Redoing readmissions

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Tom DePoy
Tom DePoy

When people are discharged from the hospital following an illness, injury or surgery, that's often not the end of the story. For example, about 40% of Medicare patients who are discharged from hospitals are admitted to a skilled nursing or rehab facility to complete their recovery. If there are complications during recovery, or if the patient was discharged too soon, it can mean rehospitalization — a trip back to the hospital. And that can lead to potentially serious health risks for patients, added expense and increased strain on the entire system. Today, Revera nursing centers are taking effective steps to bring down rehospitalization rates, control costs and improve patient outcomes.

Costs of rehospitalization

Just a few years ago, the U.S. rehospitalization trend was alarming. In 2010, nearly one in five Medicare patients discharged to a nursing center ended up back in the hospital. In 2006, Medicare expenditures for rehospitalizated patients totaled $4.3 billion. By 2010, that number had risen to nearly $17 billion a year. A study conducted by the Medicare Payment Advisory Commission found that up to two-thirds of these readmissions were unnecessary and avoidable.

The situation got the attention of consumers and government policymakers. The Patient Protection and Affordable Care Act of 2010 addressed the problem. Starting in 2013, it allowed Medicare to level financial penalties for hospitals based on readmission rates, and to implement “pay for performance” incentives and new payment models that require changes in how hospitals make discharge decisions. These changes inspired many healthcare providers, including Revera, to take cooperative action to lower their readmission rates.

Early results are promising: By the end of 2013, the government reported the lowest rehospitalization rate for Medicare patients in years — less than 18%. Revera nursing centers are contributing to the trend, adopting enhanced processes and news ways of thinking about readmissions and costs.

Effective strategies

Reducing rehospitalization starts with taking a proactive approach to change. We've seized the opportunity to improve both patient care and our relationships with referring hospitals. By creating an environment that reduces the need for rehospitalizations, our partner hospitals also benefit, and, most importantly, so do our residents and their families.

Many of our centers have launched several initiatives to reduce readmissions. These include quality improvement programs, adding more specialists to center staff at our 29 skilled nursing locations, adding staff nurse practitioners to perform higher level assessments, and expanding on-site specialty services including comprehensive ventilator care and KCI V.A.C. therapy for wounds. Our centers' staff learned that having specialty services and specialists in-house — at least in certain strategic areas — are key to reducing rehospitalizations.

One of the most effective ways to minimize readmissions is to make sure that the entire nursing home staff understands the goal and knows how to contribute. Clear, ongoing communication is important. For example, on a designated day each week at our centers, the nursing administrative team performs rounds, visiting all residents and identifying anyone who might be at risk of returning to the hospital during the next 48 hours. They discuss, and with the input of center physicians, implement interventions that can help our residents remain at the facility and stay well.

A team approach to care

Revera's executive directors encourage the entire staff, as well as the resident's family members, to be alert to changes in residents' status. From volunteers and nursing assistants to social workers, our centers have a wide variety of people who interact with residents and may see subtle changes that could indicate an underlying problem. Revera centers' staff are trained to welcome everyone's observations, because it's much easier to address a medical issue in the early stages. A team effort is probably the single most important factor in reducing hospital readmission rates from nursing homes.

Promising future

With enhanced communication between staff, residents and doctors, weekly walking rounds programs, and more specialty services programming in-house, Revera centers have seen a decrease in their rehospitalization rates. 

Revera Nursing and Rehab is one of North America's leading providers of accommodation, care and services for seniors, with a 50-year history of providing quality care. We know we must be vigilant in our processes and be open to new possibilities and ways to continually make things better. 

We see a decrease in rehospitalizaiton rates not as a possibility, but as a reality, and one that will continue in the future. 

Tom DePoy is the Revera Nursing and Rehab Vice President of Operations, Region 2 (NH, VT, WA). He is a past president and vice president of the Vermont Health Care Association, where he is currently a board member. Revera, based in Connecticut, has 29 skilled nursing facilities and rehab centers.


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