Strategies to decrease the rate of preventable readmission to hospital

• Published in: Canadian Medical Association journal (CMAJ) 2010-04, Vol.182 (6), p.538-539
• Main Author: Goldfield, Norbert
• Format: Article
• Language: English
• Subjects: Admission and discharge; Canada; Health care expenditures; Health Status Indicators; Hospitals; Humans; Medical care; Monetary incentives; Patient admissions; Patient Readmission - economics; Quality Indicators, Health Care; Quality management; Quality of care; Reimbursement, Incentive; Service enhancement; United States
• ISSN: 0820-3946; 1488-2329
• DOI: 10.1503/cmaj.100243

The LACE Index is one of several tools that can help identify preventable readmissions to hospital.9-14 Two types of tools have been developed. The mathematical (typically logistic regression) model uses data to identify factors that may predict readmission. The categorical model uses clinical logic to determine the likelihood that readmission is potentially preventable combined with subsequent validation of the data. Several issues should be considered when developing a tool to identify preventable readmission to hospital, particularly when defining what is, in fact, preventable. For example, a person's admission to hospital for an appendectomy after a previous hospital stay for congestive heart failure is clearly not preventable. As with the United Health Care measure, the LACE Index uses an all-cause readmission approach - that is, all readmissions are considered preventable. What payment incentive is reasonable? The payer has to pay for most of the costs incurred in a readmission or risk creating access problems. In designing a modest payment incentive that will encourage health professionals to become interested, it is important (in the US context of a payment system in which hospitals are paid on a per-hospital discharge basis) to distinguish between a case-specific approach and a ratebased approach. With a case-based approach, any financial incentive to decrease the rate of readmission is applied to a specific patient whose readmission was potentially preventable. With a rate-based approach, hospitals with a higher rate of readmission, when compared with best practice patterns (severity and clinically adjusted) in a geographic region, have a decrement in payment for all readmissions. The savings generated from a rate-based approach can be used as a bonus to high performing hospitals, to provide grants to lowest performing hospitals to improve their readmission processes, and as additional payment to primary care physicians who can demonstrate successful coordinated care.21