Marty's Corner: Doing Your Part to Help Reduce Readmission Penalties
We hear stories like this all the time, but this one hit close to home. A co-worker’s father had just had surgery for liver cancer and had a colostomy from previous surgery for colon cancer. He was back in his room after being in recovery. He was then served a regular diet tray in error. Certainly hungry from being NPO pre-surgery, and trusting the accuracy of any hospital treatment or action, he consumed the tray as soon as it was served. This unfortunate error resulted in not only extreme and dangerous discomfort for my friend’s dad, but also his admission being extended by nine days. Although technically not involving a readmission, this true story nevertheless illustrates the important role that all hospital personnel have in reducing adverse events and protecting patient safety.
Section 3025 of the Affordable Care Act, which added paragraph (q) to Section 1886 of the Social Security Act, is better known as the Hospital Readmissions Reduction Program, and has been in place for discharges since October 1, 2012. It established financial penalties for hospital readmissions within 30 days for three conditions: acute myocardial infarction, heart failure, and pneumonia. In FY 2015, this will be expanded to include chronic obstructive pulmonary disease (COPD) as well as patients admitted for total hip or total knee arthroplasty. Hundreds of hospitals throughout the USA are feeling the pinch of these penalties and taking steps to reduce future readmissions.
What does this have to do with a food & nutrition services operation? Nutrition is certainly an important factor in proper therapy for each of the three conditions for which the penalties are currently imposed, as well as for COPD. A patient who suffered a heart attack and was inadvertently given meals high in saturated fat, or who was not instructed on a heart-healthy diet by a dietitian, could be at added risk for readmission. A patient with heart failure whose sodium intake was not controlled or who did not understand how to continue a low sodium diet at home, could also be at additional risk. A stroke patient at risk for aspiration pneumonia who is given regular liquids during admission or whose caregivers at home do not understand the importance of serving the patient thickened liquids, is also at risk.
Automation in a food & nutrition services department can help ensure that patients are presented with meals that are appropriate for their condition, as well as helping dietitians prioritize their patient load to make sure that patients and family members receive appropriate nutrition education prior to discharge. In addition, CEOs and CFOs of hospitals who have been hit with penalties will certainly be looking for ways to reduce costs in order to absorb these penalties. Again, automation can have an important role in cost savings through reduced food waste, elimination of excess inventory, and increased productivity.
Every hospital is working towards achieving and/or maintaining $0 readmission penalties. It’s a team effort that can help this become a reality.
Article by: Marty Yadrick, MS, MBA, RD, FADA - Director of Nutrition Informatics and former President of the Academy of Nutrition and Dietetics; Fusion, 1st Quarter, 2014