Why CMOs Should Pay Attention to Physical Function Deficits

CMOs looking to reduce costly hospital readmissions should pay closer attention to their patients’ physical activity in the hospital.

According to recent research, physical function impairments can help predict the risk of readmission. Addressing them could help healthcare leaders reduce readmissions within 30 days—and the reimbursement penalties of up to 3% that can come from the Centers for Medicare & Medicaid Services for those returning patients.

“If you talk to CFOs, they will tell you that the margins are thin in treating Medicare patients, and it is hard to give back 3% of your reimbursement,” says John Romano, acting CMO of Fremont, California-based Washington Health.

The recent research, which was published by the Journal of Hospital Medicine, features a systematic review of 17 studies representing 80,000 patients.

The study includes several key findings:

• Patients with chronic obstructive pulmonary disease are 10 times more likely to be readmitted within 30 days if their grip strength is weak, compared to patients with normal grip strength.
• Impaired gait speed is one of the strongest predictors of readmission risk among patients undergoing transcatheter aortic valve replacement.
• Impairments in daily living activities were associated with a higher number of 30-day hospital readmissions among Medicare beneficiaries with a cancer diagnosis.
• Hospitalized patients at least 75 years old with low mobility, such as those limited to their beds, are twice as likely to be readmitted within 30 days, compared to those patients who can walk on their own.
• Patients with deficits in instrumental activities of daily living (IADL), such as managing a trip to the grocery store, face higher risk of readmission, according to two studies. One study estimated a 17% higher chance of readmission for patients with any IADL limitations as compared with those with no limitations.

“Functional impairments are robust predictors of hospital readmissions in older adults,” the journal article’s co-authors wrote. “Routine assessment of physical function during hospitalization can improve risk stratification and may support successful care transitions, particularly in older adults.”

Why physical function is linked to readmission risk

Physical function reflects the status of several body systems, the lead author of the journal article says.

“Physical function tells us a lot about the musculoskeletal system and the cardiovascular system as well as a patient’s cognitive status and psychosocial well-being,” says Erin Thomas, PT, DPT, associate professor of practice at The Ohio State University College of Medicine‘s School of Health and Rehabilitation Sciences. “Physical function gives us a lot of insight, and when physical function is compromised, patients are at higher risk for readmission.”

Romano says hospitalization can compromise a patient’s physical function.

At Washington Health, which includes a 415-bed acute-care hospital, Romano says about 60% of the hospital’s patients automatically work with physical therapists. That figure is likely to increase, he says, with the findings of the journal article and other research.

“Now, there are more and more protocols for post-surgical care to optimize early mobility because we know that if patients stay in bed they are not going to get well,” he says.

Measuring physical function

Thomas says there are many ways to assess physical function.

“You can look at strength,” she says. “You can look at mobility issues such as walking. You can look at how a person is able to handle their activities of daily living such as managing bathing and dressing. The are many opportunities for clinicians and nurses to look at physical function and to think inter-professionally about physical function.”

Given the research, Thomas and Romano say, hospital leaders should prioritize assessing physical function during a hospital stay.

“An important finding of our study was the importance of routine measurement of physical function,” Thomas says. “In addition, you need to recognize that physical function is like a vital sign. We should be checking physical function early and frequently during a hospitalization. This can help identify patients who are at risk for readmission.”

Improving transitions of care

Understanding a hospitalized patient’s physical function impairments can also improve transitions of care, Thomas and Romano say.

“Knowing about physical function impairments helps us to plan and think about where an individual should go after a hospitalization,” Thomas says. “It helps us make sure we are making the right decisions for post-acute care. For some individuals, it may not be safe for them to go home. They might need to go to a skilled nursing facility or a rehab facility.”

“When a patient is discharged, we have a case manager who looks at all of the patient’s needs and recommends to the attending physician what to order for the patient’s post-hospitalization,” Romano says. “Now, because we have measures of physical function, we can apply that same process for the patient’s activity needs.”