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Tuesday December 22, 2020  |  Erin Glanz, MSN, RN CNOR, NE-BC, Director, Perioperative Product Management at MEDHOST

Preventing Readmissions to Avoid Penalties and Adverse Patient Experiences

Preventing Readmissions to Avoid Penalties and Adverse Patient Experiences EHR

An estimated  82 percent of hospitals in the Hospital Readmissions Reduction Program (HRRP) received readmissions penalties1 and readmission costs were higher than initial admission costs for about two-thirds of common diagnoses in 2016.2

Generally, HRRP imposes severe financial penalties for unplanned readmission within a 30-day window. To avoid readmission penalties, healthcare facilities must focus on reducing readmission rates, improving patient outcomes, patient satisfaction, and increasing reimbursement. While readmissions are occasionally unavoidable, it is essential for facilities to focus on reducing those that are preventable.

According to a 2015 study, patients discharged from facilities serving semi-rural areas had a 32 percent greater chance of being readmitted and patients discharged from rural areas had a 42 percent greater chance of being readmitted, than those discharged from facilities in urban areas. The researchers discovered that the increase in readmission rates was driven by lower rates of post-discharge follow up care and utilization of the emergency department for primary care.3

Auerbach et al. (2016) found that approximately one quarter of readmissions are preventable by implementing discharge readiness plans, improving communication between team members, and involving the patient and caregiver in discharge planning.4 Medication reconciliation, clear discharge instructions, and patient education are key areas to consider for effective discharge planning to ensure patients can be safely transitioned to the next level of care.

Medication reconciliation ensures that patients are discharged with the correct medications, dose, time, and instructions. Your EHR should have the ability to complete medication reconciliation prior to the patient’s discharge or transition of care. Medication reconciliation can help reduce the risk of the patient experiencing an adverse drug event following discharge which is a leading preventable readmission reason.5

Ensuring that patients receive and understand the correct discharge communication and documents provides a very high return on time invested. Post-discharge follow-up appointments are critical in successfully managing the patient’s treatment outside of the hospital and reducing readmission or return visits to the emergency department. During the discharge process the patient should be provided with the dates for all follow-up appointments and digital appointment reminders should be utilized when possible.

The patient and their caregiver should have a clear understanding of the follow-up care needed, and information related to who to call and when for questions following discharge. MEDHOST provides the ability to complete discharge documents, education, and follow up instructions customized for the patient. Our solution also improves communication to primary care providers by ensuring the discharge summary is available at the time of the patients discharge. The discharge summary provides relevant information related to medication changes, pending tests or results, and follow up care that is needed.

Additionally, MEDHOST provides the ability to complete and document medication reconciliation before patient’s discharge to help reduce the risk of an adverse drug event following discharge. To increase patient engagement and improve outcomes, patients can securely access their personal health records online through YourCare Community® to review medications, instructions, lab results, receive appointment reminders, and more.

Want to learn more how MEDHOST solutions can help reduce readmission risk, contact us at or call 1.800.383.6278.



1 Advisory Board. (2018, September 27). Map: See the 2,599 hospitals that will face readmissions penalties this year.

2 Statistical Brief #248. Healthcare Cost and Utilization Project (HCUP). February 2019. Agency for Healthcare Research and Quality, Rockville, MD. Retrieved from here.

3 Horwitz, L. I., Wang, Y., Altaf, F. K., Wang, C., Lin, Z., Liu, S., Grady, J., Bernheim, S. M., Desai, N. R., Venkatesh, A. K., & Herrin, J. (2018). Hospital Characteristics Associated With Post discharge Hospital Readmission, Observation, and Emergency Department Utilization. Medical care, 56(4), 281–289. Retrieved from here.  

4 Auerbach, A. D., Kripalani, S., Vasilevskis, E. E., Sehgal, N., Lindenauer, P. K., Metlay, J. P., Fletcher, G., Ruhnke, G. W., Flanders, S. A., Kim, C., Williams, M. V., Thomas, L., Giang, V., Herzig, S. J., Patel, K., Boscardin, W. J., Robinson, E. J., & Schnipper, J. L. (2016). Preventability and Causes of Readmissions in a National Cohort of General Medicine Patients. JAMA internal medicine, 176(4), 484–493. Retrieved from here

5 Jennifer E Prey, Fernanda Polubriaginof, Lisa V Grossman, Ruth Masterson Creber, Demetra Tsapepas, Rimma Perotte, Min Qian, Susan Restaino, Suzanne Bakken, George Hripcsak, Leigh Efird, Joseph Underwood, David K Vawdrey, Engaging hospital patients in the medication reconciliation process using tablet computers, Journal of the American Medical Informatics Association, Volume 25, Issue 11, November 2018, Pages 1460–1469,

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