the condition. Early results from Kaiser’s program suggest success. Its two medical centers involved in the pilot program decreased their hospitalization and readmission rates for heart failure patients to about a third of Kaiser’s system-wide average.

A similar program developed at St. Luke’s Hospital in Cedar Rapids, Iowa, cut unplanned readmission rates in half, to 6%, as of last January. Prior to discharge, patients at St. Luke’s were asked to restate in their own words what they had been told about how to follow care instructions at home. These patients were then sent home with a refrigerator magnet that included a list of symptoms for which they should watch and an emergency number to call.

This emphasis on reducing readmission rates is no surprise to clients and regular readers of Dark Daily. The American healthcare system is actively looking to reduce medical errors, increase health outcomes, and at the same time cut the cost of care. Putting hospital readmission rates on the radar screen is consistent with this healthcare trend.

Further, the pay-for-performance dynamic makes sense. As the health insurer sees a reduction in costs because of a falling rate of hospital readmissions, it can pass these savings along to those hospitals in the form of pay-for-performance incentives or similar reimbursement arrangements. For the laboratory industry, the emphasis on reducing hospital readmission rates is a reminder that eventually pay-for-performance arrangements will arrive at the doorstep of laboratory medicine. Laboratories should be establishing internal performance measurements so they are prepared to document how their quality and efficiency improves over time.

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Making Managers in Your Laboratory More Productive and More Effective

Today’s most innovative clinical laboratories and pathology labs are tapping a powerful resource to achieve world-class outcomes-their managers! In response to a variety of market forces, laboratory administrators and medical directors are turning their attention toward encouraging more productivity and achievement from managers at all levels in their laboratory.

“This is an emerging trend,” stated Jeff Smith, Vice-President of Leadership Development for Slone Partners of Miami, Florida. “The art and science of management in clinical laboratories is now reaching the point where, for a laboratory to be competitive and financially self-sustaining, it must get top productivity from its management team. In fact, this is how first mover and early adopter laboratories are responding to ongoing budget cuts and the acute shortage of trained medical technologists (MTs) and other technical staff that makes it near impossible to operate their laboratories at 100% of authorized staffing levels.”

In recent years, Smith has been personally involved with several prominent clinical laboratories to help them create and implement effective management development programs. “It is no accident that these clinical laboratories achieve world-class management outcomes,” noted Smith. “They have three attributes that can be duplicated by any laboratory-large or small-willing to pursue management excellence.

“First, top-performing laboratories are good at assessing the strengths, weaknesses, and undeveloped potential of their managers,” he said. “This means recognizing those managers with the potential to be a management super star, as well as those managers, who, because of their attitudes and long-established patterns, are likely to roadblock and oppose efforts to improve productivity and performance within the laboratory.
“Second, top-performing laboratories create an objective, concise career path for lab managers at all levels,” continued Smith. “These career paths help senior lab leaders identify promising manager candidates at the bench, and then provide these individuals with the training, knowledge, and mentoring that allows them to develop. The goal is to help the next generation of management talent acquire skills and experience in a safe setting, and build them step-by-step, level-by-level, into confident leaders and managers.”

“Third, in those clinical laboratories and pathology laboratories with the most energized management teams, I see a well-articulated vision, clear management objectives, and detailed measurement of progress toward goals,” commented Smith. “This is accomplished in two dimensions. One dimension is the global goals and measurements for the laboratory’s operational, service, and financial objectives. The other dimension involves regular and objective feedback to managers on how they are attaining their personal milestones while managing their staff in ways that sustain the desired working culture with the laboratory.”

For those laboratory administrators, lab directors, and lab managers interested in advancing their ability to create a high-performance management team, Jeff Smith has agreed to conduct a special audio conference on this topic for readers of Dark Daily and The Dark Report. Titled: “Improving Lab Management Productivity: How To Evaluate Your Team And Stimulate Increased Performance And Profitability,” this unique learning opportunity will take place on October 21, 2008 at 1:00 P.M. Eastern Time. This will be a fact-filled, 90-minute session. For information and to register, visit

This audio conference helps you understand how to identify the super-stars on your management team. You’ll learn how to re-recruit them so they don’t go off to work in another laboratory. There will be information on how to spot the non-achievers on your existing management team, along with proven methods you can use to help these disappointing managers either overcome their barriers to self growth and lab achievement or to help them recognize their deficiencies, setting up a mutual departure from the lab. Best of all, you’ll learn the proven secrets to creating an energized, enthusiastic, “can do” management culture in your lab-one that consistently exceeds expectations. Reserve your participation in this highly valuable audio conference by registering today at

1. Register Online
2. Call toll free: 800-560-6363

Registrations accepted until Tuesday, October 21, 2008, noon EDT.
Cancellations before 5:00 p.m. EDT on Friday, October 17, 2008 may receive a full refund less a $25 service charge.

Your audio conference registration includes:
•    A site license to attend the conference (invite as many people as you can fit around your speakerphone at no extra charge)
•    Downloadable PowerPoint presentations from our speakers
•    A full transcript emailed to you soon after the conference
•    The opportunity to connect directly with our speakers during the audience Q&A session