Identifying Potentially Preventable Readmissions Obeys Willie Sutton's Law--Go where the money is!

Abstract
"Efforts are under way nationally to reduce avoidable hospital readmissions by changing payments to hospitals, but it is unclear how well or how quickly these policy changes will produce widespread reductions in hospital readmissions. To examine some of the challenges to implementing such approaches, the authors analyzed the early experiences of 3 statewide programs to reduce preventable readmissions that began in 2009. Based on interviews with program participants in 2011, the authors identified 3 key obstacles to progress: the difficulty of developing collaborative relationships across care settings, gaps in evidence for effective interventions, and deficits in quality improvement capabilities among some organizations. These findings underscore the uncertainty of success of current readmissions policies and suggest that immediate improvement in readmission rates through a change in reimbursement may be unlikely unless these other obstacles are addressed expeditiously. In particular, cultivation of productive collaboration across care settings will be critical because these kinds of relationships are not well established or naturally occurring in most communities.

Conclusion: "Policies need to consider the economic incentives for coordinating care and how to help cultivate productive human relationships to improve quality across settings."

Mittler JN*, Hora JL, Harvey JB, Press ML, Volpp KG, Scanlon DP. "Turning Readmission Reduction Policies into Results: Some Lessons from a Multistate Initiative to Reduce Readmissions."
Population Health Management (Journal), pub. online Feb. 25, 201  [PDF, Full Article]
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On 12/04/09 4:44 AM, jgk wrote to Jon Eisenhandler, PhD of 3M Health Information Systems (Wallingford, CT)

1.  Identifying Potentially Preventable Readmissions

"Given the increasing pressure to control health care costs and improve quality, and increasing public and governmental scrutiny of both, financial incentives associated with quality measures in general, and hospital readmission rates in particular, will only increase. The effectiveness of these efforts will depend on the integrity of the data and the validity of the methods used in any performance-based payment systems. This study suggests that adequate risk stratification based on patient type and severity of illness as well as identification of those readmissions that are potentially preventable are critical to the fairness and usefulness of any evaluations and comparisons of hospital readmission rates." 

2.  Heart Failure Readmission, a Methodology

"We present a hierarchical logistic regression model for 30-day readmission after HF hospitalization that is based on administrative data and is suitable for public reporting. The model is a strong surrogate for a similar “gold standard” model based on chart data. The approach employs a grouper of 15,000 ICD-9 codes that is in the public domain yielding clinically coherent variables."

3.  Rehospitalizations among Patients in the Medicare Fee-for-Service Program

Anderson and Steinberg among others have weighed demographic factors in predicting the risk of rehospitalization.  Even more powerful predictors are having a previous rehospitalization, a longer index hospitalization as compared with the norm for the DRG, needing dialysis, and the DRG to which the patient is assigned at the end of the stay.  They say the typical Medicare patient has about a 2/3^rds probability of being rehospitalized or of dying within a year after discharge. Also, facilitating a follow-up appointment with a physician  before the pateint leaves the hospital is probably the most relevant thing, medically speaking, a case-mangmemnt person can do.–"Reimbursement Methodologies for Healthcare Services," pub. by American Health Information Management Association's (AHIMA) and 3M, All Products

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And, here's how it's done—A simple way to cut costs and improve quality, in the era of HMO's, was called case management or care coordination.  Visit a fine YouTube video: search on <ACOs: Coordinated Care>