CMS chose to measure hospital readmission within 30 days because readmissions over longer periods may be impacted by factors outside hospitals’ control—such as other complicating illnesses, patients’ own behavior, or care provided to patients after discharge.
Readmissions within a shorter timeframe can often be prevented when systems within the hospital and across care settings are functioning optimally. In October 2012, as directed by the Affordable Care Act, CMS began reducing payments to certain hospitals with "excess readmissions."
People with Medicare coverage report greater dissatisfaction regarding discharge-related care than with any other aspect of care that Medicare measures.
When patients move from one care setting to another (for instance, from a skilled nursing facility to a hospital, or from a hospital to home), they are at increased risk for medication errors, worsening of or complications from existing conditions, missed treatments or lab work, and a host of other potential problems which can substantially affect their health and quality of life.
Not only is there a human cost due to the lack of coordination and communication during a transition of care, but there are also significant financial impacts.
According to the Medicare Payment Advisory Commission's Report to the Congress: Promoting Greater Efficiency in Medicare, such communication failures during hospital discharges result in avoidable return trips. MedPAC estimates that nearly one in five people with Medicare who are admitted to a hospital will be readmitted within 30 days, and that 75% of those readmissions are preventable. In 2005, Medicare spent an estimated $12 billion on preventable hospital readmissions.
This situation can be changed, and Qualis Health can help your community begin the work.