Reducing Readmissions: Can the Lab Help?

Posted by Sten Westgard, MS

Laboratories in the US probably already know this: their healthcare institutions are getting hit with fines from CMS due to excessive 30-day readmission rates for three conditions:

• (AMI) Acute myocardial infarction
• (HF) Heart Failure
• Pneumonia patients

CMS is imposing increasing fines for hospitals that have excessive readmissions. Guess how many hospitals have been fined - and how much money they've had to pay back...

In 2012, the first year the penalties were imposed, 2,217 hospitals were fined more thatn 70% of all hospitals that were evaluated, with a total penalty of $280 million dollars.

The latest update is that in 2013, slightly more hospitals were hit by fines - 2,225 hospitals - but the total size of penalties went down, to $227 million.

Nevertheless, that's half a billion dollars in penalties to hospitals. That's a fairly big incentive to change behavior. So, if you're in a lab in the US, chances are your hospital has been hit or is in danger of being hit by these penalties. They are probably already scrambling to find new ways to inexpensively reduce 30-day readmissions for these categories.

Where does the lab fit in? One sad fact is that many patients are discharged with tests having been ordered but not reported or viewed by clinicians. Studies that have assessed the impact of these "late" test results have noted that clinicians have stated that more than half of post-discharge test results might have changed their care decisions.

In other words, there is existing laboratory data that goes unused. If that last round of tests was actually reviewed, it might significantly impact whether or not that patient gets follow-up, or even discharged at all.

Here's an opportunity for laboratories to step forward and get involved in providing solutions. Don't wait for the next round of cuts. Stop enduring the pain and start leading the change.

Sources:

• Armed with bigger fines, Medicare to punish 2,225 hospitals for Excess Readmissions, Kaiser Health News, August 2nd, 2013. Jordam Rau. http://www.kaiserhealthnews.org/stories/2013/august/02/readmission-penalties-medicare-hospitals-year-two.aspx Accessed 12/17/13.
• Medicare to penalize 2,217 hospitals for excess readmissions, Kaiser Health News, August 13, 2012. Jordan Rau. http://www.kaiserhealthnews.org/stories/2012/august/13/medicare-hospitals-readmissions-penalties.aspx  Accessed 12/17/13.
• Poon EG, Gandhi TK, Sequist et al, "I Wish I Had Seen This Test Result Earlier!" Arch Intern Med 2004;164:2223-2228.