Preventing Hospital Readmissions

In October 2012, Centers for Medicare & Medicaid Services (CMS) began reducing Medicare payments for Inpatient Prospective Payment System (IPPS) hospitals with excess readmissions, which is based on a hospital’s number of “predicted” 30-day readmissions for selected high-cost or high-volume conditions and procedures (namely heart attack, heart failure, pneumonia, chronic obstructive pulmonary disease, hip/knee replacement, and coronary artery bypass graft surgery) against the “expected” readmissions for an average hospital with similar patients. A ratio greater than 1 indicates excess readmissions. The Hospital Readmissions Reduction Program is designed to improve quality of care and care transitions by incentivizing the reduction of hospital readmissions. Both the LACE index and HOSPITAL score have proven to be good indicators for helping hospitals identify patients at high risk for potentially avoidable readmission.

The LACE index identifies patients that are at risk for readmission or death within 30 days of discharge. It incorporates four parameters:

  • Patient’s Length of stay during the previous acute care admission within the last 30 days
  • Acuity of the admission (specifically, if the patient is admitted through the Emergency Department vs. an elective admission)
  • Comorbidities, incorporating the Charlson Comorbidity Index
  • Number of Emergency Department visits within the last 6 months

LACE scores range from 1-19, where a value of 10 or greater is considered high risk of readmission. The predictive power of LACE may be improved by incorporating age and sex into determination, as well as demographic and socioeconomic status (SES) data that may be collected at the time of admission to better understand which factors are most highly associated with readmission. Such an approach would allow hospitals to use a modified LACE tool, in real time, to identify discharged patients at higher risk of readmission.

The HOSPITAL score focuses on potentially avoidable readmissions as opposed to all-cause readmissions, using readily available predictors at the time of discharge. This score has the potential to reliably identify patients in need of more intensive transitional care interventions to prevent hospital readmissions.

The HOSPITAL score uses readily available predictors at the time of discharge:

  • Hemoglobin level
  • Discharge from an Oncology service
  • Sodium level
  • Procedure during the index admission (any ICD-10 coded procedure)
  • Index Type of admission (non-elective)
  • Number of Admissions during the last 12 months
  • Length of stay (≥ 5 days)

At NG Solutions, we have a team of experienced healthcare systems consultants highly motivated to work with you to implement dashboards, trend reports and alert monitors that allow you to identify patients at risk of being readmitted. We leverage your historical data across disparate systems to build a LACE index or HOSPITAL score based integrated solution that offers the flexibility to incorporate demographic, socioeconomic and other potential clinical impacting factors to produce a readmissions predicting tool tailored to your hospital needs.