Medicare hospital readmissions reduction program Archives - Page 2 of 4

New Approaches to Readmissions Reduction Program?

While Medicare’s readmissions reduction program has produced a decline in the number of Medicare readmissions within 30 days of discharge, critics – among them many safety-net hospitals – argue that the program is unfair to hospitals that serve especially large numbers of low-income patients whose distinct needs pose a greater risk of requiring readmission to address.
In a new report, the journal Health Affairs notes that such arguments have given rise to a number of proposals for possible changes in the readmissions reduction program. Among them, the Medicare Payment Advisory Commission

…has proposed a revision to the method for calculating readmissions. Rather than including patient SES [note: socio-economic status] in the risk-adjustment step, which MedPAC argues would take years to develop empirically and could mask true quality disparities, MedPAC suggests grouping hospitals into peer groups based on their share of low-income Medicare patients and then set readmissions targets for each peer group. Put another way, hospitals with similar shares of low-income patients would be compared with each other instead of all hospitals.

Other suggestions for modifying the readmissions reduction program include shortening the window on readmissions, which might better reflect the quality of care a hospital provides rather than the nature of the patients it serves; changing the quality measures on which hospitals are judged, choosing new measures that might be less sensitive to socio-economic factors; and providing additional financial or other support to hospitals that serve especially large numbers of low-income patients.
To learn more about the kinds of challenges Medicare’s hospital readmissions reduction program pose and what might be done to address them without discarding the program entirely, go here for the Health Affairs article “The Challenges Of Rewarding Value Over Volume Without Penalizing Safety-Net Hospitals.”

PA Safety Net Admin2016-04-07T06:00:04+00:00April 7th, 2016|Affordable Care Act, Medicare|Comments Off

Safety-Net Hospitals’ Readmissions Challenge

The March edition of the journal Health Affairs offers a compelling snapshot of a type of patient many safety-net hospitals serve on an almost daily basis: the “superutilizer” who lacks the ability and resources to address his own medical needs.
The article “Mr. G And The Revolving Door: Breaking The Readmission Cycle At A Safety-Net Hospital” tells the story of a patient who

…had been using drugs and alcohol since his teenage years, and he was addicted to crack cocaine and alcohol…He had been released from prison six months before we first met him, without any basic resources to help him transition back into society – not even a state ID. Lacking this fundamental necessity, he could not apply for state health insurance or a Supplemental Nutrition Assistance Program card to receive food stamps. As an ex-felon with no income, he couldn’t find a place to live. He told us he was living on the streets, where he spent his days panhandling and using the money he got to buy tacos from street vendors and hash browns from McDonald’s.

Mr. G’s first several admissions to our hospital were similar. He would walk into the emergency department, unable to breathe, and would be admitted to the hospital for treatment related to heart failure. He had a complex medical history including diabetes and extremely poor heart function – which was complicated by a clot in his heart that required the chronic use of blood thinners. Furthermore, he suffered from schizophrenia.

The hospital faced a problem in addition to caring for Mr. G.

The problem with Mr. G’s admissions, aside from their drain on hospital resources, is that to motivate hospitals to improve care, Medicare penalizes hospitals for certain patients who are readmitted within thirty days. This policy assumes that all patients have the means and internal resources to care for themselves effectively and that hospitals, by simply adhering to best practices of medical management, can avoid redundant care. Medicare fails to consider the complications imposed by poverty and the significant burden safety-net hospitals face in trying to address overwhelming social issues.

A typical admission was set in motion by Mr. G’s nonadherence to his medications, poor diet, substance abuse, or a combination of the three. With each admission, additional problems and complications cropped up that extended his stay.

The problems continue, and the article explains that

Patients like Mr. G frustrate health care providers. These patients are often dismissed as being nonadherent, and their psychosocial needs go unrecognized. Their daily challenges are compounded by poverty, mental illness, substance abuse, lack of social support, lack of transportation, and unstable housing. These factors – and other social determinants of health – set the stage for poor health outcomes in patients with low socioeconomic status.

The article concludes by noting that

Current health care policy emphasizes the reduction of readmissions but does not support the time and resources needed to achieve this goal. As the basis for payment shifts from volume to value, it will become exceedingly expensive to continue ignoring the social determinants of health.

To learn more about Mr. G, the hospital that served him, and the challenges Pennsylvania’s safety-net hospitals face when serving patients CMS has labeled “superutilizers,” go here, to the web site of the journal Health Affairs, to see the complete article “Mr. G And The Revolving Door: Breaking The Readmission Cycle At A Safety-Net Hospital.”

PA Safety Net Admin2016-04-06T06:00:21+00:00April 6th, 2016|Affordable Care Act, Medicare, Pennsylvania safety-net hospitals|Comments Off

Socio-Economic Factors Again Tied to Hospital Readmissions

Another study has linked socio-economic factors to increased hospital readmissions.
This latest study, published in the Journal for Healthcare Quality, found that

… meaningful risk-adjusted readmission rates can be tracked in a dynamic database. The clinical conditions responsible for the index admission were the strongest predictive factor of readmissions, but factors such as age and accompanying comorbid conditions were also important. Socioeconomic factors, such as race, income, and payer status, also showed strong statistical significance in predicting readmissions.

Conclusions: Payment models that are based on stratified comparisons might result in a more equitable payment system while at the same time providing transparency regarding disparities based on these factors. No model, yet available, discriminates potentially modifiable readmissions from those not subject to intervention highlighting the fact that the optimum readmission rate for any given condition is yet to be identified.

The study found that low-income patients are more likely to require readmission to the hospital than those with higher incomes and hospitals that serve higher proportions of low-income patients are more likely to incur Medicare penalties for readmissions than other hospitals.
These are the very patients served in especially large numbers by Pennsylvania’s private safety-net hospitals.
To learn more about the study, how it was conducted, and what it found, find the study “Patient Factors Predictive of Hospital Readmissions Within 30 Days” here, on the web site of the Journal for Healthcare Quality.

PA Safety Net Admin2016-03-25T06:00:42+00:00March 25th, 2016|Medicare, Pennsylvania safety-net hospitals|Comments Off

Hospitals Not Using Observation Status to Avoid Readmissions Penalties

Hospitals are not moving returning patients to observation status to avoid incurring financial penalties under Medicare’s hospital readmissions reduction program, according to new study published in the New England Journal of Medicine.
Since that program’s inception, more than 3300 hospitals have reduced the rate at which they readmit Medicare patients within 30 days of their discharge from the hospital. A moderate increase in the classification of Medicare patients in observation status led some critics to suggest that observation status was being used to avoid penalties for readmissions.
The study disagrees, concluding that

…we found a change in the rate of readmissions coincident with the enactment of the ACA, which suggested that the Hospital Readmissions Reduction Program may have had a broad effect on care, especially for targeted conditions. In the long-term follow-up period, readmission rates continued to fall for targeted and nontargeted conditions, but at a slower rate. We did not see large changes in the trends of observation-service use associated with the passage of the ACA, and hospitals with greater reductions in readmission rates were no more likely to increase their observation-service use than other hospitals.

For a closer look at the study, the methodology employed, and its conclusions, go here to see the New England Journal of Medicine article “Readmissions, Observation, and the Hospital Readmissions Reduction Program.” In addition, the U.S. Department of Health and Human Services features a commentary about the study on its blog. Go here to see that commentary, titled “Reducing Avoidable Hospital Readmissions to Create a Better, Safer Health Care System.”

PA Safety Net Admin2016-02-26T06:00:17+00:00February 26th, 2016|Health care reform, Medicare, Uncategorized|Comments Off

Feds Issue Guidance on Reducing Medicare Readmissions

The Centers for Medicare & Medicaid Services has issued a new report advising hospitals how to reduce readmissions among their racially and ethnically diverse Medicare patients.
According to a CMS news release, the guidance

…is designed to assist hospital leaders and stakeholders focused on quality, safety, and care redesign in identifying root causes and solutions for preventing avoidable readmissions among racially and ethnically diverse Medicare beneficiaries.

The guidance also notes that

Racial and ethnic minority populations are more likely than their white counterparts to be readmitted within 30 days of discharge for certain chronic conditions, such as heart failure, heart attack, and pneumonia, among others. Social, cultural, and linguistic barriers contribute to these higher readmission rates.

The document presents an overview of issues affecting readmissions and offers what it calls “high level recommendations” for hospital officials to “move the needle” on those readmissions. Those recommendations:

Create a stronger radar.
Identify the root causes.
Start from the start.
Deploy a team.
Consider systems and social determinants
Focus on culturally competent, communication-sensitive, high-risk scenarios.
Foster community partnerships to promote continuity of care.

According to the report,

Some studies have shown that certain patient-level factors, such as race, ethnicity, language proficiency, age, socioeconomic status, place of residence, and disability, among others—when tied to particular costly and complicated medical conditions such as heart failure, pneumonia, and acute myocardial infarction, to name a few—may be predictors of readmission risk and readmissions. In fact, research has demonstrated—and evaluations of the HRRP to date have found—that minority and other vulnerable populations are more likely to be readmitted within 30 days of discharge for chronic conditions, such as congestive heart failure, than their white counterparts. Given the cost and quality implications of these findings, addressing readmissions while caring for an increasingly diverse population has become a significant concern for hospitals and hospital leaders. In sum, there is a need for additional guidance on how hospitals can focus both system-wide redesign as well as targeted and specific efforts at preventing readmissions among minority and vulnerable populations.

To learn more about the new CMS document Guide to Preventing Readmissions Among Racially and Ethnically Diverse Medicare Beneficiaries, go here to read a CMS news release on its report and find the report itself here.

PA Safety Net Admin2016-02-02T06:00:41+00:00February 2nd, 2016|Medicare|Comments Off

Readmissions Down But Observation Status Up

New research suggests that the general decline in hospital readmissions may be leading to increased use of observation status.
According to new research in the journal Health Affairs,

Our independent analysis of Medicare data published by CMS revealed that the top 10 percent of hospitals with the largest drop (16 percent on average) in readmission rates between 2011 and 2012 also increased their use of observation status for Medicare patients returning within 30 days by an average 25 percent over the same time period.

The practice appears to be affecting privately insured patients, too, with the report noting that

…hospitals that reduced readmissions within 30 days also increased their share of returning observation patients in private plans. The top third of hospitals with the largest six-year (2009-2014) reduction in 30 day readmissions (26 percent on average) increased their share of returning observation patients in private plans by an average of 45 percent (Figure 2). Much of that increase started in 2012, the same year that Medicare hospital readmission penalties began.

The report concludes that

Our findings suggest that at least some hospitals are substituting observation status for inpatient readmissions, both for Medicare and privately insured patients. These trends raise a number of questions. For instance, do observation patients get the same quality of care as inpatients? Further, do drops in readmission rates truly mean that hospitals are providing better quality care? Or… is it merely that some hospitals are avoiding penalties by relabeling patients they previously would have readmitted as observation patients?

Learn more about the study, its findings, and its potential implications in the article “Is Observation Status Substituting For Hospital Readmission?” here, on the Health Affairs web site.

PA Safety Net Admin2015-11-11T06:00:09+00:00November 11th, 2015|Medicare|Comments Off

Study Considers How Best to Prevent Readmissions

A five-year study performed by researchers from the Yale School of Public Health has found that while many hospitals have successfully reduced the rate of readmission for their Medicare patients, few specific strategies have emerged as best practices for tackling this challenge.
In fact, only one strategy appears to be universally effective: discharging patients with their follow-up appointments already made.
Beyond that, researchers found that hospitals lowered their readmission rates by employing a number of tools and that most successful hospitals employed at least three such tools – although which tools they employed differed and more tools did not produce better results.
Hospitals have been working to lower their readmissions in response to Medicare’s hospital readmissions reduction program, which imposes financial penalties for hospitals that readmit “too many” of their Medicare patients.
The study’s conclusion:

Hospital readmission rates result from the confluence of diverse patient, provider, and organizational factors. Despite a wide range of hospitals and five years of study, we found little evidence that specific strategies conferred improvements across hospitals, aside from booking follow-up appointments before discharge. Rather, adopting at least three strategies, tailoring implementation efforts to local circumstances, and persistence over time seemed to be keys to success.

Find the Yale study “National Campaigns to Reduce Readmissions: What Have We Learned?” here, on the web site of the Commonwealth Fund, which underwrote the research.

PA Safety Net Admin2015-10-05T06:00:55+00:00October 5th, 2015|Medicare|Comments Off

Medicare Readmissions Program Unfair to Safety-Net Hospitals, Study Finds

Medicare’s readmissions reduction program penalizes hospitals based largely on the patients they serve rather than their performance serving them, a new study has concluded.
According to the report “Patient Characteristics and Differences in Hospital Readmission Rates,” published in the journal JAMA Internal Medicine,

Patient characteristics not included in Medicare’s current risk-adjustment methods explained much of the difference in readmission risk between patients admitted to hospitals with higher vs lower readmission rates. Hospitals with high readmission rates may be penalized to a large extent based on the patients they serve.

Among those two dozen socio-economic factors: patient income, education, and ability to bathe, dress, and feed themselves.
The study found, for example, that the worst-performing hospitals under Medicare’s hospital readmissions reduction program have 50 percent more patients with less than a high school education than the program’s best performers.
Pennsylvania’s safety-net hospitals serve especially large numbers of low-income patients and have been especially vulnerable to the readmissions reduction program’s penalties.
To learn more about the study, see this Washington Post story. To find the study itself, go here, to the web site of JAMA Internal Medicine.

PA Safety Net Admin2015-09-22T06:00:25+00:00September 22nd, 2015|Medicare|Comments Off

Is Medicare “Pay for Performance” Doing the Job?

Three Medicare initiatives – its hospital readmissions reduction program, value-based purchasing program, and hospital-acquired condition program – were designed to improve the quality of care provided to beneficiaries while eventually reducing the cost of that care.
But are they living up to their billing? That is the question considered in the Health Affairs article “Assessing Medicare’s Hospital Pay-For-Performance Programs and Whether They Are Achieving Their Goals.” Find the article here.

PA Safety Net Admin2015-08-10T06:00:27+00:00August 10th, 2015|Medicare|Comments Off

30-Day Readmission Standard Flawed, Study Suggests

A new study raises the possibility that Medicare’s policy of penalizing hospitals that readmit patients within 30 days of their discharge may be flawed.
According to a new report in the Annals of Internal Medicine, risk factors for readmission often change within those 30 days.
In addition, patients with chronic medical problems are more likely to need readmission. Even the time of day of discharge appears to affect patients’ likelihood of readmission, with those discharged between 8 a.m. and 1:00 p.m. less likely to be readmitted.
The study also found that social determinants and insurance status also increase the likelihood of readmission within 30 days of discharge.
Together, these and other findings appear to raise questions about the fairness of Medicare’s hospital readmissions reduction program.
These findings also mirror a growing body of research that suggests that the program is inherently unfair to safety-net hospitals that serve large numbers of low-income patients who have had limited and sporadic access to medical care during their lives.
To learn more, see this Fierce Healthcare report. Find the study “Differences Between Early and Late Readmissions Among Patients: A Cohort Study” here, on the web site of the Annals of Internal Medicine.

PA Safety Net Admin2015-06-08T06:00:26+00:00June 8th, 2015|Medicare|Comments Off

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