Reduce Readmissions by Discharging to Better Nursing Homes

In our experience, a common cause of hospital readmission is urinary tract infection (UTI) associated with catheter placement. This is especially true in the elderly and stroke populations discharged to nursing homes.

The belief is that a hospital treats a patient, sends her back to the nursing home from which she came, only for that nursing home to leave her catheter in too long which subsequently causes a UTI and associated symptoms such as "dizziness and giddiness" that look like they could be stroke related. Thus, the patient is admitted to the hospital, treated and the cycle continues.

Meanwhile, the hospital is unable to cover the cost of the admissions for various reasons: failure to document "present on admission," too many resources were used to diagnose the problem and rule out a stroke, the patient didn't meet admission criteria or payment for the billing DRG simply was less than the cost of the admission.

You can prevent these admissions quite simply by knowing more about the nursing homes to which you're discharging patients. We recommend looking at two pieces of quality information and sharing with families when choosing a nursing home:

1. Percent of long-stay residents who have/had a catheter inserted and left in their bladder (the national average is 5%)
2. Percent of long stay patients who had a UTI (the national average is 9%)

A quick search on nursing homes in our neighborhood yielded surprising results. We found one in Taylor, MI where 20% of long stay patients had a UTI. That's 11% above the national average! One might find that hospitals in that area discharging to this nursing home have higher than average readmission rates and are losing needless amounts of money.

If that is the case, these hospitals should quickly implement a procedure to present these simple pieces of information to families as they are making long term care choices. Armed with the right information, families can find better care for their loved ones and help you improve your bottom line.


Both of these indicators can be found on nursing homes across the country at WhereToFindCare.com. Simply search for nursing homes, click on the nursing home desired, click the Quality tab, then "See Details..." next to the Long Stay condition.

WhereToFindCare.com is working on a free tool to help you with this process. Join our mailing list to receive an update as soon as it is available.

4 Tips to Improve Hospital Bottom Lines

Not even health care is immune to current economic conditions. Hospitals are reducing staff to control their increasing loses. But is this the best strategy?

Sure it’s a good time to reassess staffing levels but reducing staff costs money and hurts morale—critical to patient satisfaction scores. So what else can be done? Some ideas that can save at least a few FTEs:

1. Make sure Medicare is not unnecessarily penalizing you with transfer DRG payment reductions. For example CABG patients sent home too early and with homecare will not earn full payment. Be mindful of Medicare’s expected lengths of stay.

2.Take steps to ensure proper documentation of critical criteria for DRG assignment and avoid DRG downgrading. For example with PTCA patients, documenting the use of drug eluting stents or the presence of major cardiovascular diagnoses is imperative to the correct DRG assignment. Consider modifying the physician operative note to include reminders or create a new document that will trigger proper documentation.

3. Verify that Medicare’s “3-day rule” is being implemented correctly by your automated billing rules. Services unrelated to the inpatient admission do not apply and may be billed separately, thereby increasing revenue.

4. Reduce infections, complications and fall rates (see Falls article, this issue)

Don’t like these tips? There are plenty of other options. You can find new ways to improve profitability by performing methodical and thorough data analyses. Start by assessing the profits and losses on each of your service lines, drilling down to the DRG, physician and even patient levels while looking for patterns.

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