The readmission rate refers to patients who are discharged, then readmitted to the same facility for the same medical condition within a specific time period. For example, if I am discharged with Heart Failure and I return to the same hospital with Heart Failure conditions within 15 or 30 days, that is considered a readmission.
The rate is calculated by dividing the number of readmissions for the time period by the total number of patients admitted during that same period. The formula for Readmission Rate = Patients Readmitted / Total Patients Admitted. This is a Key Performance Indicator.
Hospitals are facing penalties from Medicare reimbursements if their 30 day readmissions rate is not reduced. This is creating challenges for hospitals since many factors contribute to readmission.
Patients in lower socioeconomic ranges, patients who won’t follow instructions, patients who have multiple diseases, and older patients are high risk for readmission. Hospitals are forced to develop social programs to deal with these situations or risk losing hundreds of thousands of dollars in Medicare reimbursements.
Part of this solution is answered by using business intelligence. BI can help the care team identify the patients with the highest likelihood of readmission. This can be gleaned from the EHR data already captured. Care team staff can be motivated to provide more proactive follow-up with these patients to ensure they are getting the proper medication and follow-up visits on time. BI can flag those who are not and create nearly real-time reporting so the care team can take action.
This is a big change in the way our healthcare system works. We are evolving from a ‘fix what is broken’ mentality to a more preventative approach to healthcare. Readmissions rate tracking and penalties are part of the catalyst to generate working Accountable Care Organizations (ACOs). While care providers are feeling pain for not doing this today, this pain is fueling the gains in improved healthcare outcomes overall.
To learn more about BI in healthcare, download our new whitepaper, “Business Intelligence Primer for Healthcare Professionals.” Also, join Perficient for the webinar “Healthcare Business Intelligence for Power Users” on September 13th at 12pm CDT.
