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Strategies to Reduce Readmission Christy Rakoczy

November 7th, 2012

RevolvingDoorReadmission is a major problem in U.S. hospitals, so much so that Hospital Impact reports that one out of every five Medicare patients is readmitted to the hospital within 30 days of being discharged.  Hospital Impact reports that these readmissions come at a cost of approximately $17.5 billion each year.

While Fierce Healthcare reports that Medicare has a new policy- called a Readmissions Reduction Program – that docks up to 1 percent of pay for hospitals with high readmission rates, simply penalizing hospitals isn’t the answer. No hospital or rehabilitative care facility wants patients to be sent back into the hospital. The problem, as News Medical reports, is that hospitals are lacking in cohesive strategies to reduce readmission.  Developing a detailed discharge plan, therefore, is a key first step in helping patients to thrive once they’ve left the hospital. So, how can hospitals succeed at doing this? Here are a few tips.

1.     Form partnerships with nursing home practitioners and provide detailed discharge guides.

Health Research & Educational Trust (HRET) created a “Health Care Leader Action Guide to Reduce Avoidable Readmissions.” Among other techniques, the guide advocated arranging nursing home placements for discharged patients who need assistance and providing detailed discharge instructions to the nursing home. Certain care facilities are better equipped than others to address patient needs, and finding the right nursing home and communicating openly with healthcare professionals there is one of the keys to minimizing readmissions.

2.     Leverage available technologies

Hospital Impact’s October 2012 article entitled Hospital Readmission Penalties: Seize the Opportunity stressed that hospitals should look at Medicare penalties for excess readmissions as an important opportunity to streamline their discharge plans and to get better at preventing readmissions.

One of the suggestions made in the article was to leverage all available technologies to reduce readmissions. According to the article, technologies are available to identify patients at high-risk of readmission and to monitor effectiveness in real-time. Many web-based technologies today allow for greater communication between hospitals, nursing homes and patients. Taking advantage of new and easy forms of identifying appropriate nursing homes and communicating with caregivers and discharged patients only makes sense.

3.     Tailor the discharge plan to the patient

In the Bangor Daily News, an article on “How to reduce hospital readmission rates” recapped a study performed by Health Management Associates. The study looked at how four hospitals achieved their low readmissions. Based on a survey of successful hospitals in Utah, Iowa, Texas and Missouri, hospitals with discharge plans tailored to individual patients tend to have lower readmissions rates.

A Cedar Rapids Iowa hospital, for example, targeted at-risk patients and sent social workers to visit them after discharge. An Ogden, Utah hospital trained nurses and case managers to assess each patient’s literacy skills and adjust their instructions accordingly.  These different programs both focused on catering to the individual needs of each patient, recognizing that different types of support or care may be necessary for different discharge situations.

4.     Address medication issues

News Medical stresses the medication reconciliation process as key in avoiding readmission. By implementing a strategy where all patients receive detailed information about their medication and by using teach-back techniques to make sure patients understand, patients may be more likely to keep up with their own care after discharge. For those patients who are not able to manage their own medication needs, providing detailed information to nursing homes or caregivers about medication is also essential.

Creating a Comprehensive Strategy to Limit Readmissions

These four steps are just a few of the many that hospitals can put into place to cut readmission rates. The key for every hospital is to come up with a detailed strategy that uses proven techniques that work. By creating a discharge strategy tailored towards meeting the needs of the patient, finding the right facility or caregiver for the patient upon discharge, and taking advantage of advances in technology that allow for more effective discharges, hospitals may begin to reduce their readmission rates.


About the Author

Christy Rakoczy has a JD from UCLA School of Law and an undergraduate degree in English Media and Communications from University of Rochester. Her career background includes teaching at the college level as well as working in the insurance and legal industries. She is currently a full-time writer who specializes in the legal, financial and healthcare sectors. Ms. Rakoczy writes online content as well as textbooks for adult learners.



  1. Mark November 16, 2012

    I feel home visits by social services is a very important part of the continuum of care. I believe there is a lack of understanding among in hospital healthcare providers as to the conditions the patients are discharged to.

    Comments have been made to me by in hospital providers that I work in an upper income area and there should not be a problem in the homes. In reality, it does not matter what the social/economic status may be. There are many disfunctional homes in both upper income and lower income regions.

    I believe a requirement of all levels of healthcare education should include time going to homes with social services/homecare providers.
    It is so easy for doctors and nurses to complain when we transport regulars to the emergency department for basic needs when pt’s fail to comply with their discharge instructions. We have no choice but to transport when the pt . Request transport.
    Mark PreFontaine B.A.S Healthcare Admin. EMT-P


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