Readmissions Are Down, Penalties Are Up — What Do You Do Now?

The Medicare readmission reduction program has been in place for five years but, despite decreasing readmissions, hospitals are still receiving penalties — $528 million in fiscal 2017 alone. The program has been criticized for basing penalties on a tiered structure so hospitals may be penalized despite cutting readmissions, and for not taking into account socioeconomic issues and other factors beyond hospitals' control that result in patients getting sicker. To help hospitals succeed, and to provide better care, case managers should work to prevent readmissions for all patients, including the Medicaid population, and adapt readmission prevention initiatives to meet the specific needs of patients in different demographic groups or with different conditions. Case managers should work closely with their counterparts at other levels of care to develop consistent educational tools and share information via the electronic medical record or nurse-to nurse calls to ensure smooth transitions and provide follow-up education and medication reconciliation for patients discharged to home. Case managers in the ED are essential to begin the discharge planning assessment while the family is still present and to prevent readmissions by lining up services in the community when appropriate.