Hospital readmissions pose a significant risk to the nation’s fiscal and physical health.
by Christopher Metzler
August 7, 2015
The medical profession — hospitals specifically — has been slow to accept and implement business approaches that put patient care front and center while recognizing there are documented, common disparities in health care delivery.
For example, according to the 2014 National Healthcare Quality and Disparities Report, many challenges in improving quality and reducing disparities still exist despite efforts to improve.
Disparities by income and race and ethnicity are large and persistent, and have not, through 2012, improved substantially. Yet, several racial and ethnic disparities in rates of childhood immunization and rates of adverse events associated with procedures were eliminated, so elimination is possible.
The medical profession is moving rapidly operationalize diversity and inclusion via cultural competency. This is partly because of the reality of a demographically diverse population. Further, understanding culture can save lives.
Source: Calvert Investments, Diversity Report Supplement, March 2015
Health care executives understand and appreciate that patient satisfaction and outcomes based treatment is critical to crack the health care code and improve financial and patient bottom lines. However, cracking the cultural competency code will require leadership and data analysis.
How do we explain to our teams that cultural competency is not an option? It must be how we deliver care to patients and their families. But do we have the outcomes-based data to drive decisions on cultural competency, and how are we using that data?
According to the Robert Wood Johnson Foundation, 1 in 8 Medicare patients were readmitted to the hospital within 30 days of being released after surgery in 2010, while 1 in 6 patients returned to the hospital within a month of leaving the hospital after receiving medical care. Patients were not significantly less likely to be readmitted in 2010 than in 2008.
Beginning on Oct. 1, 2012, the ACA required the Centers for Medicare & Medicaid Services, or CMS, to penalize hospitals for “excess” readmissions when compared with “expected” levels of readmissions. In fiscal year 2013, payment penalties were based on hospital readmissions rates within 30 days for heart attack, heart failure and pneumonia.
In 2015, the CMS will add readmissions for patients undergoing hip or knee replacement, and in 2016, readmissions for patients with chronic obstructive pulmonary disease. By law in 2015, the CMS will increase the maximum penalty from 2 percent to 3 percent, and it will include total hip/total knee arthroplasty and chronic obstructive pulmonary disease as new measures.
The organization is likely to add other measures in the future. Further, the CMS expects 2,623 hospitals will see their Medicare payments cut, more than last year because of the added readmissions measures, totaling $422 million in decreased payments.
Hospital readmissions pose a significant risk to the nation’s fiscal health. And the data indicate those readmitted to hospital disproportionately represent racial and ethnic minorities.
Medical professionals have to recognize that hospitals operate within a system. As such, cultural competency in health care describes a system’s ability to provide care to patients with diverse values, beliefs and behaviors, including tailoring health care delivery to meet patients’ social, cultural and linguistic needs.
A culturally competent health care system incorporates assessment of cross-cultural relations, recognizes the potential effect of cultural differences, expands cultural knowledge, and adapts services to meet culturally unique needs.
Ultimately, cultural competency becomes an essential means with which to reduce racial and ethnic disparities in health care, thus decreasing readmissions. The nation’s health depends on it.
This article originally appeared in Chief Learning Officer's sister publication, Diversity Executive.
