Hospitalization and readmission rates affect payment and star rating. They also matter to referral sources,hospitals care about readmissions.
Care and documentation
Good care reduces avoidable hospitalizations: medication management, teaching, and early response to changes. Document what you’re doing so it’s visible in the chart. When you prevent a hospitalization (e.g. you caught a problem and the physician adjusted the plan), note it. That supports both the patient and your outcomes.
Handoffs
When a patient is discharged from home health to hospital or SNF, send a summary. When they come back to you, get the discharge summary and reconcile meds. Gaps in handoffs drive readmissions,and hospitals track which home health partners have lower readmission rates. Plan handoffs using discharge planning and transitions of care so the next team has what they need. We have a readmission reduction checklist you can download: care practices, documentation, and handoff steps. Use the button below to get it.