Rule #2 for Preventing Re-Hospitalization? Prepare Patient for Exacerbations.

Medicare charges hefty financial penalties to providers who send patients back to the hospital after a recent hospital admission. 

Medicare Seeks to Reduce Billions in Overspending on Hospital Re-Admissions

The 2010 Affordable Care Act introduced an initiative to address the problem of excessive readmissions. The Hospital Readmission Reduction Program (HRRP) imposes financial penalties (as much as 3% of total annual Medicare inpatient operating expenses) on hospitals with rates above the national readmission-rate average.

Re-Hospitalizations Imply Sub-Standard Care

In the eyes of any payer - Medicare, Medicaid, commercial payers included - a re-hospitalization SUGGESTS poor care... 'Why was the patient discharged in the first place if they now need to be re-hospitalized?'

Rule #1: Don't admit patients who are unstable OR don't have a teachable caregiver or patient.

If a home health referral is not appropriate - the patient is unstable and/or there is no teachable patient or caregiver - its up to the home health agency to send the patient back to the facility from where the patient was discharged.

Rule #2: Prepare the Patient/Caregiver for Exacerbations STARTING ON ADMISSION.

ON THE ADMISSION VISIT start teaching caregiver/patient to be on HIGH ALERT for symptoms specific to the patient's diagnoses.

If the caregiver, or patient, notifies the HHA IMMEDIATELY of ANY CHANGE TO A CONDITION, the nurse or therapist has a chance to address the condition before hospitalization is necessary. The clinician can make an emergency prn visit and, with new physician orders, adjust the careplan without incurring acute care.

If the clinician can't make an emergency prn visit, then the patient should go to the hospital.

Keep It Simple.

Focus on FIVE (5) of the most important symptoms related to the patient's most serious condition for which the patient is receiving home health services. For example - for wound or catheter, ANY amount of related pain, foul smell or discharge or change in mental status. For cardiac or respiratory conditions, any amount of unexpected shortness of breath or chest pain.

Ask for Symptom Recall on Admission Visit, and Every Visit Thereafter

As part of your routine visit protocol, remind the patient/caregiver

1. to recall the list of 'alertable' symptoms at every visit.
2. reinforce the need to be vigilant with reporting any new or unusual symptoms
3. Reinforce the HHA's desire to implement EARLY INTERVENTION to avoid hospitalization.