Medicare hospital readmissions reduction program Archives - Safety-Net Association of Pennsylvania

Safety-Net Hospitals, Others Benefit From Changes in Medicare Readmissions Program

Safety-net hospitals are among the leading beneficiaries of changes implemented this year in Medicare’s hospital readmissions reduction program.

According to a new study, safety-net, academic, and rural hospitals have enjoyed improved performance under the program since Medicare began organizing hospitals into peer groups based on the proportion of low-income patients they serve rather than simply comparing individual hospital performance to that of all other hospitals.

While the current fiscal year is still under way, it appears that safety-net hospitals will enjoy a collective decline of $22 million in Medicare readmissions penalties while 44.1 percent of teaching hospitals and 43.7 percent of rural hospitals will face smaller penalties than last year.

Learn more about the readmissions reduction program and how changes in that program have significantly altered its outcomes in the JAMA Internal Medicine study “Association of Stratification by Dual Enrollment Status With Financial Penalties in the Hospital Readmissions Reduction Program.”

PA Safety Net Admin2019-04-29T10:20:17+00:00April 29th, 2019|Medicare|Comments Off

New Study: Social Risk Factors Affect Provider Performance and Patient Outcomes

Medicare patients with social risk factors fare worse than others in programs that measure quality and the providers that serve them also perform worse than others on quality measures.
This news comes from a new report presented to Congress by the U.S. Department of Health and Human Services’ Office of the Assistant Secretary for Planning Evaluation.
The report, mandated by the Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014, focused on nine Medicare payment programs:

the hospital readmissions reduction program
the hospital value-based purchasing program
the hospital acquired condition reduction program
the Medicare Advantage (Part C) quality star rating program
the Medicare shared savings program
the physician value-based payment modifier program
the end-stage renal disease quality incentive program
the skilled nursing facility value-based purchasing program
the home health value-based purchasing program

APSE concluded that:

Beneficiaries with social risk factors had worse outcomes on many quality measures, regardless of the providers they saw, and dual enrollment status was the most powerful predictor of poor outcomes.
Providers that disproportionately served beneficiaries with social risk factors tended to have worse performance on quality measures, even after accounting for their beneficiary mix. Under all five value-based purchasing programs in which penalties are currently assessed, these providers experienced somewhat higher penalties than did providers serving fewer beneficiaries with social risk factors.

Among the solutions suggested in the report for addressing these problems are:

adjusting quality and resource use measures
adjusting payments
addressing the underlying issues

The report also suggests that HHS’s strategy for accounting for social risk in Medicare’s value-based purchasing programs should consist of the following three steps:

measure and report quality for beneficiaries with social risk factors
set high, fair quality standards for all beneficiaries
reward and support better outcomes for beneficiaries with social risk factors

And in carrying out these steps, the report recommends that HHS

provide specific payment adjustments to reward achievement and/or improvement for beneficiaries with social risk factors, and
where feasible, provide targeted support for providers who disproportionately serve them.

Medicare beneficiaries who present with socio-economic risk factors are served by Pennsylvania safety-net hospitals in especially large numbers.
Learn more about the problems APSE found and its proposals for dealing with those problems by reading Report to Congress: Social Risk Factors and Performance Under Medicare’s Value-Based Purchasing Programs.

PA Safety Net Admin2016-12-30T06:00:20+00:00December 30th, 2016|Medicare, Pennsylvania safety-net hospitals|Comments Off

New Study Questions 30-Day Readmissions as Measure of Hospital Quality

Hospital readmissions within 30 days of discharge may not be a good way of judging the quality of care hospitals provide, a new study suggests.
Seven days may be more like it.
According to a new study published in the journal Health Affairs, the impact of the quality of care a hospital provides appears to be most evident immediately upon patients’ discharge from the hospital.
Further, the study suggests,

… most readmissions after the seventh day postdischarge were explained by community- and household-level factors beyond hospitals’ control.

The researchers’ conclusion?

Shorter intervals of seven or fewer days might improve the accuracy and equity of readmissions as a measure of hospital quality for public accountability.

The findings call into question the approach employed by Medicare through its’ hospital readmissions reduction program. Some of the issues the study cites – community and household factors – are the very kinds of challenges that Pennsylvania’s safety-net hospitals face far more often than the typical community hospital in the state.
To learn more about how the study was performed and what its implications might be, go here to see the Health Affairs study “Rethinking Thirty-Day Hospital Readmissions: Shorter Intervals Might Be Better Indicators Of Quality Of Care.’

PA Safety Net Admin2016-10-12T06:00:20+00:00October 12th, 2016|Medicare, Pennsylvania safety-net hospitals|Comments Off

Senate May Tackle Socio-economic Risk Adjustment

With a House bill to adjust Medicare payment penalties based upon the socio-economic challenges posed by the patients some hospitals serve folded into a House bill that passed in June, the Senate may take up this issue during its fall session.
Health economists, policy experts, and providers generally agree that the performance of hospitals that serve especially large numbers of low-income patients is affected in a number of areas, including Medicare readmissions, meeting value-based purchasing criteria, and others.
And while the Centers for Medicare & Medicaid Services acknowledges the challenge, the agency has rejected calls for risk adjustment so far, repeatedly writing that it does not “want to mask potential disparities or minimize incentives to improve the outcomes of disadvantaged populations.”
Meanwhile, a growing body of research has documented that the anticipated impact of serving socioeconomically challenged patients is real and more and more people are joining the call for Congress or CMS to address the problem.
Compounding the challenge is that hospitals that serve such patients are faced with growing financial penalties from Medicare if they fail to perform at levels comparable to hospitals that face fewer challenges.
For a closer look at the issue, the arguments on both sides, and the prospects for congressional action this fall, see this article from CQ Roll Call presented by the Commonwealth Fund.

PA Safety Net Admin2016-09-20T06:00:19+00:00September 20th, 2016|Medicare|Comments Off

There’s More to Quality Than Readmissions, Study Suggests

Hospitals with high readmissions rates may also have lower mortality rates for some conditions, according to a new study.
The study, published in the Journal of Hospital Medicine, found that patients suffering from heart failure, stroke, and chronic obstructive pulmonary disease who are served in hospitals with higher readmission rates have a slightly better chance of survival than if they were treated in hospitals with lower readmission rates.
Such findings call into question the value of focusing on readmissions as a measure of the quality of care hospitals provide – a focus exemplified by Medicare’s hospital readmissions reduction program.
Find the study “Associations between hospital-wide readmission rates and mortality measures at the hospital level: Are hospital-wide readmissions a measure of quality?” here and find a summary of the study in this article in McKnight’s Long-Term Care News.

PA Safety Net Admin2016-09-07T13:00:05+00:00September 7th, 2016|Medicare|Comments Off

Hospital Group Models Risk-Adjusted Medicare Readmissions

The Missouri Hospital Association has published data that demonstrates that risk-adjusting Medicare readmissions based on social determinants of health reduces the readmission rates of hospitals that care for large numbers of low-income patients.
The data, modeling, and risk adjustment methodology, developed by the association based on data from Missouri hospitals, published on the association’s “Focus on Hospitals” web site, and described in an article on the NEJM Catalyst web site, showed that

SDS [note: sociodemographic status)-enriched models yielded significant relative reductions in the range of risk-standardized readmission ratios for each of…6 outcomes…Overall, SDS enrichment best improved the 30-day readmission assessments of hospitals that served higher concentrations of Medicaid patients and higher-poverty communities.

The lack of risk adjustment for socioeconomic risk factors has been a controversial aspect of Medicare’s hospital readmissions reduction, with a growing body of research suggesting that without such risk adjustment, the program is unfair to hospitals that care for especially large numbers of low-income patients- hospitals like Pennsylvania’s private safety-net hospitals.
Learn more about the work done by the Missouri Hospital Association, and its implications, in its report Risk Adjustment for Sociodemographic Status in 30-Day Hospital Readmissions and this description of and commentary on the association’s research on the NEJM Catalyst web site.

PA Safety Net Admin2016-09-07T06:00:05+00:00September 7th, 2016|Medicare, Uncategorized|Comments Off

Medicare Readmissions Penalties Rise

Medicare will impose more than $500 million in penalties in FY 2017 on hospitals that readmit too many Medicare patients within 30 days of their discharge from the hospital.
The penalties, part of Medicare’s hospital readmissions reduction program, represent a 20 percent increase over the penalties the program levied in FY 2016.
Under the program, most (but not all) hospitals are evaluated on their performance with patients with six medical conditions: heart attacks, heart failure, chronic lung disease, hip and knee replacement, and the need for coronary bypass surgery. The maximum penalty is three percent of hospitals’ Medicare payments and the average penalty in FY 2017 will be 0.73 percent – up from 0.61 percent in FY 2016.
The program is widely credited with driving a national reduction in the number of Medicare patients readmitted to the hospital within 30 days of discharge, although as the program’s FY 2017 penalties suggest, reducing those readmissions is proving a considerable challenge for some hospitals.
Ever since the program’s introduction, critics have maintained that hospitals that serve large numbers of low-income patients are treated unfairly by the program. Such patients, a growing body of research has found, are more difficult to treat and more likely to lack the financial, social, and family supports needed to recover from illnesses and injuries without requiring a return to the hospital. Pennsylvania’s safety-net hospitals serve especially large numbers of such patients.
Learn more about how the readmissions reduction program works and how it will treating hospitals in FY 2017 in this Kaiser Health News report.

PA Safety Net Admin2016-08-11T06:00:36+00:00August 11th, 2016|Uncategorized|Comments Off

Bill Proposes Risk-Adjusting Medicare Readmissions Program

A new bill introduced in the House Ways and Means Committee would apply risk adjustment for socio-economic factors to Medicare’s hospital readmissions reduction program.
According to a committee summary of the bill, The Helping Hospitals Improve Patient Care Act of 2016 includes a provision that would direct the Secretary of Health and Human Services to

… implement a transitional risk adjustment methodology to serve as a proxy of socio-economic status for the Hospital Readmissions Reduction Program. In addition to the transitional adjustment, the section clarifies that the Secretary is able to permanently use a more refined methodology following the analysis required by the Improving Medicare Post-Acute Care Transformation Act of 2014. The section also requires a study by the Medicare Payment Advisory Commission (MedPAC), and allows for an analysis of “V-codes” and an exploration of potential exclusions.

The bill would be beneficial for Pennsylvania’s private safety-net hospitals because they serve more low-income patients who are more challenging to treat than typical hospital patients and are more likely to require post-discharge readmission to address continuing medical and social issues.
For a closer look at the bill’s socio-economic risk adjustment provision and other proposals, go here to see the committee’s summary of H.R. 5273, The Helping Hospitals Improve Patient Care Act of 2016, and go here to see the bill itself.

PA Safety Net Admin2016-05-23T06:00:17+00:00May 23rd, 2016|Medicare, Pennsylvania safety-net hospitals|Comments Off

Hospitals Turn to Community Health Workers to Prevent Readmissions

It’s a new twist on an old concept: employ peers of low-income patients to go out into the community and work with those recently hospitalized to ensure that they are getting the care and assistance they need to recover from their illnesses and injuries.
Traditionally employed by local health departments and other government agencies, community health workers are increasingly being hired by hospitals to reach out to challenging patients and help prevent readmissions to the hospitals for which Medicare (through its hospital readmissions reduction program), and increasingly state Medicaid programs as well, penalize them.
And the early results are encouraging: some hospitals that employ community health workers have lowered their Medicare readmissions and avoided federal penalties.
Among the challenges hospitals face in employing such an approach is how to pay for community health workers. Some do so out of operating funds; others receive foundation grants; some have obtained funding from the federal government and some through enhanced Medicaid payments for this purpose; and even health insurers, lured by the prospect of reducing the cost of claims, have started helping.
For a closer look at how community health workers are helping hospitals keep their patients healthier and out of the hospital, see the Kaiser Health News report “Hospitals Eye Community Health Workers to Cultivate Patient Success.”

PA Safety Net Admin2016-04-15T06:00:04+00:00April 15th, 2016|Medicare|Comments Off

Readmissions Reduction Target Too High?

Medicare’s goal of reducing hospital readmissions 20 percent – a key aspect of its hospital readmissions reduction program – may be too ambitious, researchers have concluded after evaluating the results of a special Connecticut effort to reduce readmissions.
In that program, a new approach to reducing readmissions tested on 10,000 older patients considered at high risk of readmissions employed interventions, transition support, education, follow-up telephone calls, and assistance finding community resources and assistance. The result? It cut Medicare hospital readmissions nine percent – less than half the 20 percent goal Medicare has set.
jama internal medicine The study’s creators concluded that

Our analysis revealed a fairly consistent and sustained but small, beneficial effect of the intervention on the target population as a whole.

Learn more about the study in this Fierce Healthcare report and find the study itself here, on the web site of JAMA Internal Medicine.

PA Safety Net Admin2016-04-14T06:00:34+00:00April 14th, 2016|Medicare|Comments Off

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