FEBRUARY 21, 2012

Welcome to the Medicare Readmissions Update eNewsletter
This issue sponsored by the National Medicare-Medicaid Payment Summit

Rethinking Hospital Readmissions
Starting this fall, hospitals that readmit the same patients over and over in a short period of time will be fined. That has medical providers looking for better ways to keep people healthy when they're off hospital grounds. The following article has a number of interviews with experts in the field who are attempting to grapple with this intractable problem. (Health Leaders Media - February 8, 2012)

AHCA: Reduce Hospital Readmissions, Not Medicare Funding, for SNFs
The nursing home industry is working to prevent further Medicare reimbursement reductions, this time in the form of cuts to bad debt payments, by proposing an alternative: a plan to reduce hospital readmissions from skilled nursing facilities. On Wednesday, Feb. 1, the American Health Care Association (AHCA) pitched its plan to a House-Senate conference committee to show that it's a "viable alternative to just cutting bad debt," says Greg Crist, vice president of public affairs at AHCA. (Senior Housing News - January 31, 2012)

Curbing Readmissions Doesn't hHave to be Costly
When Chicago's Mount Sinai Hospital embarked on reducing readmissions with the Project Re-Engineered Discharge model, otherwise known as Project RED, program leaders couldn't believe it lowered readmissions from 34% (from July 2010 to January 2011) to only 5% (from February 2011 to July 2011). Even better, it didn't require new staff or additional dollars. (FierceHealthcare - January 30, 2012)

In the Literature: Physician Reviews of HM-Related Research
Hospital readmission has received national attention as an indicator of poor healthcare quality and unnecessary costs. While some studies suggest that some readmissions are preventable, the exact number is unknown. Understanding preventability and the views of front-line clinicians might help hospitalists balance multifactorial compromise between throughput and length of stay. A group of 17 hospitalists analyzed the inpatient and outpatient charts of 300 consecutive patients readmitted within 21 days of discharge using a structured data collection tool to record patient characteristics, process measures, and perceived preventability of the readmission. Patients were either discharged by internal-medicine hospitalists or had an internal-medicine consultation during their initial stay. (The Hospitalist - February 2012)

Readmission Rate Culprits Remain Elusive
Despite ongoing research to keep patients from bouncing back to the hospital, many organizations are still struggling. In fact, even the number one hospital in the country with the lowest readmission rate for congestive heart failure doesn't know exactly how they accomplished it. St. Patrick Hospital in Montana recently learned it earned the highly desirable spot, based on data from the Center for Medicare & Medicaid Services from 2007 to 2010 at more than 4,000 hospitals nationwide, the Missoulian reported. St. Patrick's Hospital's readmission rate is 18.2 percent, compared to the national average of 24.8 percent. (FierceHealthcare - January 27, 2012)

Hospitalist/Palliative-Care Collaboration Aims to Reduce Readmissions
Hospitalists at the Aurora West Allis (Wis.) Medical Center are given education and modeling on how to hold family conferences with patients and their families to elicit their goals of care. Collaboration between HM and palliative care is spreading to the hospital's ICUs, to patients transitioning out of the hospital to nursing homes, and to two other Aurora hospitals in the Milwaukee area. Since the BOOST tools have been implemented, preliminary evidence points to reduced readmissions, increased patient satisfaction, and increased palliative-care consults at the hospital. (The Hospitalist) - February 1, 2012

Studies Contrast on Hospital Readmission
Kaiser Health News published a cumulative analysis of 3,119 different hospitals in December 2011, using readmission for congestive heart failure, the most common cause of rehospitilization with 30 days for Medicare patients, as its metric. According to Medicare's data and the analysis, 11.7 percent of the hospitals that treat the poorest patients had an above-average readmission rate, compared to 4.3 percent for other hospitals. However, a Yale professor has rebutted a recent academic study finding that hospitals that treat more low-income patients tend to have higher readmission rates. (Yale Daily News - January 23, 2012)

UPMC Incorrectly Billed Medicare for Same-Day Readmissions
The Pittsburgh Post-Gazette has reported that following federal recommendations, the University of Pittsburgh Medical Center (UPMC) has refunded $26,547 for overcharging Medicare with incorrectly billed same-day readmissions. In 2008 and 2009, UPMC Presbyterian-Shadyside improperly billed seven readmissions as separate inpatient stays instead of continuous stays, according to a report from the Office of Inspector General (OIG). For the incorrect claims, the readmission was related to the initial admission's medical condition and should have been billed as one continuous stay. (FierceHealthcare - January 18, 2012)

Mayo Clinic Readmissions Page

Mayo Clinic is a nonprofit worldwide leader in medical care, research and education for people from all walks of life. Doctors from every medical specialty work together to care for patients, joined by common systems and a philosophy of "the needs of the patient come first." Mayo Clinic is governed by a 33-member Board of Trustees.

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Use of Social Media in Readmission Strategies - the Next Arrow in the IT Quiver?

Benjamin Miller, PsyD
University of Colorado Depression Center, University of Colorado School of Medic, Aurora, CO

Mark Ryan, MD, FAAFP
Virginia Commonwealth University School of Medicine, Richmond, VA