Pathology/Lab Coding Alert

Hospital Lab:

Do Your Part for 'Hospital Readmissions Reduction'

Published on Tue Nov 08, 2016

Leverage test results to predict risk.

If you never thought about how your hospital lab can help meet goals for the Hospital Readmissions Reduction Program (HRRP) that is part of the Affordable Care Act, think again.

With $17 billion in avoidable hospital Medicare costs each year associated with readmissions within 30 days of discharge, HRRP aims to cut costs and improve patient care. Read on to see how some laboratories are making a difference toward this goal.

Don’t Miss This Progress Report

The HRRP recently shared data in a CMS blog post that reaffirmed its progress with research showing “readmissions rates fell by 8 percent nationally” from 2010 to 2015 in all 50 states and the District of Columbia.

“Across states, Medicare beneficiaries avoided approximately 100,000 readmissions in 2015 alone, compared to if readmission rates had stayed constant at 2010 levels,” said Patrick Conway MD, CMS principal deputy administrator and chief medical officer and Tim Gronniger, CMS deputy chief of staff in the blog post. “Cumulatively since 2010, the Health and Human Services Assistant Secretary for Planning and Evaluation estimates that Medicare beneficiaries have avoided 565,000 readmissions.” But there’s more work to be done, and hospital labs, coupled with bioinformatics, might be at the center of some improvements.

Learn What Your Lab Can Do

Because test results are significant diagnostic and prognostic indicators that are generally a large part of the hospital’s Electronic Medical Record (EMR), the laboratory is uniquely positioned to leverage data to improve outcomes.

“It is estimated that laboratory data has an impact on over 70 percent of medical decisions, yet spending on laboratory services accounts for only 2.3 percent of U.S. health care expenditures and 2 percent of Medicare expenditures,” according to a Policy Statement on Accountable Care Organizations (ACOs) published by the American Society for Clinical Pathology (ASCP).

“One way the value of pathology could be demonstrated may be to help integrate clinical testing into decision support systems in electronic medical record systems,” commented Steven J. Bernstein, referenced in the ASCP Policy Statement.

For instance: Hospitals can use laboratory data to predict risk, such as using results of biomarker tests like 83880 (Natriuretic peptide), 83006 (Growth stimulation expressed gene 2 [ST2, Interleukin 1 receptor like-1]), 86140 (C-reactive protein), or 82777 (Galectin-3) to predict the risk of readmission or mortality from heart attack or heart failure.

Similarly, research and demonstration projects using data from various hospitals are developing algorithms using readily-available EMR data from common lab tests such as complete blood count (such as 85025, Blood count; complete [CBC], automated [Hgb, Hct, RBC, WBC and platelet count] and automated differential WBC count) and various metabolic panels (such as 80053, Comprehensive metabolic panel…) to predict readmission risk and modify patient treatment to minimize that probability.

Check Out These Resources

If you want to learn more about the HRRP program and what labs are doing to help reduce hospital readmissions, here are links to some of the resources you read about in this article: