A record number of hospitals received cuts to their Medicare reimbursements for failing to meet targets on patient hospital readmissions, according to data released by the Centers for Medicare and Medicaid Services (CMS).
Nearly 80% of the nearly 3,400 hospitals judged on readmission rates received financial penalties, with 39 hospitals receiving the highest penalty, according to a report in Kaiser Health News. Every hospital in New Jersey and the majority of facilities in 28 states will be fined this year, according to the Kaiser report.
The penalties are part of CMS’s Hospital Readmissions Reduction Program, a provision of the Affordable Care Act that aims to encourage hospitals to improve transitions of care with other providers after patients are released. Hospitals are tracked on their rate of readmissions within 30 days of discharge for some specific conditions, including heart failure, heart attack, pneumonia, elective knee and/or hip replacements, chronic obstructive pulmonary disease, chronic bronchitis and other lung ailments. The penalties are levied as a reduction in Medicare reimbursements ranging from less than 1% to 3% for hospitals with the highest readmission rates.
Preventable hospital readmissions are a major factor in the high cost of healthcare, and contribute to a large portion of Medicare’s expenses. In 2013, nearly 18% of hospitalized Medicare patients were readmitted within a month, according to Kaiser Health News. It’s estimated that $17 billion is spent on avoidable patient readmissions.
Preventing hospital readmissions
Researchers and doctors are still sorting out the best strategies to prevent “turnstile readmissions.” A review article published in 2011 in the Annals of Internal Medicine found a dozen potential interventions that have been studied, including medication reconciliation and home visits. But the researchers couldn’t isolate any one or specific bundle of steps that have consistently reduced readmissions, in part because of limitations in the quality of the studies.
One common measure, implemented in studies and quality improvement efforts, has been to add a post-discharge care coordinator. In one initiative involving Oregon Health & Science University (OHSU) a care manager was added in each of four primary care clinics. The manager was a registered nurse able to triage medical issues, says Brett White, MD, the study’s lead author. The nurse was able to address gaps in care, starting with ensuring that the hospital discharge paperwork reached the clinic, White says.
Previously, the hospital physician typically would fax that paperwork to the primary care physician, he says. “With really no way of knowing whether that ever arrived, whether it was attended to, whether that primary care physician then followed up on it, reviewed it, or any of that,” says White, who previously practiced at OHSU and now is health plan medical director at ZoomCare in Portland.
Under the new approach, the nurse care manager also would call the patient shortly after discharge, reaching roughly 90% compared with fewer than 10% previously, according to White’s recollection. That early call was particularly key to catching medication problems, from potential interactions to difficulties in obtaining or affording prescriptions, he says.
White recalls a patient of his who had been hospitalized for an exacerbation of his chronic obstructive pulmonary disease.
Follow up after discharge determined that the patient wasn’t faring well. “It was in large part because of the inhalers that he was prescribed upon discharge—he couldn’t afford them,” White says. “And so he just didn’t pick them up. So he was using his albuterol inhaler over and over and over to no avail.”
The patient was brought in for an office appointment and switched to a more affordable inhaler, says White, who believes that a readmission was thus prevented.
Information provided by Modern Medicine Network
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