Readmission Risk Assessment Tools

The Revolving Door Problem of Hospital Readmissions

Reducing hospital readmission rates has become a priority to policymakers as readmissions are common, costly and, at least in theory, a reasonable fraction of them should be preventable. Policymakers therefore believe that reducing readmission rates represents a unique opportunity simultaneously to improve quality of care and reduce costs. As part of the Affordable Care Act (ACA), Congress directed the Centers for Medicare and Medicaid Services (CMS) to penalize hospitals with “worse than expected” 30-day readmission rates. This part of the ACA has motivated hospitals, health systems, professional societies and independent organizations to invest substantial resources into finding and implementing solutions for the “readmissions problem”.


avixena provides unique Readmission Risk Assessment Survey tools which were developed after reviewing more than 60,000 inpatient Medicare FFS, Medicare Advantage, D-SNP, and Managed Medicaid admissions.

The average cost of a single readmission to a hospital


The scoring methodology and analysis was based on a review of 7,000 readmissions, resulting in a scoring system allowing for automatic generation of options, such as a discharge plan. avixena apps are the most advanced assessment tool in their class with >90% specificity and >90% sensitivity. These tools incorporate and quantify the effect on readmission of Social Determinants of Health – availability of transportation, housing, social support system, and insurance.


General Readmission Risk Assessment Survey Tool

The most advanced assessment tool in its class. Designed to identify patient's readmission risk status, has a scoring system, and allows for generation of options, such as a discharge plan.

Readmission Root Cause Assessment Tool

Designed to assess root causes and contributing factors that have resulted in readmissions and automatically creates an action plan to mitigate and manage the identified issues.

Extended Care Facility Transfer Readmission Risk Assessment Tool

Designed to alert and assist extended care facilities with managing moderate and high-risk patients prior to transfer from the acute care setting. The same methodology was used to develop and validate its effectiveness as was used for the RAS Tools.

Pediatric Readmission Tool

Has all the features described in the Adult RAS Tool but also incorporates and quantifies the effect of issues limited to pediatric population on read- missions (i.e., impact of pre-term birth, genetic conditions, immunization status, impairment of growth and development, and caregiver’s mental health status). The Pediatric RAS Tool was developed based on Dr. Shafa’s experience with two of the largest Pediatric-only managed care organizations in the US.

Behavioral Health Readmission Tool

The Behavioral Health RAS Tool has all the features described in the RAS Tool and is the only tool of its kind that identifies and incorporates the impact of age, previously diagnosed behavioral health conditions, and discharge destination on readmissions.

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