With nearly one in five Medicare patients returning to the hospital within a month of discharge, the government considers less than 30-day readmissions symptomatic of an overly expensive and uncoordinated health care system. Primary causes of readmissions are health literacy, poorly designed discharge care plan instructions and lack of patient adherence. The Affordable Care Act now imposes stiff financial penalties on hospitals for 30-day readmissions. As a result of payment reform, reducing re-hospitalizations among Medicare beneficiaries has become a high priority for policymakers and CMS, with the overall intent of decreasing costs.
Last year, Medicare began paying for Transitional Care Management (TCM) services, to the tune of more than $1 billion. CMS is investing an astonishing amount of money on the promise of TCM generating upstream savings from a reduction in repeated and prolonged hospitalizations. CMS is paying physicians and other qualified non-physician professionals for the work needed to successfully transition a patient out of institutional care back into the community setting. ACOs, insurers and healthcare providers need to communicate more effectively, engage patients and activate them in their care, if they are to share in the savings and incentives of both TCM and the ACA.
In view of the escalating penalties for these less than 30-day readmissions, it is prudent to create a way to avoid such readmissions using good science in the service of good health practice. At the outset, hospitals should know their current readmission rates, benchmarking their specific rates against the rates of other organizations in their hospital referral region. Hospitals must immediately, actively and resolutely initiate effective compliance measures to safeguard their Medicare reimbursement, increase patients’ satisfaction and secure their reputation for having low readmission rates.
Better Understanding Leads To Better Health
We believe health can't be improved solely through diagnostic and clinical measures. Providers telling people what to do about their illnesses and recommending treatments only works some of the time. Health is as much about behavior and motivation as it is about education. Each person’s attitudes, preferences, likes and dislikes, and social norms are unique. We can understand, influence and motivate them to improve their health by applying the science of “Mind Genomics” and "Addressable Minds".