JUNE 27, 2012

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

4 Steps to Leveraging "Big Data" to Reduce Hospital Readmissions
Paul Bradley, PhD, Chief Scientist at MethodCare, Inc., discusses how "big data,' the mountains of data an organization collects constantly though its clinical information systems, can be mined for understanding the key drivers of readmissions. He details four keys to data mining: 1) creating clean data, 2) integrating financial and clinical data, 3) structuring the data elements, and 4) employing algorithms to analyze and forecast. He also cites the American Hospital Association's "Hospitals and Care Systems of the Future" which emphasizes the growing importance of data mining. (Becker's Hospital Review, June 4, 2012)

AHA: Exclude Some Readmissions from Readmissions-Reduction Program
CMS is being pressed by the American Hospital Association to exclude both planned readmissions and new admissions or admissions unrelated to the previous admission from the Hospital Readmissions and Reduction Program required by the Affordable Care Act calling such a policy inappropriately punitive and inconsistent. (Inside Health Policy, June 20, 2012)

Unintended Consequences of Steps to Cut Readmissions and Reform Payment May Threaten Care of Vulnerable Older Adults
This Health Affairs article presents ways in which the Affordable Care Act fails to adequately address fragmentation because of its principal focus on inpatient care. Policies and programs such as the Hospital Readmission Reduction Program will produce unanticipated consequences on older adults receiving long-term care. Such shortsightedness could severely limit the benefits of the intended reform. (Health Affairs, June, 2012)

NQF's All-Cause Readmissions Project
The National Quality Form recently endorsed Performance Measure 1789: Hospital-wide all-cause readmission measure which was developed by Yale University and CMS. This measure, which estimates risk-standardized 30 day readmissions, will produce results in five specialties: 1) general surgery/gynecology, 2) general medicine, 3) cardiorespiratory, 4) cardiovascular, and 5) neurology services. The endorsement has been appealed by five hospital systems (see Modern Healthcare story next) and will be reconsidered by the NQF Board on June 25, 2012. (National Quality Forum, June 2012)

Minnesota Readmissions Initiative Breaks Down Silos
"Everyone is rallying around the goals. They are all talking at the table, and starting to break down the silos between hospital, nursing home, clinic, and the chasms in between." So says hospitalist Howard Epstein, MD, FHM, ICSI's Chief Health Systems officer. ICSI (the Institute for Clinical Systems Improvement, a nonprofit collaborative of 55 medical groups and hospitals) has partnered with the Minnesota Hospital Association and Stratis Health, Minnesota's quality improvement organization, to establish the RARE (Minnesota Reducing Avoidable Readmissions Effectively) campaign which set a goal of preventing 4,000 avoidable readmissions among commercially insured patients. The program is expected to surpass its goal. (The Hospitalist: The eWire, June 13, 2012)

Calif. Nursing Home Demo Decision Signals Heavy Reliance on Duals Demo
The State of California is preventing organizations from participating in the CMS demonstration aimed at reducing hospitalizations from nursing homes because of perceived overlap with the CMS demonstration on dual eligibles. CMS writes in an e-mail, "California has determined that many aspects of the Initiative to Reduce Avoidable Hospitalizations among Nursing Facility Residents overlap with CA's Implementation Demonstration proposal for Dual Eligible Beneficiaries, and therefore the State is not supporting applications under this Initiative." While California proposes locking dual eligibles in to managed care plans, CMS has said they may not do so. (Inside health Policy, June 13, 2012)

Reducing 30-day Readmission, Simply
This case study documents how Intermountain Health's 352-bed McKay-Dee Hospital in Ogden, Utah, reduced its readmission rates for pneumonia by almost 50% in two years to 7.8%. Timothy Trask, MD, medical director of the McKay-Dee's hospitalist program, credits the care coordination program which employs evidence-based care and a commitment to standardization through best practices. (HealthLeaders Media, June 25, 2012)

Health Affairs Paper Recognizes Video Ethnography's Role in Rapid Quality Improvement
The June issue of Health Affairs includes a paper supporting video ethnography and how Kaiser uses the technology for improvement, including reducing rates of readmissions for elderly patients with heart failure. The article cites Kaiser's results in reducing readmissions from 13.6% to 9.0% in just six months following implementation of the use of video ethnography. (Kaiser Permanente Center for Total Health Blog, June 12, 2012)

Checklist to Reduce Readmissions

The American Association for Respiratory Care (AARC) has released helpful guidelines to assist in reducing respiratory-related ICU readmissions. Other checklists are also available at the site.

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Readmissions Policies, Processes, and Penalties - Implications for Hospitals

Caroline Steinberg
Vice President of Health Trends Analysis