Experienced medical transcription companies are focused on efficiently meeting physicians’ patient record documentation needs. They provide physicians with timely and accurate clinical notes, History & Physical, consults, lab reports, operative notes, and discharge summaries. They are well aware of the importance of providing timely and accurate transcripts of discharge summaries. In fact, researchers have found that timely discharge summaries should be a top priority because the documentation not only provides the basis for continuing patient care but can also reduce readmissions.
Under the Hospital Readmissions Reduction Program (HRRP), Inpatient Prospective Payment System (IPPS) hospitals that have excessive readmissions face reduced payments. Up to 3 percent of regular reimbursements can be withheld from hospitals that are penalized. Studies have reported that the 30-day risk-standardized readmission rates declined rapidly after the HRRP was enacted, especially among the hospitals that had a higher number of readmissions before the program. However, according to a report from Patient Bond, the Centers for Medicare and Medicaid Services(CMS) released data showing that in the 2018 fiscal year, up to 2,573 hospitals face penalties for readmissions. The report says that about $564 million in payments with be withheld in the 2018 fiscal year, which is even higher than the amount withheld in the 2017 fiscal year. Hospitals face penalties under the HRRP based upon readmissions for six specific conditions:
- Heart attacks
- Chronic lung disease
- Knee and hip replacements
- Coronary artery bypass graft surgery
- Heart failure
Researchers say that speedy discharge summaries can play a key role in reducing hospital readmissions.
Published in the June 2016 Journal of Hospital Medicine, the retrospective cohort study was based on an evaluation of 87,994 consecutive discharges between January 1, 2013 and December 31, 2014, from Johns Hopkins Hospital. The researchers’ goal was to examine whether the number of days to complete hospital discharge summaries is related to the 30-day readmission rate. The researchers found that
- About 16% of the 87,994 patients were readmitted, and 43% of those patients were readmitted before their discharge summaries were completed
- Median time to discharge summary completion was 8 days
- the probability of a 30-day readmission increases by 9% if it took more than three days after discharge to complete summaries raised
- there was a 1% increase in 30-day readmissions for every three additional days it took to complete and send off discharge summaries
- 3% of readmissions occurred before discharge summaries were completed
- While surgical patients tend to be readmitted for new complications, patients with medical problems tend to be readmitted for the same condition over and over again
The team concluded that the greater the number of days to complete discharge summaries, the higher the rates of all-cause hospital readmissions. Therefore, prompt discharge summary completion time can serve as a quality indicator to evaluate current practice and as a potential tactic to improve patient outcomes.
A lot of physicians can relate to the experience of not knowing what happened during a patient’s hospital stay,” the study’s lead author Erik H. Hoyer, MD, physician advisor for patient safety and quality in the department of physical medicine and rehabilitation at Baltimore’s Johns Hopkins University told Today’s Hospitalist.
According to CMS guidelines, the key elements to be included in the discharge summary are:
- The outcome of the hospitalization
- The disposition of the patient
- Provisions for follow-up care including appointments, statements of how care needs will be met, and plans for additional services (such as hospice, home health assistance, skilled nursing)
It should also contain information that is critical to the aftercare providers.
Dr. Hoyer listed physicians’ busy schedules as a key challenge for the timely release of discharge summaries and made the following suggestions to speed up the discharge summary process:
- Avoiding documentation of a complete synopsis of everything that happened to the patient in the hospital. Primary care physicians only have a short time with patients, and it would be impossible for them to review a lot of documentation.
- To ensure quality, the summary should include the most important points from the perspective of coordination of care – the reason for the hospitalization, the medications and follow-up plans, and what is pending at the time of discharge.
- Keeping a running log of information and updating this on a regular basis during the patient’s hospitalization will prove very useful in preparing the final summary.
Here are discharge summary best practices from www.uhnmodules.ca
- Complete a Discharge Summary for all inpatients regardless of Length of Stay
- Start the Discharge Summary on Day 1 of the patient’s stay
- Document course of stay information chronologically
- Tailor information to each patient and situation (avoid copy & paste)
- Consider what information you would like to receive as a Provider
- Be concise and succinct – use point-form lists if appropriate
- Update the Discharge Summary prior to a patient’s transfer
- Ensure patients are assigned to the appropriate MRP in the Electronic Patient Record (EPR)
With the shift to value based reimbursement, decreasing the rate of hospital readmissions is a high priority. Completing discharge summaries fast is an important strategy to prevent unnecessary readmissions. Hospitals have different options such as scribes, nurse practitioners, and medical transcription outsourcing companies to help with ensuring timely and accurate discharge summaries. Investigating the time-savings of these options and the resulting impact on quality of care can help providers implement the best strategy.