Preventing Readmissions and Reducing Utilization of Unnecessary Services
By Ivy Xiwen Deng
Data Visualization by Sanat Malhotra
In the wake of the Affordable Care Act (ACA), hospitals have drawn attention from policymakers as key partners in reducing the overall cost of care. Consequently, the effort has led to an enhanced focus on preventing readmissions and reducing unnecessary care.
The ACA implemented several policy measures to hold hospitals accountable for what happens to patients post-discharge. For example, the Hospital Readmissions Reduction Program, Bundled Payment for Care Improvement Initiative (BPCI), and Comprehensive Care for Joint Replacement (CJR). Such models aim to incentivize hospitals to be more proactive in impacting patient outcomes and reducing a patient’s overall cost of care. The Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACT Act) mandates data submission of standardized patient assessments, quality measure, and resource use by post-acute care providers (PAC). The Act targets improvements in care coordination and communications to lower the cost of care.
Finding the Gaps with Data
Despite the emphasis placed on these efforts, significant knowledge gaps persist in assessing the variations and obstacles within post-acute care systems, including skilled nursing facilities (SNF), home health agencies (HHA), hospices, rehabilitation hospitals, and long-term hospitals. CareJourney data show that, in 2018, on average, almost half of Medicare patients discharged from inpatient short-term acute care hospitals went directly home.
Hospital discharge patterns vary dramatically by facility (see figure below). Based on data pulled from CareJourney’s Network Advantage platform, in 2018, 73.25% of inpatient short-term acute care facilities discharged less than 50% of their Medicare Fee-for-Service (Medicare FFS) patients to any post-acute settings. 26.75% of facilities discharged at least 50% of their Medicare FFS patients to post-acute facilities.