Nobody likes to stay in a hospital. The beds aren’t comfortable, the food is mediocre at best and getting a good night’s sleep is nearly impossible. What’s even worse is having to be readmitted. 

Hospital readmissions are problematic because they lead to poor clinical outcomes, reduced patient satisfaction and an increased length of stay. They also are typically associated with congestive heart failure, blood infections (septicemia), pneumonia, pulmonary issues and cardiac dysrhythmias, which impact individuals of any background or age. It is not at all surprising, then, that in-hospital mortality has been found to be higher for patients who are readmitted versus those who are not. 

The average hospital readmission rate in the United States is 14.5 percent, although readmissions range from  11.2 to 22.3 percent. Adverse drug events are the most common post-discharge complication, though hospital-acquired infections and procedural complications also cause considerable morbidity. 

For hospitals, the price for readmissions is hefty. The average readmission cost is $15,200, with an estimated annual cost for Medicare of unnecessary readmissions at $26 billion. 

How the HRRP Impacts Hospital Readmissions 

To combat growing numbers of readmissions, the Centers for Medicare & Medicaid Services (CMS) created the Hospital Readmissions Reduction Program (HRRP). It penalizes hospitals by withholding up to three percent of regular reimbursements if they have a higher-than-expected number of readmissions within 30 days of discharge for six specific conditions

In fiscal year (FY) 2023, roughly 2,300 hospitals — approximately 75 percent of those subject to program penalties — faced penalties from the HRRP amounting to $320 million with an average payment reduction of .43 percent. In fiscal year 2024, CMS stated that nearly 7.5 percent of hospitals will receive readmission penalties of greater than one percent. 

Although readmission rates have fallen for Medicare beneficiaries across all types of hospitals since the inception of the HRRP, one-fifth of Medicare patients discharged from a hospital have an acute medical problem within 30 days that requires a further admission for treatment. Medicare beneficiaries with six or more chronic conditions have a readmission rate of 25 percent compared to nine percent for those with one or none. 

Employing AI Technology to Streamline Post-Discharge Phone Calls 

By reducing readmissions, hospitals have the potential to lower costs, improve quality and increase patient satisfaction. Coordinated care, including better discharge planning, across healthcare providers lowers the total cost of care by reducing relapses and readmissions. 

Multiple studies show that hospitals can perform specific activities to lower their rate of readmissions. At the top of this list is post-discharge follow-up. 

There are numerous reasons to follow up with patients after a hospital stay, including scheduling a visit with their primary care provider to review current and ongoing symptoms that led to admission, going over test results, reviewing potential medication changes and checking vital signs. The follow-up process also mitigates post-discharge complications and gives the patient a chance to talk with his or her primary care physician about any other health concerns. 

A follow-up appointment within seven days of discharge is significantly associated with lower readmission risk across all patient types, including medical and surgical patients. If a patient experiences a post-discharge complication, a well-timed follow-up appointment may prevent a costly hospital readmission arising from medication discrepancy or acute decompensation. However, half of all readmitted patients do not see their doctor for their follow-up appointments. 

Post-discharge phone calls are important for a smooth and effective care transition for patients who have been hospitalized — they are one of the most economic and effective strategies recommended to reduce 30-day hospital readmission rates. In fact, multiple studies have found that follow-up phone calls were associated with reduced readmissions. 

Consistently conducting outreach to every recently hospitalized patient can be time-consuming, especially when healthcare provider staff members have to repeatedly contact a patient to reach them. And, when it is a best practice for any outreach to be customized to a patient’s specific situation, it’s an even more arduous process. 

Implementing an automated phone call post-discharge follow-up program can reduce 30-day hospital readmissions and has been shown to increase patient satisfaction scores in the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) discharge information domain questions. Such programs not only enable healthcare providers to reach out to each patient but also do so multiple times throughout the 30-day window. 

Conversational artificial intelligence (AI) is increasingly being utilized by hospitals and other healthcare providers for post-discharge follow-up. It can be scaled to direct patients to the right level of care to close gaps in care, whether through an in-office appointment or an at-home screening. 

Also, by streamlining and automating administrative tasks, conversational AI enables healthcare providers to spend more time providing quality care to patients.  The result is increased satisfaction for patients AND their providers. 

Try out the new demo of our Conversational AI solution for patient engagement, and contact us to learn more about it.