MAY 1, 2012

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

Gender as Risk Factor for 30 Days Post-discharge Hospital Utilization: A Secondary Data Analysis
A study by the Boston University School of Medicine, reported in the British Medical Journal, found that males in the study had a higher rate of readmissions, suggesting that gender is a factor to be considered in readmission reduction plans. Factors influencing the male readmissions were observed to be marital status (unmarried/divorced were more likely to be readmitted), employment status (e.g., retired), men suffering from depression and those having no PCP visits post-discharge. (BMJOpen, April 18, 2012)

NQF Endorses All-Cause Readmissions Measures
The National Quality Forum has endorsed two measures intended to reduce readmissions. The first measure, developed by the NCQA, counts the number of over 18 year-old inpatient stays that were followed by an acute readmission for any diagnosis within 30 days. The second measure is a CMS -- Yale tool that estimates the risk of unplanned readmissions based on conditions or procedures. (National Quality Forum, April 24, 2012)

Thirty-Day Readmissions -- Truth and Consequences
A study by the Harvard School of Public Health suggests that the ACA's incentives dilute attention paid to mortality in favor of a focus on those efforts that reduced 30-day readmissions. Readmission incentives form a larger percentage of incentive payments and penalties than do mortality rates. Ashish Jah, MD, MPH, an internist and policy researcher at Harvard, says "What you see is a pattern where the best hospitals tend be very low on mortality rates, but tend to be high in readmissions." Ashish and his co-author Karen E. Joynt, MD, MPH, question whether readmissions always reflect poor quality. As only 12% of all readmissions are preventable according to studies, the authors suggest the focus should shift and incentives should be based principally on prevention and quality -- the factors that ultimately produce the readmissions. (New England Journal of Medicine, March 28, 2012)

Predictive Modeling Cuts Hospital Readmissions
Three hospital systems are examined in terms of their use of statistical models which predict the likelihood of readmissions. The development of successful algorithms drawing from data already available in the EMR is key to the creation of systems that will assist providers in decreasing their preventable admissions and reducing readmissions as well as improving quality and outcomes thereby maximizing capacity. (HealthLeaders Media, April 27, 2012)

Proposed Rules Clarify Readmissions Penalties
CMS released its proposed rules for the FFY Inpatient Prospective Payment System payment updates for FFY commencing October 1, 2012. Included are proposed rules clarifying penalties under the Hospital Readmissions Reduction Program and requirements for the Value-Based Purchasing Program. (HealthLeaders Media, April 25, 2012)

A Randomized Controlled Trial of Telemonitoring in Older Adults with Multiple Health Issues to Prevent Hospitalizations and Emergency Department Visits
A study by the Mayo Clinic with support Purdue University found little effect from telemonitoring in reducing ED visits and hospitalizations among older patients. Other studies (e.g., Geisinger Health Plan investigation) have demonstrated some positive results although these studies were not limited to older patients. (Annals of Internal Medicine Online, April 16, 2012)

Hospital Readmission Rates Misleading
The University of California San Francisco has found that reported readmission rates are overestimated by up to 25%. This conclusion was reached after researcher analyzed thousands of spinal encounters from 2007-2011 at UCSF Medical Center. The UCSF team also found that an "all cause" readmission rate cannot be counted on to distinguish between planned or unplanned surgeries for complications, scheduled, or staged surgeries. (Newswire, April 12, 2012)

Admissions Drop When Pharmacists Visit Patients' Homes
The Springfield, Mass.-based HMO Health New England has implemented a new model addressing medication management post-discharge for its Medicare Advantage members. The program provides for pharmacists making home visits to patients at increased readmission risk including chronic patients and those with multiple medications. (Fierce Health Payer, April 16, 2012)

Reducing Avoidable Hospital Readmissions

This early presentation by Stephen Hines, PhD, Vice President, Health Research and Education Trust, on the subject of readmissions outlines the work of HRET on the phenomenon of readmissions offers helpful background, data, insights and strategies.

To update or remove your address, please click the "Unsubscribe/Manage" link below or email your request to: listmgr@HealthcareeNewsletters.com.

Readmissions Update e-Newsletter is one of a family of free e-Newsletters providing a complimentary video presentation and regularly updated news and key resources on major health care issues such as ACOs, bundled payment, comparative effectiveness, Medicaid, pay for performance and patient safety. To view and subscribe to other e-Newsletters go to www.HealthCareeNewsletters.com.

Reducing Readmissions by more than 20% through an ACO Model

Juan DaVilla
Senior Vice President, Network Management, Blue Shield of California