JULY 25, 2012

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

Hospitals' Readmissions Rates Not Budging
Recently released Medicare data shows little progress in reducing the frequency of readmissions. According to Ashish Jha of the Harvard School of Public Health, "Either we have no idea how to really improve readmission, or most of the readmissions are not preventable and the efforts being put on it are not useful." This sentiment was echoed by Nancy Foster, American Hospital Association Vice President, who noted that the figures cited are for three years and therefore do not highlight the successes of 2011. "We are seeing precipitous drops in admissions for all three of these conditions," she said, "and we suspect it is because the patients who are relatively well are being better managed in the ambulatory setting" and therefore not being admitted leaving a sicker patient base who are more likely to be readmitted. (Kaiser Health News, July 19, 2012)

A Plan for Post-Acute Care Providers Looking to Better Coordinate Care
The Medicare Hospital Readmission Reduction Program (HRRP), which will lower Medicare payment rates for hospitals with greater-than-expected 30-day readmission rates for specific conditions, goes into effect October 1, 2012. This change will make hospitals increasingly interested in partnering with high-performing post-acute providers. The author recommends four steps for post-acute providers to take advantage of this opportunity: 1) follow the data on readmissions, 2) design and document readmission-reducing programs, 3) communicate results to hospitals, and 4) initiate collaborations with hospitals. (McKnight's, June 26, 2012)

Nursing Homes and Hospitals INTERACT to Reduce Readmissions
This Hospital Financial Management Association (HFMA) article describes the INTERACT (Interventions to Reduce Acute Care Transfers) program developed by Joseph G. Ouslander, MD, a geriatrician at the Charles E. Schmidt College of Medicine at Florida Atlantic University. The program, developed under contract with CMS, was designed to reduce transfers to hospital ERs from nursing homes. "Some nursing home residents who would otherwise be transferred to a hospital, generally for evaluation in the emergency department, can be managed safely and effectively without transfer." says Dr. Ouslander, INTERACT's project director. Free tools and resources are available at INTERACT's web site http://interact2.net/. (Hospital Financial Management Association, July 18, 2012)

UPMC Medical Home Slashes Readmissions, Cuts Utilization Costs
The University of Pittsburgh Medical Center (UPMC) has seen a decrease in readmission rates, utilization and costs resulting from their implementation of the Patient-Centered Medical Home. "We've seen a drop in the overall per member per month cost trends as compared to the rest of our patient population," says Stephen Perkins, MD, Vice President of Medical Affairs for UPMC Health Plan. The overall readmission rate dropped 12.5% compared to non-medical home practices in the first year and 18.5% in the second year. (Dorland Health, July 6, 2012)

Integrated Managed Care Model for Dual Eligibles Reduces Readmissions
Alavere recently analyzed the outcomes of the Mercy Care Plan's integrated model in Arizona for keeping people out of the hospital and lowering readmissions rates for dual-eligible beneficiaries. Mercy Care's results when compared to Medicare fee-for-service dual eligibles produced impressive results including 43% fewer hospital days and a 21% lower readmission rate. Integrated approaches like the Mercy Care Plan must be considered by policy makers and administrators according to the Avalere author. (Health Affairs Blog, July 18, 2012)

Reducing Readmission from Long-Term Care
Poor post-acute care has not affected hospital revenues in the past but beginning October 1, 2012 with the commencement of the Hospital Readmission Recovery Program (HRRP) how long-term care (LTC) facilities manage their patients can significantly affect hospitals' finances. These authors bring the experience of Advocate Health to bear on the problem. They describe at length these five strategies for improving the performance of long-term care facilities: 1) bring LTCs up to speed, 2) pay attention to care delays, 3) strengthen communication, 4) create low-tech workarounds, and 5) think outside the box. (H&HN Daily, July 12, 2012)

Care Transitions Intervention Program Applauded for Improving Home Health Access to Reduce Costly Hospital Readmissions
The Care Transitions Intervention pilot program has demonstrated a 25% reduction in hospital readmissions according to an announcement by the Finger Lakes Health systems Agency. The pilot was a collaborative effort among hospitals, home health agencies and a Medicaid-managed care program in upstate New York between Fall 2010 and Spring 2012. The results show success in both 30-day and 60-day periods following a patient's initial hospitalization. (MarketWatch, July 13, 2012)

AHCA Urges Lawmakers to Fix Hospital Observation Status Conundrum
The American Health Care Association (AHCA), which represents more than 11,000 nursing homes and other non-acute organizations, has alerted Congress to the fact that an increase in hospital observation stays is reducing nursing homes' revenues. The hospital industry had recently told Congress they are feeling pressured into more observation stays to avoid overpayment claims and audits. Because observation stays are treated as outpatient stays they do not qualify for the 100 days Medicare pays for nursing facility cared following discharge. (Inside Health Policy, July 10, 2012)

Innovations in Reducing Preventable Hospital Admissions, Readmissions, and Emergency Room Use

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.

The Medicare of Tomorrow -- a Value-Based Purchaser

Jonathan Blum, MPP
Centers for Medicare and Medicaid Services, Washington, DC