Readmissions are a critical quality metric for hospitals, significantly impacting financial and reputational outcomes under the Hospital Readmissions Reduction Program (HRRP) and the Centers for Medicare & Medicaid Services (CMS) Star Rating system. The HRRP imposes penalties on hospitals with higher-than-expected readmission rates for specific conditions, aiming to incentivize improvements in hospital discharge planning and post-discharge care. Similarly, the CMS Star Rating system evaluates hospitals on various performance measures, including readmission rates, to help consumers compare hospitals more easily. High readmission rates can lead to reduced Medicare payments and lower star ratings, which may influence patient choice and hospital revenue.

Dexur's analysis of Medicare claims data provides insight into the duration of stay for patients readmitted with certain conditions, highlighting the percentage of readmissions with a length of stay (LOS) of one and two days who are alive at discharge. This data is crucial for understanding hospital performance, patient outcomes, and the potential efficiency of care provided. The table below summarizes the findings for the 2024 CMS reporting period across several conditions showing 18-30% of total readmissions staying for 1 or 2 days only.

The data reveals a notable pattern of short-stay readmissions across various conditions, with the highest percentages observed in AMI, CABG, and TKA. These findings suggest a subset of readmissions may be related to issues that do not require extended hospital stays to resolve, such as complications or issues manageable with short-term interventions. Understanding the factors leading to these short-stay readmissions is essential for hospitals to address potential quality improvement areas, reduce unnecessary readmissions, and improve their performance under the HRRP and CMS Star Rating system.

Strategies to Mitigate Short-Stay Readmissions

1. Enhanced Post-Discharge Planning and Follow-Up: Implementing comprehensive discharge planning that includes clear instructions on medication management, symptoms monitoring, and when to seek medical attention can reduce confusion and prevent readmissions. Scheduled follow-up calls or visits can help catch and address complications before they necessitate readmission.

2. Patient Education and Engagement: Educating patients about their condition, treatment plan, and what symptoms to watch for can empower them to manage their health proactively. Providing educational materials and access to resources that encourage self-care and awareness can make a significant difference.

3. Improved Care Coordination: Coordinating care among the patient's healthcare providers ensures that everyone involved in the patient's care is informed about the treatment plan, follow-up care, and any potential issues. This can include primary care physicians, specialists, and home health services.

4. Utilization of Technology: Telehealth and remote patient monitoring can be invaluable for keeping tabs on patients' health status without requiring them to return to the hospital. These technologies can alert healthcare providers to potential issues before they become severe enough to require readmission.

5. Targeted Intervention Programs: Developing intervention programs for high-risk patients, such as those with chronic conditions or those undergoing major surgeries like CABG and TKA, can address specific needs that might lead to readmissions. These programs can include specialized nursing care, physical therapy, and dietary planning. Dexur provides an intervention tracking software to help understand the impact of interventions on measures.

6. Medication Reconciliation: Ensuring that patients' medication lists are accurate and up-to-date at the time of discharge can prevent adverse drug events, which are a common cause of readmissions. This process should include a thorough review of all medications the patient is taking, with adjustments made as necessary.

7. Quality Improvement Initiatives: Hospitals should continuously analyze readmission data to identify trends, underlying causes, and areas for improvement. Quality improvement teams can use this data to develop targeted strategies to reduce short-stay readmissions. Dexur provides in depth data on readmission and short stay readmissions as well to help Hospitals reduce these potential avoidable readmissions.

By focusing on these strategies, hospitals can address the factors contributing to short-stay readmissions. This not only improves patient care but also aligns with the goals of the HRRP and CMS Star Rating system, thereby enhancing the hospital's overall performance and reputation. Effective implementation of these strategies requires a multidisciplinary approach, involving clinicians, nurses, pharmacists, and other healthcare professionals, along with the integration of health information technology to support patient care and communication.