The CMC readmission reduction program was legislated in Section 3025 of the affordable care act (1) the program officially started on Oct. 1st 2012, two months after the final program details were published. In the first year 2217 hospitals received penalties that ranged from 0.01 % to 1% of their Medicare revenue generated during FY 13 ( Oct 2012 to Sept. 2013). The readmission penalties are expected to rise as more diagnosis are being added to the group for penalties.
Patients who lack an outpatient appointment at the time of discharge represent 50% of readmitted cases nationwide. Relying on patients to make this initial appointment when they return home increases the risk that appointment setting will not happen.
A simple way to help them take this step that does not require a complicated process is to give them the date and time of the appointment after coordinating with Physicians office and the patient. This can be achieved easily by the RN Coordinator during the initial phone conversation with the patient as per the discharge instructions from the hospital. Assigned RN Coordinator also ensures that the patient has all the reminders and arrangements to reach the Physician office for the scheduled appointment. This completely takes away the guess work and once the Patient completes the visit, RN coordinator coordinates with Physicians office to schedule any further follow up, any new medications, diagnostics performed or to be performed. The information helps the RN Coordinator to keep the patient aligned with the providers care plan and adherence.