The Surprising Way to Reduce Readmissions in Rural Hospitals

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The Readmission Problem

Hospital readmission is a big problem in the United States. It is estimated that one in five Medicare patients discharged from the hospital is readmitted within 30 days. That’s 20 percent of patients – and that figure doesn’t account for what happens after the first month.

The readmission problem is especially prevalent in rural hospitals. It’s no secret that the location of a hospital has a significant effect on readmission rates.A study published in Medical Care found that patients discharged from hospitals in large rural settings had a 32 percent higher risk of unplanned readmissions as compared to those discharged from urban hospitals. Additionally, patients who were discharged from small rural settings had a 42 percent higher risk of unplanned readmissions. North Carolina is no exception. A study from the Duke Endowment Center found the total readmission rate in rural hospitals was 14.8%.  Of those readmissions, 47% were found to be potentially preventable.

Unnecessary readmissions carry a heavy cost, and rural areas bear most of that burden. The introduction of the Affordable Care Act changed the alignment of financial incentives, rewarding high-quality care. Hospitals now face a readmission penalty for higher-than-expected 30-day readmission rates. In 2017, hospitals risk losing 1.5% of their Medicare reimbursements if they don’t show improvements in both process of care measures and patient experience. Not only that, unnecessary readmission leads to unhappy patients, who are more likely to leave a hospital system after a poor experience. It is estimated that a hospital loses $3,000 each time a patient leaves a network for an appointment.  Between missed reimbursements and lost patient revenue, hospitals stand to lose millions.

Root Causes of Readmissions

All kinds of issues have been blamed for high readmission rates, including medication errors, poor transition of care, and ineffective treatment plans. Yet studies have shown that efforts to improve hospital discharge planning have not significantly decreased readmission rates.

So what gives?

The Harvard Business Review conducted a study on readmissions using six years of data from nearly 3,000 acute-care hospitals. Their findings suggest that it is the communication between caregivers and patients that have the largest impact on reducing readmissions. In fact, the results indicate that a hospital would, on average, reduce its readmission rate by 5% if it were to prioritize communication with patients in addition to complying with evidence-based standards of care. In a similar test done in Carrol County, Maryland, a hospital implemented a program in which a peer would follow-up with the patient after care was administered. The program reduced readmissions of those patients by 30%.

These results paint a clear picture – the simple act of following-up with a patient after discharge is one of the most important measures that can be taken to reduce patient readmission and increase the overall quality of care.

Improving follow-up care in Rural Hospitals

While the data is new, improving follow-up communication between physicians and patients is a long-held goal for most rural hospitals. The very nature of a rural community means many patients live far from the hospital, making follow-up care an issue. Many rural hospitals have developed strategies to address the issue.  Collaborating with community resources to fill in gaps in care, working to broaden access to specialists, and partnering with agencies to provide transportation and social support are all tactics hospitals have employed to improve patient follow-up.

Yet for many rural hospitals, these solutions can unrealistic to implement. Readmission programs can be costly and complex to implement.  By far, the biggest barriers for hospitals employing readmission reduction programs are cost implications and lack of resources.

Telemedicine as a solution

Telemedicine is considered the practice of a doctor consulting with a patient remotely through the means of audio and video conferencing. Although it was introduced to the healthcare market more than a decade ago, the practice has taken off in recent years.  Traditionally, telemedicine has been used as a way for patients to be treated for common ailments. But what if telemedicine was used for follow-up communication after the initial diagnosis? What would that look like in rural communities, where many patients are required to drive hours to see a doctor for a quick follow-up conversation?

Many healthcare experts believe telemedicine has the power to revolutionize healthcare, especially in rural areas. In fact, the Duke Endowment released a report recommending telemedicine as the number one way to reduce readmissions in rural communities.

The reason is simple. Almost half of rural readmissions are due to “logistics of follow-up care”. Telemedicine removes the logistics barrier by providing a patient direct access to a caregiver from the comfort of their home. And compared to most readmission programs which require a significant investment in money and resources, telemedicine is an extremely cost effective and efficient.

Return on Investment

Investing in a follow-up practice is a big leap for many hospitals, and many executives want specifics on ROI before taking the plunge. Interestingly enough, research from the Harvard Business Review shows that improving the communication-focused dimension of the patient experience is less expensive than the alternatives. When relating back to ACA reimbursement for customer experience scores, the study found that it was less expensive to invest in follow-up care ($48 per patient discharged from an average U.S. hospital for a one-percentage-point increase in patient experience scores) than improving the response focus dimension ($62 per patient discharged from an average U.S. hospital for a one-percentage-point increase in patient experience scores).

When hospitals invest in improving communication between caregivers and patients, they win big- and telemedicine is the easiest and most cost-effective way to achieve those results.

May 15, 2017

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