The CMS Readmissions Reduction Program
According to CMS, approximately 20% of recently admitted Medicare patients return to the hospital within 30 days of discharge. Many factors impact the rate of readmissions. However, as CMS continues its drive towards value based care, the impact of readmissions is having a negative financial impact on a majority of facilities. Indeed, roughly 3 out of every 4 hospitals were penalized as part of CMS’s Hospital Readmissions Reduction Program (HRRP).
The CMS formula for calculating penalties is complicated and based in part on the hospital’s readmission rate during the 3 years prior to the penalty effective date. CMS recognizes that there are mitigating factors contributing to hospitalizations. However, not included are other key factors such as the sociodemographic characteristics of the local patient population and community resources – factors largely beyond the control of hospitals and health systems.
FTI’s Convergence Solutions team consists of deep and experienced professionals who can assist you in minimizing, if not eliminating, potential penalties under the CMS HRRP. We work closely with you to asses and understand the potential areas of opportunity. Although we tailor our work efforts to your specific needs, our standard approach is as follows:
- Assess the health system’s readiness to effectively manage the defined population of Medicare patients to prevent avoidable readmissions
- Determine the degree of alignment between the health system and the medical staff
- Apply advanced analytic tools to determine:
- Combination of patient attributes (i.e. demographics, prior healthcare utilization patterns)
- Patterns of care that drive readmissions (i.e., sociodemographic factors, prior pharmacy adherence
- Maximize deployment of care management services using geo-spatial maps in relation to:
- Primary admission site
- Attributed provider
- Access to Urgent Care
- Readmission facility location