Reducing readmissions is vital for ACOs because it aligns with their goals of improving patient outcomes, controlling healthcare costs, maintaining financial stability, and meeting regulatory requirements.
Readmission metrics between an Accountable Care Organization (ACO) and a home care provider are crucial for assessing the effectiveness of their collaboration in preventing avoidable hospital readmissions. These metrics typically focus on the following areas:
30-Day Readmission Rate
- Definition: This metric measures the percentage of patients who are readmitted to the hospital within 30 days of discharge. It is one of the most commonly tracked metrics in ACO-home care collaborations.
- Importance: High 30-day readmission rates may indicate gaps in post-discharge care, such as inadequate follow-up, poor communication, or lack of adherence to care plans. Reducing these rates is often a primary goal of ACOs and home care providers.
Readmission Rate By Condition
- Definition: This involves tracking readmission rates based on specific conditions, such as heart failure, pneumonia, or chronic obstructive pulmonary disease (COPD).
- Importance: By focusing on condition-specific readmission rates, ACOs and home care providers can identify areas where targeted interventions or specialized care might be needed to prevent readmissions.
Preventable Readmission Rate
- Definition: This metric identifies readmissions that could have been prevented with appropriate home care interventions, such as medication management, patient education, or timely follow-up care.
- Importance: Monitoring preventable readmissions helps ACOs and home care providers to refine their care strategies, ensuring that high-risk patients receive the necessary support to avoid returning to the hospital.
Readmission Rates By Demographics
- Definition: Tracking readmission rates based on patient demographics, such as age, gender, or socioeconomic status.
- Importance: This can help identify disparities in care and ensure that all patient groups receive equitable care and follow-up, ultimately reducing readmissions across all populations.
Readmission Rates Post-Home Care Initiation
- Definition: This metric looks at readmission rates specifically for patients who have received home care services after hospital discharge.
- Importance: It helps evaluate the effectiveness of the home care provider’s interventions in keeping patients out of the hospital.
Time To First Readmission
- Definition: Measures the average time from discharge to the first readmission.
- Importance: Shorter times may indicate a need for more immediate or intensive post-discharge support from home care services.
Emergency Department (Ed) Visits Leading To Readmission
- Definition: Tracks the percentage of ED visits that result in hospital readmission.
- Importance: This metric highlights the need for better emergency care coordination and more robust support for patients who are at risk of readmission.
Cost Of Readmissions
- Definition: This metric calculates the financial impact of readmissions on the healthcare system.
- Importance: By reducing readmissions, ACOs and home care providers can achieve significant cost savings, which is a critical objective for both entities.
Example: Readmission metrics can also include:
- 30-day readmission and 30-day return rate by payer and provider
- 30-day readmission and 30-day ER return rate by diagnosis
- 30-day readmission and 30-day ER return rate by timeframe
- 30-day readmission and 30-day ER rate by length of stay
- 30-day readmission and 30-day ER return by service type
Monitoring these readmission metrics allows ACOs and home care providers to assess the success of their joint efforts, make data-driven decisions, and continuously improve patient care.
Lisa Remington
Lisa is a home care and health care growth and business development strategist. As president of the Home Care Leadership Think Tank and publisher of The Remington Report, she is well-known as a trusted industry advisor aligning strategic market intelligence into actionable strategies and business blueprints for decades. Lisa has led C-suite education to over 10,000 organizations through a variety of platforms, including think tanks, strategic improvement programs, board retreats, executive leadership programs, peer-to-peer networking groups, and advisory services.
