News Feature | April 5, 2017

Accurate Readmissions Predictions Are Now Possible

Christine Kern

By Christine Kern, contributing writer

Reduce Readmission Rate With Post-Surgical Care

Partnership provides hospitals in North Carolina with earlier, better readmission predictions.

Hospitals have played a guessing game of sorts when it comes to readmission rates, wondering if they will face CMS penalties or not. In 2017, it is estimated more than 2,500 hospitals will be penalized more than half a billion dollars for exceeding the benchmarks set by CMS, according to agency data. While the number of penalized hospitals in FY 2017 represents a decline from FY 2016, according to a Kaiser Health News analysis, CMS will withhold $528 million in payments over the next year, under the Hospital Readmission Reductions Program (HRRP), marking an all-time high and an increase of some $108 million year over year.

High readmission rates are a $17 billion problem for hospital administrators and, even more troubling, a portion of 30-day readmissions are preventable, as Health IT Outcomes reports. A University of California, San Francisco (UCSF) study published in the New England Journal of Medicine found 27 percent of readmissions could be avoided.

In an effort to help avoid these costly penalties and improve patient outcomes, Durham, NC-based predictive analytics provider Forecast Health and the North Carolina Hospital Association (NCHA) have announced a partnership to provide hospitals in the Tar Heel state with earlier, more accurate predictions of their readmission rates. This marks the first step in a rollout of advanced analytics to help NCHA member hospitals pinpoint high-risk patients for improved outcomes and minimized costs across the care continuum.

Tilson, Interim President of the NCHA, says, “Working with Forecast Health, we have improved the accuracy of our readmissions rate predictions across all measures by more than 34 percent. This information will help our member hospitals better manage care for high risk patients and improve the overall health of the communities they serve.”

Identifying the right data and the right patients is key in a world inundated with data analytics. “Today, too many hospitals are left guessing whether they are going to be hit with CMS penalties and what they can do about it,” said Norm Storwick, FSA MAAA, Forecast Health’s Chief Actuary and Director of Product Management. “It doesn’t need to be this way. Working together, Forecast Health and NCHA enable NCHA members to understand how CMS measures their readmission rates as well as their actual and risk adjusted rates so they avoid penalties and improve clinical and financial performance.”