The readmission rate is dropping, but are hospitals just doing a quick shuffle--shifting patients from inpatient status to observation services--to make that change happen?
The study "Readmissions, Observation, and the Hospital Readmissions Reduction Program" published in the February 24 issue of the New England Journal of Medicine says that is not the case. The decline in readmissions is real, says the study, and likely in response to the Hospital Readmissions Reduction Program (HRRP), which fines hospitals for excessive readmissions.
CMS implemented the HRRP in 2010 in an effort to save the government money on the $17 million in estimated avoidable costs incurred each year from unnecessary hospital readmissions and to spare patients the poor outcomes that send them back to the hospital after they are discharged home.
The readmission rate has declined since the implementation of HRRP. But at the same time, some pointed to the fact that use of observation services was increasing and wondered if the two were connected. Others questioned whether the HRRP was actually making a difference in readmission rates, which were already on the decline before the program went into place.
The findings of this study validate what some case managers say they knew all along.
"Personally, as a director of case management I have never seen observation status used to avoid the readmission penalty," says June Stark, RN, BSN, MEd, director of care coordination at St. Elizabeth's Medical Center, Steward Healthcare in Boston.
Accurate patient matching within the EMR should not be a concern limited to HIM professionals. Ensuring that medical record data is correct and complete and that duplicate records are not created is key to various healthcare initiatives, including population health management, analytics, information governance, patient-centric care, health information exchanges, and finance. It all starts with the patient's record. Reducing the number of duplicate records at a hospital and being able to effectively match records is critical to ensuring that these healthcare initiatives are successful, says Lesley Kadlec, MA, RHIA, CHDA, director of HIM practice excellence for AHIMA.
"Patient matching is really the underpinning of all the strategic initiatives that are going on in healthcare," Kadlec says. "You have to have accurate patient information to have accurate patient care. Ensuring that you have the right patient and the right information at the right time is really what drives the physicians' and clinicians' ability to actually provide that patient with care."
More than half of HIM professionals work with mitigating duplicate patient records, and of that group, 72% do so on a weekly basis, according to a recent survey of AHIMA members. Unfortunately, less than half of all respondents have quality assurance in place for their registration or post-registration processes. (A summary of the data is available in the Journal of AHIMA.)
"The challenge is having the staff to be able to dedicate to making the corrections, doing the matching, and ensuring that everything is getting put back together," Kadlec says.
Patient matching and duplicate records are a major issue right now because hospitals are using so many different systems and there is often a lack of information governance across those systems, says Megan Munns, RHIA, identity manager at Just Associates, Inc., based in Denver.
Few in the healthcare industry would argue that the way the government currently pays for drugs is the most cost-effective, efficient, and equitable method possible.
Last year, as ICD-10 implementation approached, organizations throughout the U.S. reported varying levels of comfort with regard to readiness and understanding of the impact of ICD-10 on physician workflow. For some, it was business as usual. For other physicians, ICD-10 became one more check box on the list of reasons to leave practice.
CMS proposed an extensive five-year, two-phase plan to overhaul Part B drug payments for physicians and hospitals in March outside of the normal OPPS rulemaking cycle that could be implemented as early as this fall.
