Protect Your 30 Day Discharge Window: Knowing Discharge Options

Nearly 2 million Medicare beneficiaries are readmitted within 30 days of release each year, costing Medicare $17.5 billion in additional hospital bills. Kaiser Health

The Basics

The birth of the Affordable Care Act brought about the principle of penalizing hospitals for re-admission of patients with identified diagnoses within 30 days of discharge. Beginning in Fiscal year 2012, CMS finalized policies regarding readmission measures under the Hospital Readmissions Reduction Program. (CMS)

  • Hospital readmission would be defined as a 30 day window following discharge.
  • Initial readmission measures would apply to conditions of: Acute Myocardial Infarction, Heart Failure, and Pneumonia.
  • An algorithm was established to compute the payment adjustment amount based upon the percentage of readmissions.

In Fiscal year 2013, the penalty of 1% reduction rate was established and increases to a 2% reduction in hospital payments in Fiscal year 2014, which began October 1, 2013. In Fiscal year 2015, the program will be expanded to include diagnoses including: chronic obstructive pulmonary disease, elective total hip arthroplasty and elective total knee arthroplasty.  Proposed for Fiscal year 2015 is another penalty increase to 3%. (CMS)

Why home is not always the best option immediately following an acute hospitalization

It is not uncommon in the geriatric population for physical and mental declines to develop during an acute hospitalization. Because of these resulting conditions, many elderly patients need continued care after leaving the hospital. Returning home immediately following hospitalization is not always the safest option; for some it is not the most effective place to be cared for upon discharge. In many cases, a skilled nursing facility can provide a safe place for nursing and rehabilitation staff to care for and treat individuals who are still at risk for falls due to the following factors.

Delirium

Delirium has been recognized as a common syndrome in the hospitalized elderly. It occurs in 20-38% of elderly patients. Symptoms of delirium are known to persist at the time of discharge in 95% of patients who develop it while hospitalized.

Drops in Blood Pressure

With decreased activity, as is common in hospitalization, the elderly may also experience muscle strength decreases by 5% per day. Bed rest in the supine position results in loss of plasma volume averaging about 600 mL, contributing to the susceptibility for postural hypotension and syncope, which is already associated with usual aging.

Bone Loss

When on bed rest, vertebral bone loss accelerates to 50 times the active rate in healthy men. In one study we reviewed, the loss of bone incurred within 10 days of bed rest required 4 months to restore. Frequent falls that occur with the hospitalized elderly have increased the likelihood of fractures, particularly hip fractures.(5)

Incontinence

About 40-50% of hospitalized persons over the age of 65 become incontinent, many within a day of hospitalization. The functional incontinence that occurs in the hospital explains the discrepancy between incontinence rates in community-dwelling and newly hospitalized patients. (5) Even though this decline is reversible, long periods of rehabilitation will be required because reconditioning time is longer than deconditioning time. (5)

What about medication compliance?

If the patient were to return to home, he/she would receive minimum exposure to skilled intervention with the burden of medication compliance falling on the patient or the caregiver. The majority of elderly patients experienced modifications in their medication regimen during the first month following hospital discharge. Skilled nursing services in a nursing home will provide guaranteed medication compliance upon discharge from the hospital, and therapy/nursing will be more acutely aware of any adverse drug reactions.

Why Therapy Center and our partner facilities are different

The level of services provided by the SNF setting, encompassing nursing care and rehab, will create a more solid network to prevent and/or decrease risk of rehospitalization, particularly within the 30 day window. Many of the Therapy Center’s patients are short stay, rehab clients.

So far in 2013, the Therapy Center’s return to home average is 54%. Having full-time therapists, in each of our partner skilled nursing facilities, allows us to address physical and cognitive dysfunction, and monitor medical condition while they are in our care. A fully staffed therapy department is needed in order to run an intense therapy program and we pride ourselves on making the return to home a priority. Our therapists are trained holistically, providing individualized treatment programs that prepare the patient for successful discharge to their desired location. The skilled nursing homes we partner with have long-term, consistent nursing staff, which also contributes to personal and individualized treatment.

 

Why we are your solution

Therapy Center’s goal is to play a positive part in adjusting to the evolving readmissions guidelines set forth by CMS. Our mission is to help educate hospital personnel on how we, along with our partner skilled nursing facilities, can help to reduce rehospitalizations and avoid costly penalties.  We believe that we can help to protect your 30 day window by achieving positive, long-term outcomes for the patients in the local communities we serve.

 

Resources:

1.Burroughs, Jonathan H., 6 strategies hospitals should steal from the airline industry, http://www.hospitalimpact.org/index.php/2013/09/17/p4354, September 17, 2013
3.Rau, Jordan, Medicare to Penalize 2,211 Hospitals for Excess Readmissions, http://www.kaiserhealthnews.org, August 13, 2012
4.Mansur, N, et. al, Continuity and adherence to long-term drug treatment by geriatric patients after hospital discharge: a prospective cohort study, http://www.ncbi.nlm.nih.gov/pubmed/18808210
5.Creditor, Morton C.,  Hazards of Hospitalization of the Elderly, Annals of the Internal Medicine. 1 February 1993, Volume 118 Issue 3, Pages 219-2223
6.Murray, Anne M., et. al, Acute Delirium and Functional Decline in the Hospitalized Elderly Patient, Journal of Gerontology: Medical Sciences, 1993, Vol 48, No 5, M81-M186

 

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Author Info

Kristi Fredieu

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