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Beginning in the 2013 fiscal year, inpatient prospective payment system hospitals with higher-than-expected readmission rates will experience reduced Medicare payments for all Medicare discharges. Prior to implementation (March 23, 2012, or two years after enactment), the U.S. Department of Health and Human Services will make available a program to allow eligible hospitals to improve their readmission rates through patient safety organizations. Performance evaluation will be based on the 30-day readmission measures for heart attack, heart failure and pneumonia, criteria that are currently part of the Medicare pay-for-reporting program and reported on Hospital Compare.

Here are some steps hospitals can take now to mitigate this problem.

Talk to the Patient

I have found during many years of experience that talking with a patient can be very valuable. Often, homeless patients will talk about their estranged family, work history and perhaps a time when they were able to survive independently before entering life on the streets. These snapshots of information may help a hospital determine if the patient is receiving all the benefits they deserve. Perhaps they meet criteria for Social Security Disability Insurance or even Supplemental Security Income. Only a professional social worker can help make that determination, but even a brief discussion about the benefits they currently receive is extremely helpful.

Try to Locate Family Members

Sometimes patients will tell you that they haven’t seen their children, siblings or other relatives in many years. Many say that they would like to reconnect. With the patient’s permission and some background information, searches can be performed through various databases to see if a relative can be located. This identification of a relative may be very helpful, especially if the homeless patient eventually loses the capacity to make decisions, as it could avert the cost of a guardianship proceeding. Relatives often do not want to reconnect but at least are willing to act as next of kin for consent or transfer purposes. Some relatives respond favorably to proposed contact with the patient.

Obtain a Payer Source, If Possible

Statistics documenting hospitalizations of the homeless are staggering. A commonly quoted figure is that one in five homeless people visits the emergency department of a hospital or becomes an inpatient at least three times annually. Obtaining a payer source, if possible, helps the homeless obtain the services they deserve while also helping providers achieve reimbursement for care. Medicaid is a likely source, but some patients cannot meet its strict criteria. Be sure to have your social work and finance departments perform an in-depth review of any patient searching for a viable payer source.

Set up Outpatient Appointments

In order to try to stop the readmission cycle, refer patient to clinics and other outpatient healthcare providers that will follow up with the patient. It’s not as though all patients will comply with these outpatient appointments, but it is worth the effort to arrange them. Some will, and that one appointment may be what halts the next readmission.


The Hospital Readmissions Reduction Program doesn’t kick in until Oct. 1, 2012, but CMS currently is collecting the data that will underpin the program, information against which IPPS hospitals will be measured. The HRRP is another provision of the Patient Protection and Affordable Care Act of 2010 aimed at increasing the quality of care while reducing costs, and hospitals that are successful in reducing readmissions will be rewarded. Hospitals that have “excess readmissions” will be penalized with reduced DRG payments.

Despite the considerable lead time, hospitals need to stay on top of their readmissions and begin to design strategies to reduce readmissions and avoid payment penalties.

Although these steps may seem more than obvious to most hospitals, they are necessary and often overlooked.

There are many homeless caught in the cycle of hospital readmissions, and if hospitals take these steps now, they may find a way to break the cycle.

About the Author

Patricia Furci is currently part-time, In-house Counsel at several hospitals, providing legal services specially addressing inpatient issues, Case Management functions and Guardianship services.

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