Reimbursement Accountability Program
Expatiate Communications has developed a comprehensive program to effectively bring you in compliance with two of the targeted (HRRP) quality outcome measures. At Expatiate, we utilize innovative techniques and strategic planning to reduce readmissions markedly while improving your HCAHPS scores for both transitional care and satisfaction. As we know, Pneumonia and COPD are among the leading causes for readmissions to the hospital primarily due to the inherent challenges of post discharge care complexity. With the enactment of the Affordable Care Act, the Centers for Medicare & Medicaid Services (CMS) hold hospitals accountable for excess rehospitalizations by linking readmission rates to reimbursement. Our specially trained team of experts will manage your patient post discharge and help you prevent reimbursement penalties imposed by the CMS.
Many studies have focused on the Medicare population with all-cause 30-day readmission rates of 17%-25%. The variability was explained by overall admission rates, patient case mix, quality of discharge planning, and bed supply. In a similar study with nearly 12 million participants, the 30-day readmission rate for patients discharged after pneumonia hospitalization was 20.1% to 29.1, the remaining readmissions were because of other active comorbidities including heart failure (7.4%), COPD (6.1%), and septicemia (3.6%).
Pneumonia is responsible for close to 1 million hospital admissions and nearly 140,000 hospital readmissions per year costing more than $10 billion in hospital expenditures. Approximately 1 in 5 patients with pneumonia is readmitted to the hospital within 30 days of discharge. It is responsible for approximately 1 million hospital admissions and more than 50,000 deaths annually with 10%-20% of pneumonia cases require admission to the intensive care unit. In 2013, CMS identified 2,225 hospitals for reimbursement reduction based on readmission rates.
COPD, on the other hand, is estimated to affect one in 10 people globally and at least at least 15 million people in the United States. In 2012 COPD became the third leading cause of death in the United States. Nationally hospitalizations for acute exacerbations of COPD account for $13.2 billion of the nearly $50 billion in annual direct costs for COPD. In a retrospective analysis of patients with culture-confirmed bacterial pneumonia, 30-day readmission occurred in 19.3% of patients with the most common reason for readmission was not pneumonia but COPD and congestive heart failure.
An aging and frail population, increasing comorbidities such as, but not limited to, diabetes mellitus, chronic obstructive pulmonary disease (COPD), and congestive heart failure and a resistance to antibiotics has contributed immensely to large number of pneumonia-related admissions in recent years drawing attention to the accountability, and related cost to allow for preventative measures and a better continuum of care post discharge. Expatiate Communications provides the solution and accountability for our hospital partners. Our specially trained team of experts will manage your patient post discharge and help you prevent reimbursement penalties imposed by the CMS.